MDS Alert

Know when you need to complete only the Admission assessment.

In most cases, you will need to complete a Significant Change in Status Assessment (SCSA) when a resident starts or revokes hospice services — but not in every case. And knowing when an SCSA is required can be puzzling sometimes.

Resource: The RAI manual details the requirement of completing an SCSA on pages 2-21 and 2-22. Pay attention to the instructions in the manual and refer back to these pages whenever you’re unsure about whether to complete an SCSA for a hospice-service commencement or revocation.

How to Set the ARD

Rule of thumb: You must complete an SCSA (A0310 = 04) when a resident is receiving hospice services and then decides to discontinue those services (known as revoking of hospice care), according to the Oklahoma State Department of Health (OSDH) Quality Improvement & Evaluation Service. The Assessment Reference Date (ARD) must be within 14 days from one of the following:

1. The effective date of the hospice election revocation (which can be the same or later than the date of the hospice election revocation statement, but not earlier than); or

2. The expiration date of the certification of terminal illness; or

3. The date of the physician’s or medical director’s order stating the resident is no longer terminally ill.

Base your determination of whether the SCSA is required due to the hospice discharge on one of the three above situations, OSDH said. Seek clarification from the hospice to determine if the hospice is discharging for any of these reasons. You should also request documentation from the hospice regarding how it views the change in level of care (e.g., discharge to hospital).

No SCSA Needed in These Situations

Caveat: You do not need to complete an SCSA if the resident is admitted on the hospice benefit (meaning the resident is coming into the facility having already elected hospice), or elects hospice on or prior to the ARD of the Admission assessment, the RAI manual states. Instead, you should complete the Admission assessment, checking Item O0100K — Hospice care. 

In this case, you don’t need to complete an SCSA after the Admission assessment. An SCSA is also not required when hospice election occurs after the Admission assessment ARD but prior to its completion. Instead, you may choose to adjust the ARD to the date of hospice election and complete only the Admission assessment.

Another situation in which an SCSA is not required is when the resident is admitted on the hospice benefit but decides to discontinue it prior to the ARD of the Admission assessment. In this case, you should complete the Admission assessment, checking O0100K. Again, you may choose to adjust the ARD to the date of hospice revocation so that only the Admission assessment is required and an SCSA is not required.

Keep the SCSA Basics in Mind

Remember: You must complete an SCSA when there is a decline or improvement in a resident’s status that:

1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions;

2. Impacts more than one area of the resident’s health status; and

3. Requires interdisciplinary team review and/or revision of the care plan.