MDS Alert

Here's what you need to capture during the assessment reference period.

Classifying a resident into rehab low plus extensive services can require a juggling act to capture all of the requisite services, especially on the 14-day MDS.

To qualify for RLX, the resident's ADL score can range from 7 to 18. He must have received at least one of the following extensive services during the appropriate lookback period which is seven days for parenteral/IV fluid therapy (K5a) and 14 days for IV medication (P1ac); suctioning (P1ai); tracheostomy care (P1aj); ventilator or respirator (P1al).

In addition, the resident must meet the Rehab low-intensity criteria. Either (1) or (2) below may qualify:

(1) In the last 7 days (section P1b [a,b,c] and P3): 45 minutes or more (total) of therapy per week AND at least 3 days of any combination of the 3 disciplines AND 2 or more nursing rehabilitation services received for at least 15 minutes each with each administered for 6 or more days.

(2) If this is a Medicare 5-day or a Medicare Readmission/Return Assessment, then the following apply (section P3 and section T1b, T1c, T1d):

Ordered therapies: T1b is checked AND in the first 15 days from admission, 75 or more minutes are expected (T1d) AND rehabilitation services expected on 5 or more days (T1c) AND 2 or more nursing rehabilitation services received for at least 15 minutes each with each administered for 2 or more days (coded at P3).

Restorative Nursing/Nursing Rehabilitation Services

H3a,b** Any scheduled toileting program and/or bladder retraining program
P3a,b** Passive and/or active ROM
P3c Splint or brace assistance
P3d,f** Bed mobility and/or walking training
P3e Transfer training
P3g Dressing or grooming training
P3h Eating or swallowing training
P3i Amputation/prosthesis care
P3j Communication training

**Count as one service even if both provided ADL Score: 7-18

Source: RAI manual, chapter 6.