MDS Alert

Make your SCSA coding easier by confronting the nitty-gritty.

Check your answers against these, along with rationales from the RAI Manual.

1) “Improves.” “There is a determination that a significant change (either improvement or decline) in a resident’s condition from his/ her baseline has occurred as indicated by comparison of the resident’s current status to the most recent comprehensive assessment and any subsequent Quarterly assessments,” the RAI Manual says, on page 2-23.

2) True.

3) True. However, there’s more work involved here. The RAI Manual says, on page 2-23: “This status requires an Entry tracking record each time the resident returns to the facility and an OBRA Discharge assessment each time the resident is discharged. However, if the IDT determines that the resident would benefit from an SCSA during the intervening period, the staff must complete an SCSA. This is only allowed when the resident has had an OBRA Admission assessment completed and submitted prior to discharge return anticipated (and resident returns within 30 days) or when the OBRA Admission assessment is combined with the discharge return anticipated assessment (and resident returns within 30 days).”

4) False. “The ARD must be within 14 days from the effective date of the hospice election (which can be the same or later than the date of the hospice election statement, but not earlier than). An SCSA must be performed regardless of whether an assessment was recently conducted on the resident. This is to ensure a coordinated plan of care between the hospice and nursing home is in place. A Medicare-certified hospice must conduct an assessment at the initiation of its services. This is an appropriate time for the nursing home to evaluate the MDS information to determine if it reflects the current condition of the resident, since the nursing home remains responsible for providing necessary care and services to assist the resident in achieving his/her highest practicable well-being at whatever stage of the disease process the resident is experiencing,” the RAI Manual says, on page 2-23

5) “Revoking.” “The 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); 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,” the RAI Manual explains, on pages 2-23 and 2-24.

6) “14.”

7) True. Care plans are also an important aspect of documenting a resident’s condition and care.

8) False. “If there is only one change, staff may still decide that the resident would benefit from an SCSA. It is important to remember that each resident’s situation is unique, and the IDT must make the decision as to whether or not the resident will benefit from an SCSA. Nursing homes must document a rationale, in the resident’s medical record, for completing an SCSA that does not meet the criteria for completion,” the RAI Manual says on page 2-24.

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