If there is only one change, the resident can still benefit from an ASCA as determined by the IDT or initiated by the resident due to changes in the care plan. It is important to remember that each resident`s situation is unique. The facility must document in the resident`s medical record a rationale for completing an ASCA that does not meet the graduation criteria. Section 483.20(b)(2)(ii) Within 14 days after the day on which the facility determined, or should have determined, that the resident`s physical or mental condition has changed significantly. This does not alter the facility`s obligation to promptly consult with a resident`s physician for changes pursuant to 42 CFR § 483.10(i)(14)(14). Once a CDB-CDSA has been concluded, the next annual assessment is not due until 366 days after the ARD of the significant change in status. Ensure that any resident experiencing a significant change in status is fully assessed using the Resident Assessment Instrument (RAI) process specified by the CMS. Why are you asking? Because in the proposed payment system, a CDSA will be the only way to change the level of payment after the first assessment. An CDSA, including Area of Care (ABA) assessments, must be completed within 14 days of determining that there has been a significant change in the resident`s status from baseline. This can be determined by comparing the resident`s current condition with the last full assessment and the last quarterly assessment, and the resident`s condition is not expected to return to baseline within 2 weeks. A CAWD is appropriate if there are two or more areas of MDS decline or two or more areas of improvement, or if the TDI determines that the resident would benefit from the CDSA assessment and subsequent review of the care plan. The facility should document in the medical record if it is determined that the resident meets the criteria for a significant change in status. The «Significant Change in Status Assessment» is a comprehensive assessment that must be completed when the Interdisciplinary Team (IAD) has determined that a resident meets the guidelines for significant change for significant improvement or decline.
«If the team feels that the patient`s condition requires the interdisciplinary review and management necessary to refine the care plan, a significant change in the condition assessment is warranted. Circumstances in which a change in residency status is not significant include, but are not limited to: NOTE: For information on planning the MDS assessment, please refer to Chapter 2 of the Resident Assessment Instrument 3.0 User Guide for Long-Term Care Facilities. Link to LTCF ARI User Manual: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/NursinghomeQualityInits/MDS30RAIManual.html. Examples of rejection include: A significant change in MDS status is required if: The «Assessment Reference Date (AIR)» is the specific parameter for review periods in the Minimum Data Set (MSD) assessment process. This review period is also referred to as the observation or evaluation period. (ed. 173, published: 11-22-17, in force: 11-28-17, implementation: 11-28-17). The establishment cannot conduct a CDSA until a full accreditation review has been completed. Ultimately, the team must remember one very important element: the proposed RCS-1 (Resident Classification System) payment system generates waves of questions and comparisons with the existing system. Each item leads to hours of discussion in a rabbit hole path.
In true Harmony Healthcare International (HHI) style, we like to distill and synthesize without drama or delay. An important point that needs to be addressed today in preparation for tomorrow is the criterion for a significant change in status status. If the staff of the institution do not fully understand the reasons for this assessment, the institution may be unduly compensated for the services provided. The criteria for conducting a Significant Change in Status Assessment (SCSA), as described in the MDS 3.0 RAI User Guide, are as follows: Note that patients with improvements in the above areas should be screened for AUCS improvement. No guidelines are recommended at this time. Come back later.