Health Facilities Education and Quality

Test Your Knowledge Answers:

1) Since an OBRA Discharge assessment is not completed for LOAs, the resident remains “yours”. Any falls or development of problems, including skin breakdown, would be facility acquired. Of course, your documentation will show that the problem occurred while they were out with family, but any future MDS must be marked appropriately if the skin breakdown is present during the look-back period.

2) No, if the resident goes from Medicare to Managed Medicare there is no need to provide a NOMNC.

3) Regulations have not changed in terms of daily skilled need.

Reply by CMS to COVID-19 FAQs:

Question: "Can a positive COVID-19 test qualify a beneficiary (including a beneficiary who is currently receiving non-skilled services in a nursing home?) for a covered Medicare Part A skilled nursing facility (SNF) stay?"

Answer: "A COVID-19 diagnosis would not in and of itself automatically serve to qualify a beneficiary for coverage under the Medicare Part A SNF benefit. That's because SNF coverage isn't based on particular diagnoses or medical conditions, but rather on whether the beneficiary meets the statutorily-prescribed SNF level of care definition of needing and receiving skilled services on a daily basis which, as a practical matter, can only be provided in a SNF on an inpatient basis."

4) Per the RAI: "the weight loss was planned and pursuant to a physician's order. In cases where a resident has a weight loss of 5% or more in 30 days or 10% or more in 180 days as a result of any physician ordered diet plan or expected weight loss due to loss of fluid with physician orders for diuretics, K0300 can be coded as 1".

This scenario would not fit this description. There is not a doctor order, there are no diuretic orders, the weight loss is due to natural decline and is not "Planned".