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Contact Information

Wendy Castro

MDS Training Coordinator RAC-CT

 wendy.castro@state.co.us

cdphe_mds_colorado@state.co.us

303-692-2854

Test Your Knowledge Answers:

1) When an MDS is modified, Z0400 will be signed attesting to the accuracy of the updated item. If the Z0500 date and signature were not incorrect, those items would not be changed. The MDS had been completed and submitted successfully but now an error or errors have been identified. The modification form is completed, the MDS is opened to correct the items that were in error, and then the MDS is closed and transmitted. There is no reason to change the date in Z0500, just attest to the items corrected in Z0400.  Information on MDS modifications and inactivations is located in Chapter 5 of the RAI User's Manual. 

2) An OBRA discharge would not be completed for an LOA. An OBRA discharge is only completed when the discharge meets the MDS definition of a discharge.

Refer to the RAI User's Manual, Chapter 2, page 2-11:

Discharge refers to the date a resident leaves the facility or the date the resident's Medicare Part A stay ends but the resident remains in the facility. A day begins at 12:00 a.m. and ends at 11:59 p.m. Regardless of whether discharge occurs at 12:00 a.m. or 11:59 p.m., this date is considered the actual date of discharge. There are three types of discharges: two are OBRA required-return anticipated and return not anticipated; the third is Medicare required-Part A PPS Discharge. A Discharge assessment is required with all three types of discharges. Section 2.6 provides detailed instructions regarding return anticipated and return not anticipated types, and Section 2.8 provides detailed instructions regarding the Part A PPS Discharge type. Any of the following situations warrant a Discharge assessment, regardless of facility policies regarding opening and closing clinical records and bed holds:

• Resident is discharged from the facility to a private residence (as opposed to going on an LOA);

• Resident is admitted to a hospital or other care setting (regardless of whether the nursing home discharges or formally closes the record);

• Resident has a hospital observation stay greater than 24 hours, regardless of whether the hospital admits the resident.

• Resident is transferred from a Medicare- and/or Medicaid-certified bed to a non-certified bed.

• Resident's Medicare Part A stay ends, but the resident remains in the facility. 

3) You should consider "How is the resident affected by the device? Are they restrained from moving or accessing their body?"  If so, they have been restrained regardless of intent. 

4) An unstageable PU must be staged once the numerical stage has been determined. If the PU presented as a Stage 3 upon admission (after returning from the hospital), it should be coded as a Stage 3.  

5) CMS Quality Support replied saying "The two Transfer of Health measures will be added to the SNF QRP Resident-Level Reports on 10/01/2024, we collect a year of data, and the initial reporting will be available 10/01/2023 - 09/30/2024."

6) Any behaviors that occurred during the 7-day look-back from the ARD should be coded on the MDS. 

7) When a resident discharges or passes away, this does not remove them from the QM calculation. This resident will be triggered until their death date (the date which ended the episode of care) is no longer in the 3-month target period for the long-stay record selection. This is because the long-stay look-back scan includes all episodes of care within the 3-month target period even though the ARD of the qualifying assessment that captured catheter use was in Jan. 2024. The MDS 3.0 Quality Measure User’s Manual explains “The target assessment need not have a target date within the target period, but it must occur within 120 days of the end of the resident’s episode (either the last discharge in the target period or the end of the target period if the episode is ongoing.)” 

8) It would be recommended to have a consistent policy with a legitimate clinical rationale for determining which PHQ to use.

You may wish to avoid using a PHQ completed by external providers who are not supervised or trained by you and are not subject to the RAI Manual User’s Manual instructions (and likely will never read it or have read it.) They may be using and adapting the PHQ for different purposes that are inconsistent with your needs.

9) The RAI User's Manual says to use the name as spelled on the Medicare Card or other government document. Since the resident has Medicare, he would be in the Common Working File/HETS system. Someone from the facility should call to have the information pulled from the HETs system. That information would then be used for MDS and billing purposes. The care plan can state that he prefers to be called Jimmy, but the MDS must match what is in the federal database as his name and other identifiers.