a) Activities of
Daily Living (ADL)
1) Documentation shall
support the ADL coded level as defined in the Resident Assessment Instrument
(RAI) Manual.
2) Documentation of
ADLs shall support the RAI requirement was met for coding Self Performance and
Support during the look-back period. It is the responsibility of the person
completing the assessment to consider all episodes of the activity that
occurred over a 24-hour period during each day of the 7-day look-back period.
There shall be signatures/initials of staff providing the ADL assistance and
dates to authenticate the services were provided as coded during the look-back
period. If using an ADL grid for supporting documentation, the key for
self-performance and support provided shall be equivalent to definitions to the
MDS key.
3) The ADL scores for
residents lacking documentation shall be reset to zero.
b) Extensive Services. Documentation shall
support that the following requirements were met during the look-back period
based on the MDS items identified.
1)
Documentation shall support tracheostomy care was completed during the
look-back period while a resident in the facility.
2) Documentation shall support the use of a
ventilator or respirator during the look-back period while a resident in the
facility. Documentation shall support the device was an electrically or
pneumatically powered closed-system mechanical ventilator support device that
ensures adequate ventilation in the resident who is, or who may become, unable
to support his or her own respiration. This does not include BiPAP or CPAP
devices or a ventilator or respirator that is used only as a substitute for
BiPAP or CPAP.
3) Documentation
supports the need for and use of isolation during the look-back period while a
resident is in the facility.
4)
Documentation shall support the following conditions for "strict isolation"
were met during the look-back period:
A) The
resident has active infection with highly transmissible or epidemiologically
significant pathogens that have been acquired by physical contact or airborne
or droplet transmission;
B)
Precautions are over and above standard precautions. That is,
transmission-based precautions (contact, droplet, and/or airborne) must be in
effect; and
C) The resident is in a
room alone because of active infection and cannot have a roommate even if the
roommate has a similar active infection that requires isolation. The resident
must remain in his/her room. This requires that all services be brought to the
resident (e.g., rehabilitation, activities, dining, etc.).
5) Treatment and/or procedures the resident
received shall be care planned and reevaluated to ensure continued
appropriateness.
6) Extensive
services are defined as indicated in the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL RUG-IV GROUP
|
|
Extensive Services - At least one of the
following:
Tracheostomy Care while a resident
(O0100E2)
Ventilator or Respirator while a resident
(O0100F2)
Infection Isolation while a resident
O0100M2)
|
[GREATER THAN OR EQUAL TO] 2
[GREATER THAN OR EQUAL TO] 2
[GREATER THAN OR EQUAL TO] 2
|
Tracheostomy care and Ventilator/Respirator
Tracheostomy care OR Ventilator/Respirator
Infection Isolation:
* Without trach
* Without Ventilator /Respirator
|
ES3
ES2
ES1
|
c) Rehabilitation. Documentation shall
support the following requirements were met during the look-back period based
on the MDS items identified.
1) All RAI
Manual requirements and definitions shall be met, including the qualifications
for therapists.
2) Documentation
shall support medically necessary therapies that occurred after admission or
readmission to the facility that were:
A)
Ordered by a physician based on a qualified therapist's (i.e., one who meets
Medicare requirements) assessment and treatment plan;
B) Documented as delivered in the clinical
record; and
C) Care planned and
periodically evaluated to ensure the resident receives needed therapies and the
current treatment plans are effective. Any service provided at the request of
the resident or family that is not medically necessary shall not be included,
even when performed by a therapist or a therapy assistant. It does not include
the services performed when a facility elects to have licensed professionals
perform repetitive exercises and other maintenance treatments or to supervise
aides performing these maintenance services that are considered restorative
care.
3) Documentation
shall support the therapies were provided while the individual was living and
being cared for at the long-term care facility. It does not include therapies
that occurred while the person was an inpatient at a hospital or recuperative
or rehabilitation center or other long-term care facility, or recipient of home
care or community based services.
4) Documentation shall support the services
were directly and specifically related to an active written treatment plan that
is approved by the physician after any needed consultation with a qualified
therapist and is based on an initial evaluation performed by a qualified
therapist prior to the start of these services in the facility.
5) Documentation shall support the services
were a level of complexity and sophistication, or the condition of the resident
shall be of a nature that requires the judgment, knowledge, and skills of a
therapist.
6) Documentation shall
support the services were provided with expectation, based on the assessment of
the resident's restoration potential made by the physician, that the condition
of the patient will improve materially in a reasonable and generally
predictable period of time, or the services shall be necessary for the
establishment of a safe and effective maintenance program.
7) Documentation shall support the services
are considered under accepted standards of medical practice to be specific and
effective treatment for the resident's condition.
8) Documentation shall support that services
are medically necessary for the treatment of the resident's condition. This
includes the requirement that the amount, frequency, and duration of the
services shall be reasonable and they must be furnished by qualified
personnel.
9) Documentation shall
include the actual minutes of therapy. Minutes shall not be rounded to the
nearest 5th minute and conversion of units to
minutes or minutes to units is not acceptable.
10) Documentation shall identify the
different modes of therapy (i.e., individual, concurrent, group) and the
documentation shall support the criteria for the mode identified is
met.
11) Documentation shall
support that the restorative program include nursing interventions that promote
the residents ability to adapt and adjust to living as independently and safely
as possible. The program actively focuses on achieving and maintaining optimal
physical, mental, and psychosocial functioning.
12) Documentation shall include the following
components for a restorative program is met:
A) There are measurable
objectives/interventions established for the performance of the
activity;
B) A licensed nurse shall
evaluate and document the results of the evaluation related to the program on a
quarterly basis.
C) Documentation
includes the actual number of minutes the activity were performed and supports
at least 15 minutes in a 24-hour period for a minimum of 6 days; and
D) Individuals who implement the program
shall be trained in the interventions and supervised by a nurse.
13) Documentation shall support
the requirements identified for coding ADL were met.
14) Rehabilitation is defined as indicated in
the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL Rug-IV Group
|
|
At least 5 distinct calendar days (15 min per day
minimum) in any combination of Speech, Occupational or Physical Therapy in the
last 7 days. (O0400A4, O0400B4, O0400C4) AND 150 minutes or greater of any
combination of Speech, Occupational or Physical Therapy in the last 7 days
(O0400A1, O0400A2, O0400A3, O0400B1, O0400B2, O0400B3, O0400C1, O0400C2,
O0400C3)
OR
At least 3 distinct calendar days (15 min per day
minimum) in any combination of Speech, Occupational, or Physical Therapy in the
last 7 days (O0400A4, O0400B4, O0400C4) AND 45 minutes or greater in any
combination of Speech, Occupational or Physical Therapy in the last 7 days
(O0400A1, O0400A2, O0400A3, O0400B1, O0400B2, O0400B3, O0400C1, O0400C2,
O0400C3) AND at least 2 nursing rehabilitation services.
See description of Restorative in subsection (h)
|
15-16
11-14
6-10
2-5
0-1
|
None
None
None
None
None
|
RAE
RAD
RAC
RAB
RAA
|
d) Special Care High-Documentation shall
support the following requirements were met during the look-back period based
on the MDS items identified.
1) Documentation
shall support the requirements and criteria for coding an active disease
diagnosis were met.
2)
Documentation shall support the ADL scores met the requirements and criteria
for coding.
3) Documentation shall
include the date completed and the staff member completing the Mood interview
when indicated. Documentation shall demonstrate the presence and frequency of
clinical mood indicators when staff assessment of mood is utilized. This shall
include date observed, a brief description of the symptoms, staff observing,
and any interventions.
4)
Documentation shall support a diagnosis of coma or persistent vegetative
state.
5) Documentation shall
support an active diagnosis of Septicemia. Interventions and/or treatments for
the diagnosis shall be documented upon delivery.
6) Documentation shall support an active
diagnosis of diabetes, and shall support insulin injections were given the
entire 7 days of the look-back period and there were orders for insulin changes
on 2 or more days during the look-back period.
7) Documentation shall support the active
diagnosis of Quadriplegia.
8)
Documentation shall support the active diagnosis of Chronic Obstructive
Pulmonary Disease (COPD) and/or asthma with shortness of breath while lying
flat. Interventions and/or treatments for the condition shall be documented
upon delivery.
9) Documentation to
support fever shall include a recorded temperature of at least 2.4 degrees
higher than the previous recorded baseline temperature and documentation shall
support one of the following: pneumonia, vomiting, weight loss, and/or feeding
tube with at least 51% of total calories or if 26-50% of the calories there is
also fluid intake of 501cc or more per day. Interventions and/or treatments for
the condition shall be documented upon delivery.
10) Documentation shall support the
intervention of parenteral or IV feedings. Documentation shall support the
intervention was administered for nutrition or hydration purposes.
11) Documentation of respiratory therapy
shall include the following:
A) Physician
orders that include a statement of frequency, duration, and scope of
treatment;
B) The actual minutes
the therapy was provided while a resident is in the facility;
C) Evidence that the services are provided by
a qualified professional; and
D)
Evidence that the services are directly and specifically related to an active
written treatment plan that is based on an initial evaluation performed by
qualified personnel.
12)
Special Care High is defined as indicated in the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL RUG-IV Group
|
|
Special Care High (ADL Score of [GREATER THAN OR EQUAL
TO] 2 or more and at least one of the following:
Comatose (B0100) and completely ADL dependent or ADL
did not occur (G0110A1, G0110B1, G0110H1, G0110I1 all = 4 or 8)
Septicemia (I2100)
Diabetes (I2900) with both of the following:
* Insulin injections for all 7 days (N0350A = 7)
* Insulin order changes on 2 or more days (N0350B
[GREATER THAN OR EQUAL TO] 2)
Quadriplegia (I5100) with ADL score [GREATER THAN OR
EQUAL TO] 5(ADLs as above)
Asthma or COPD (I6200) AND shortness of breath while
lying flat (J1100C)
Fever (J1550A) and one of the following:
* Pneumonia (I2000)
* Vomiting (J1550B)
* Weight Loss (K0300 = 1 or 2)
* Feeding Tube (K0510B1 or K0510B2) with at least 51%
of total calories (K0710A3 = 3) OR 26% to 50% through parenteral/enteral intake
(K0710A3 = 2) and fluid intake is 501cc or more per day (K0710B3 = 2)
Parenteral/IV Feeding (K0510A1 or K0510A2)
Respiratory Therapy for all 7 days (O0400D2 = 7)
If a resident qualifies for Special Care High but the
ADL score is a 1 or less, then the resident classifies as Clinically
Complex
|
15-16
15-16
11-14
11-14
6-10
6-10
2-5
2-5
|
Depression
No Depression
Depression
No Depression
Depression
No Depression
Depression
No Depression
(Note: See description of depression indicators in
subsection (k))
|
HE2
HE1
HD2
HD1
HC2
HC1
HB2
HB1
|
e) Special Care Low - Documentation shall
support the following requirements were met during the look-back period based
on the MDS items identified.
1) Documentation
shall support the requirements and criteria for coding disease diagnosis were
met. This includes an active diagnosis of Cerebral Palsy, Multiple Sclerosis,
or Parkinson's.
2) Documentation
shall support an active diagnosis of respiratory failure and the administration
of oxygen therapy while a resident. Documentation shall include the date and
method of delivery. Documentation shall support a need for the use of
oxygen.
3) Documentation shall
support the requirements and criteria for coding ADLs were met.
4) Documentation shall include the date, and
staff completing the Mood interview. Documentation shall demonstrate the
presence and frequency of clinical mood indicators when staff assessment of
mood is utilized. This shall include date observed, a brief description of the
symptom, any interventions implemented and identification of staff
observing.
5) Documentation shall
support the presence of a feeding tube and the proportion of calories received
through the tube feeding.
6)
Documentation shall support the presence of 2 or more Stage 2 pressure ulcers
or any Stage 3 or 4 pressure ulcer as defined in the RAI Manual. Documentation
shall include observation date, location, and measurement and description of
the ulcer. Other factors related to the ulcer shall be noted including:
condition of the tissue surrounding the area (color, temperature, etc.),
exudates and drainage present, fever, presence of pain, absence or diminished
pulses, and origin of the wound (such as pressure, injury or contributing
factors) if known. Interventions and/or treatments for the ulcer shall be
documented as delivered.
7)
Documentation shall support the presence of 2 or more venous or arterial ulcers
as defined in the RAI Manual. Documentation shall include observation date,
location, and measurement and description of the ulcer. Interventions and/or
treatment for the ulcer shall be documented as delivered.
8) Documentation shall support the presence
of a Stage 2 pressure ulcer and a venous or arterial ulcer. Documentation shall
include observation date, location, and measurement and description of the
ulcer. Interventions and/or treatments for the ulcer shall be documented as
delivered.
9) Documentation shall
support 2 or more of the following interventions when ulcers are noted:
pressure relieving devices, turning and repositioning, nutrition and/or
hydration, ulcer care, application of dressing and/or application of ointments.
Documentation shall support the interventions identified were implemented
during the look-back period.
10)
Documentation and/or observation shall support the use of pressure relieving
devices for the resident. This does not include egg crate cushions, doughnuts
or rings.
11) Documentation for a
turning and repositioning program shall include specific approaches for
changing the resident's position and realigning the body and the frequency it
is to be implemented. Documentation shall support the program was implemented
and is monitored and reassessed to determine the effectiveness of the
intervention.
12) Documentation
shall support the nutrition and/or hydration interventions were delivered.
These shall be based on an individual assessment of the resident's nutritional
deficiencies and needs. Vitamins and mineral supplements shall only be coded on
the MDS when noted through a thorough nutritional assessment.
13) Documentation for ulcer care shall
support the care was delivered. Documentation shall include the date delivered,
type of care delivered, and identification of the staff delivering the
care.
14) Documentation shall
support the application of non-surgical dressing and shall include date applied
and identification of the staff delivering the care. This does not include
application of a band-aid.
15)
Documentation shall support the application of ointments or medications were
actually applied to somewhere other than the feet. This includes only ointments
or medications used to treat and/or prevent skin conditions. Documentation
shall include name and description of the ointment used, date applied, and
identification of the staff delivering the care.
16) Documentation of infections of the foot
and/or presence of diabetic foot ulcers or open lesions to the foot shall
include a description of the area.
17) Documentation shall support interventions
and/or treatments for the problems noted were implemented. Documentation shall
define the intervention and treatment, the date delivered and the
identification of the staff delivering the care.
18) Documentation shall support the
application of dressing to the feet was actually delivered. Documentation shall
include the date applied and identification of the staff delivering the
care.
19) Documentation shall
support the reason for and the administration of radiation while a resident.
Documentation shall include the date of administration and identification of
the staff delivering the care.
20)
Documentation shall support dialysis was administered while a resident.
Documentation shall include type of dialysis, date delivered, and
identification of the staff delivering the care.
21) Special Care Low is defined as indicated
in the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL RUG- IV Group
|
|
Special Care Low-ADL score of 2 or more and at least
one of the following:
Cerebral Palsy (I4400) with ADL score [GREATER THAN OR
EQUAL TO] 5
Multiple Sclerosis (I5200) with ADL score [GREATER THAN
OR EQUAL TO] 5
Parkinson's disease (I5300) with ADL score [GREATER
THAN OR EQUAL TO] 5
Respiratory Failure (I6300) and oxygen therapy while a
resident (O0100C2)
Feeding Tube (K0510B1 or K0510B2) with at least 51% of
total calories (K0710A3 = 3) OR 26% to 50% through parenteral/enteral intake
(K0710A3 = 2) and fluid intake is 501cc or more per day (K0710B3 = 2)
2 or more Stage 2 pressure ulcers (M0300B1) with 2 or
more skin treatments
* Pressure relieving device for chair (M1200A) and/or
bed (M1200B)
* Turning/Repositioning (M1200C)
* Nutrition or hydration intervention (M1200D)
* Ulcer care (M1200E)
* Application of dressing (M1200G)
* Application of ointments (M1200H)
Any Stage 3 or 4 pressure ulcer (M0300C1, D1, F1) with
2 or more skin treatments-See above list
2 or more venous/arterial ulcers (M1030) with 2 or more
skin treatments-See above list
One Stage 2 pressure ulcer (M0300B1) and one
venous/arterial ulcer (M1030) with 2 or more skin treatments-See above
list
Foot infection (M1040A), Diabetic foot ulcer (M1040B)
or other open lesion of foot (M1040C) with application of dressing to feet
(M1200I)
Radiation treatment while a resident (O0100B2)
Dialysis treatment while a resident (O0100J2)
If a resident qualifies for Special Care Low but the
ADL score is 1 or less-then the resident classifies as Clinically
Complex
|
15-16
15-16
11-14
11-14
6-10
6-10
2-5
2-5
|
Depression
No Depression
Depression
No Depression
Depression
No Depression
Depression
No Depression
|
LE2
LE1
LD2
LD1
LC2
LC1
LB2
LB1
|
f) Clinically Complex - Documentation shall
support the following requirements were met during the look-back period based
on the MDS items identified.
1) Documentation
shall support the requirements and criteria for coding disease diagnosis were
met. This shall include documentation of an active diagnosis of pneumonia that
includes current symptoms and any interventions.
2) Documentation shall also support an active
diagnosis of hemiplegia or hemiparesis.
3) Documentation shall support the
requirements and criteria for coding ADLs were met.
4) Documentation shall include the date
completed, and staff completing the Mood interview when indicated.
Documentation shall demonstrate the presence and frequency of clinical mood
indicators when staff assessment of mood is utilized. This shall include date
observed, brief description of the symptom, any interventions, and
identification of staff observing.
5) Documentation shall support the presence
of open lesions other than ulcers. The documentation shall include, but is not
limited to, an entry noting the observation date, location, measurement and
description of the lesion and any interventions. Documentation of interventions
shall include at least one of the following: surgical wound care, application
of non-surgical dressing to an area other than the feet and/or application of
ointments to an area other than the feet. Documentation shall include all the
types of interventions, dates delivered, and the staff delivering the
interventions.
6) Documentation
shall support the presence of a surgical wound. The documentation shall include
an entry noting the observation date, origin of the wound, location,
measurement and description, and any interventions. Documentation of
interventions shall include at least one of the following: surgical wound care,
application of non-surgical dressing to an area other than the feet and/or
application of ointments to an area other than the feet. Documentation shall
include the type of intervention, dates delivered, and the staff delivering the
interventions.
7) Documentation
shall support the presence of a burn. Documentation shall include an entry
noting the observation date, location, measurement and description, and any
interventions.
8) Documentation
shall support the administration of a chemotherapy agent while a resident in
the facility. Documentation shall include the name of the agent, date delivered
and the staff delivering.
9)
Documentation shall support the administration of oxygen while a resident in
the facility. This shall include the date and method of delivery. Additionally,
documentation shall support a need for the use of oxygen.
10) Documentation shall support the
administration of an IV medication while a resident in the facility. The
documentation shall include the name of the medication, date delivered, method
of delivery, and identification of staff delivering.
11) Documentation shall support the resident
received a transfusion while a resident was at the facility. Documentation
shall include the date received, reason and identification of staff delivering
the care.
12) Clinically Complex is
defined as indicated in the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL RUG -IV Group
|
|
Clinically Complex-At least one of the
following:
Pneumonia (I2000)
Hemiplegia/hemiparesis (I4900) with ADL score [GREATER
THAN OR EQUAL TO] 5
Surgical wounds (M1040E) or open lesion (M1040D) with
any of the following selected skin treatments:
* Surgical wound care (M1200F)
* Application of non-surgical dressing (M1200G) not to
feet
* Application of ointment (M1200H) not to feet
Burns (M1040F)
Chemotherapy while a resident (O0100A2)
Oxygen therapy while a resident (O0100C2)
IV Medication while a resident (O0100H2)
Transfusions while a resident (O0100I2)
If a resident qualifies for Special Care High or
Special Care Low, but the ADL score of 1 or 0, then the resident classifies in
Clinically Complex CA1 or CA2
|
15-16
15-16
11-14
11-14
6-10
6-10
2-5
2-5
0-1
0-1
|
Depression
No Depression
Depression
No Depression
Depression
No Depression
Depression
No Depression
Depression
No Depression
|
CE2
CE1
CD2
CD1
CC2
CC1
CB2
CB1
CA2
CA1
|
g) Behavioral Symptoms and Cognitive
Performance - Documentation shall support the following requirements were met
during the look-back period based on the MDS items identified.
1) Documentation shall include the date
completed, and staff completing the Mood interview. Documentation shall
demonstrate the presence and frequency of clinical mood indicators when staff
assessment of mood is utilized. This shall include date observed, brief
description of the symptom, any interventions and identification of staff
observing.
2) Documentation shall
include the date and staff completing the Brief Interview for Mental Status
(BIMS).
3) Documentation shall
support the occurrence of a hallucination and/or delusion that include the date
observed, description, and name of staff observing.
4) Documentation shall include the date
observed, staff observing, frequency, and description of resident's specific
physical, verbal or other behavioral symptom. Documentation shall include any
interventions and the resident's response.
5) Documentation shall include the date
observed, staff observing, frequency and description of the behavior of
rejection of care. Rejection of care shall meet all of the coding requirements.
Residents, who have made an informed choice about not wanting a particular
treatment, procedure, etc., shall not be identified as "rejecting care".
Documentation shall include any interventions and the resident's
response.
6) Documentation shall
include the date observed, staff observing, frequency and description of any
wandering behavior. Documentation shall support a determination for the need
for environmental modifications (door alarms, door barriers, etc.) that enhance
resident safety and the resident's response to any interventions. Care plans
shall address the impact of wandering on resident safety and disruption to
others and shall focus on minimizing these issues.
7) Documentation shall identify how the coded
behavior affected the resident, staff and/or others. Care plan interventions
shall address the safety of the resident and others and be aimed at reducing
distressing symptoms.
8)
Documentation supports presence of a restorative program. This shall include,
but is not limited to, the following: Documentation of the actual number of
minutes the program was provided that equals 15 minutes, in a 24-hour period, a
restorative care plan that contains measurable objectives, and goals that are
specific, realistic and measurable. In addition, documentation shall support
the programs are delivered 6-7 days a week, supervised by a licensed nurse, a
quarterly evaluation is completed by a licensed nurse, and staff are trained in
skilled techniques to promote the resident's involvement in the
activity.
9) Behavioral Symptoms
and Cognitive Performance is defined as indicated in the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL RUG- IV GROUP
|
|
Behavioral Symptoms and Cognitive Performance
BIMS score of 9 or less AND an ADL score of 5 or
less
OR
Defined as Impaired Cognition by Cognitive Performance
Scale AND an ADL score of 5 or less
Hallucinations (E0100A)
Delusions (E0100B)
Physical Behavioral symptom directed toward others
(E0200A = 2 or 3)
Verbal behavioral symptom directed towards others
(E0200B = 2 or 3)
Other behavioral symptom not directed towards others
(E0200C = 2 or 3)
Rejection of care (E08002 or 3)
Wandering (E0900 = 2 or 3)
|
2-5
2-5
0-1
0-1
|
2 or more Restorative Nursing Programs
0-1 Restorative Nursing Programs
2 or more Restorative Nursing Programs
0-1 Restorative Nursing Programs
|
BB2
BB1
BA2
BA1
|
h) Reduced Physical Function
1) Documentation shall support the ADL coded
level.
2) Documentation shall
support presence of a restorative program. This shall include, but is not
limited to, documentation of the actual number of minutes the program was
provided that equals 15 minutes, in a 24-hour period, 6-7 days a week, a
restorative care plan that contains measureable objectives, and goals that are
specific, realistic and measurable, documentation that supports the programs
are supervised by a licensed nurse, a quarterly evaluation is completed by a
licensed nurse and staff are trained in skilled techniques to promote the
resident's involvement in the activity.
3) Reduced Physical Function is defined as
indicated in the following chart.
|
Category (Description)
|
ADL Score
|
End Splits or Special Requirements
|
IL RUG- IV Group
|
|
Reduced Physical Function
List of Restorative Programs
Passive (O0500A = 6 or 7) or Active (O0500B = 6 or 7)
ROM
Splint or brace assistance
(O0500C = 6 or 7)
Bed Mobility (O0500D = 6 or 7)
and/or walking training (O0500F = 6 or 7)
Transfer training (O0500E = 6 or 7)
Dressing and/or grooming training
(O0500G = 6 or 7)
Eating and/or swallowing training
(O0500H = 6 or 7)
Amputation/prostheses care
(O0500I = 6 or 7)
Communication training
(O0500J = 6 or 7)
Urinary (H0200C) and/or bowel training (H0500)
No Clinical Conditions
These programs count as one service even if both are
provided
|
15-16
15-16
11-14
11-14
6-10
6-10
2-5
2-5
0-1
0-1
|
2 or more Restorative
0-1 Restorative
2 or more Restorative
0-1 Restorative
2 or more Restorative
0-1 Restorative
2 or more Restorative
0-1 Restorative
2 or more Restorative
0-1 Restorative
|
PE2
PE1
PD2
PD1
PC2
PC1
PB2
PB1
PA2
PA1
|
i) Illinois Specific Classification - This is
assigned to a resident for whom RUGs resident identification information is
missing or inaccurate, or for whom there is no current MDS record for that
quarter. In addition, a resident for whom an assessment is necessary to
determine group classification is incomplete or has not been submitted within
14 calendar days of the time requirements in Section
147.315
shall be assigned the default group.
|
An assessment that is missing and/or submitted more
than 14 days late from the due date
|
N/A
|
|
AA1
|
j)
Additional Scoring Indicators
|
ADL
|
Self-Performance
|
Support
|
ADL Score
|
|
Bed Mobility (G0110A)
Transfer (G0110B)
Toilet Use (G0110I)
|
Coded -, 0, 1, 7, or 8
Coded 2
Coded 3
Coded 4
Coded 3 or 4
|
Any Number
Any Number
-,0, 1, or 2
-,0,1 , or 2
3
|
0
1
2
3
4
|
|
Eating (G0110H)
|
Coded -, 0, 1, 2, 7 or 8
Coded -, 0, 1, 2, 7 or 8
Coded 3 or 4
Coded 3
Coded 4
|
-, 0, 1 or 8
2 or 3
-, 0 or 1
2 or 3
2 or 3
|
0
2
2
3
4
|
k)
Depression - Additional Scoring Indicator - The depression end split is
determined by either the total severity score from the resident interview in
Section D0200 (PHQ-9) or from the total severity score from the caregiver
assessment of Mood D0500 (PHQ9-OV).
|
Resident
|
Staff
|
Description
|
|
D0200A
|
D0500A
|
Little interest or pleasure in doing things
|
|
D0200B
|
D0500B
|
Feeling down, depressed or hopeless
|
|
D0200C
|
D0500C
|
Trouble falling or staying asleep, sleeping too
much
|
|
D0200D
|
D0500D
|
Feeling tired or having little energy
|
|
D0200E
|
D0500E
|
Poor appetite or overeating
|
|
D0200F
|
D0500F
|
Feeling bad or failure or let self or others
down
|
|
D0200G
|
D0500G
|
Trouble concentrating on things
|
|
D0200H
|
D0500H
|
Moving or speaking slowly or being fidgety or
restless
|
|
D0200I
|
D0500I
|
Thoughts of better off dead or hurting self
|
|
|
D0500J
|
Short tempered, easily annoyed
|
|
Residents that were interviewed D0300 (Total Severity
Score) [GREATER THAN OR EQUAL TO] 10 but not 99
|
|
Staff Assessment-Interview not conducted D0600 (Total
Severity Score ) [GREATER THAN OR EQUAL TO] 10
|
l)
Restorative Nursing - Additional Scoring Indicators
Activities that are individualized to the resident's needs,
planned, monitored, evaluated, and documented in the resident's clinical
record. These are nursing interventions that promote the resident's ability to
adapt and adjust to living as independently and safely as possible. The concept
actively focuses on achieving and maintaining optimal physical, mental, and
psychosocial functioning. The program shall be performed for a total of at
least 15 minutes during a 24 hour-period. Measurable objective and
interventions shall be documented in the care plan. There shall be evidence of
periodic evaluation by the licensed nurse. A registered nurse or licensed
practical nurse shall supervise the activities. This does not include groups
with more than 4 residents per supervising staff.
Restorative Nursing Programs-2 or more required to be provided
6 or more days a week
Passive Range of Motion (O0500A) and/or Active Range of Motion
(O0500B)*
These are exercises performed by the resident or staff that are
individualized to the resident's needs, planned, monitored, and evaluated.
Movement by a resident that is incidental to dressing, bathing, etc. does not
count as part of a formal restorative program. Staff must be trained in the
procedures.
Splint or Brace Assistance (O0500C) - This includes verbal and
physical guidance and direction that teaches the resident how to apply,
manipulate, and care for a brace or splint; or there is a scheduled program of
applying and removing a splint or brace. The resident's skin and circulation
under the device should be assessed and the limb repositioned in correct
alignment.
The following activities include repetition, physical or verbal
cueing, and/or task segmentation provided by any staff member under the
supervision of a licensed nurse.
Bed Mobility Training (O0500D) and/or walking training
(O0500F)* - Bed Mobility - Activities provided to improve or maintain the
resident's self-performance in moving to and from a lying position, turning
side to side and position self in bed. Walking - Activities provided to improve
or maintain the resident's self-performance in walking, with or without
assistive devices.
Transfer Training (O0500E) - Activities provided to improve or
maintain the resident's self-performance in moving between surfaces or planes
either with or without assistive devices.
Dressing and/or grooming training (O0500G) - Activities
provided to improve or maintain the resident's self-performance in dressing and
undressing, bathing and washing, and performing other personal hygiene
tasks.
Eating and/or swallowing training (O0500H) - Activities
provided to improve or maintain the resident's self-performance in feeding
oneself food and fluids, or activities used to improve or maintain the
resident's ability to ingest nutrition and hydration by mouth.
Amputation/Prosthesis (O0500I) - Activities provided to improve
or maintain the resident's self-performance in putting on and removing
prosthesis, caring for the prosthesis, and providing appropriate hygiene at the
site where the prostheses attaches to the body.
Communication training (O0500J) - Activities provided to
improve or maintain the resident's self-performance in functional communication
skills or assisting the resident in using residual communication skills and
adaptive devices.
No count days required for current toileting program or trial
(H0200C) and/or bowel training program (H0500)* - This is a specific approach
that is organized, planned, documented, monitored, and evaluated that is
consistent with the nursing facility's policies and procedures and current
standards of practice. The program is based on an assessment of the resident's
unique voiding pattern. The individualized program requires notations of the
resident's response to the program and subsequent evaluations as needed. It
does not include simply tracking continence status, changing pads or wet
garments, and random assistance with toileting or hygiene.
*Count as one service even if both are provided.
m) Cognitive Impairment -
Additional Scoring Indicators
Cognitive impairment is determined by either the summary score
from the resident interview in Section C0200-C0400 (BIMS) or from the
calculation of Cognitive Performance Scale if the BIMS is not conducted.
Brief Interview for Mental Status (BIMS)
BIMS summary score (C0500 [GREATER THAN OR EQUAL TO] 9)
n) Cognitive Performance Scale -
Additional Scoring Indicators
Cognitive Performance Scale is based off staff assessment. The
RUG-IV Cognitive Performance Scale (CPS) is used to determine cognitive
impairment.
The resident is cognitively impaired if one of the three
following conditions exists.
B0100 Coma (B0100 = 1) and completely ADL dependent or ADL did
not occur (G0110A1, G0110B1, G0110H1, G0110I1 all = 4 or 8)
C1000 Severely impaired cognitive skills (C1000 = 3)
B0700, C0700, C1000 Two or more of the following impairment
indicators are present:
B0700 > 0 Problem being understood
C0700 = 1 Short term memory problem
C1000 > 0 Cognitive skills problem
And
One or more of the following severe impairment indicators are
present:
B0700 [GREATER THAN OR EQUAL TO] 2 Severe problem being
understood
C1000 [GREATER THAN OR EQUAL TO] 2 Severe cognitive skills
problem
