Long-Term Care

More info on RAI updates

MDS 3.0 Insider, September 19, 2011

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CMS released version 1.07 of the RAI User’s Manual August 31. While this new version of the manual included a lot of changes, many of them were to solve formatting mistakes, correct minor issues, and clarify certain aspects of the assessment process. However, some of the most notable changes included in this version of the manual are as follows:

  • New assessment schedule: CMS made changes to the assessment schedule by changing the assessment reference date (ARD) window and allowable grace days for most assessments. This was done in an effort to eliminate overlap from different assessments and capture the most accurate representation of residents’ conditions and services provided. However, the new assessment schedule essentially makes the window to set the ARD smaller, which doesn’t leave much wiggle room for facilities.
  • Introduction of the Change of Therapy (COT) OMRA: Complete when the intensity of therapy, which includes the total reimbursable therapy minutes (RTM), and other therapy qualifiers such as number of therapy days and disciplines providing therapy, changes to such a degree that the beneficiary would classify into a different RUG-IV category than the RUG-IV category determined by the previous Medicare assessment. The observation period for the COT OMRA is a rolling seven-day window, with the first window ending seven days after the ARD of the previous Medicare assessment. The requirement to complete a change of therapy is reevaluated with additional seven-day COT observation periods ending on the 14th, 21st, and 28th days after the most recent Medicare payment assessment ARD and a COT OMRA is to be completed if the RUG-IV category changes. If a new assessment used for Medicare payment has occurred, the COT observation period will restart beginning on the day following the ARD of the most recent assessment used for Medicare payment.

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