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Date ArticleType
1/3/2017 Payment/Reimbursement
Changes to Resident Assessment Instrument Supportive Documentation

FSSA and Myers & Stauffer are publishing, in the Myers & Stauffer newsletter, updated Supportive Documentation Requirements effective for assessments with an Assessment Reference Date (“ARD”) of on or after September 1, 2016 for Activities of Daily Living (“ADL”).  These updated directly correlate to changes in the RAI manual pages G-3 and G-4, the definitions for ADLs.  The state expects that all staff members participating in documentation for MDS assessments have this information immediately available to them at the time of completion for accurate coding of the MDS.  The requirements include, but are not limited to the following:

• The ADL key for self-performance and support provided must include all the MDS key options and be equivalent to the intent and definition of the MDS key (key of “7” self-performance is optional).
• The ADL key for self-performance and support provided must be understood and readily available to staff.
• ADL definitions must include all tasks and components related to the specific ADL activity as specified in the RAI Manual.
a. Example – The following MUST be documented for the definition of eating: “Eating – how resident eats and drinks, regardless of skill. Do not include eating/drinking during medication pass. Includes intake of nourishment by other means (e.g. tube feeding, total parenteral nutrition, IV fluids administered for nutrition or hydration).
b. Each late-loss ADL MUST include all RAI/MDS tasks/components.

• Care plan must address functional status and interventions tailored to the resident’s cognitive, physical/functional, and social abilities and improve quality of life.

Effective for assessments with an ARD of July 1, 2017 and after - the RN Reviewer, for the case mix review, will no longer accept the following related to ADLs:

1) ADL self-performance key definitions that are not included in the electronic data or on the hard copy ADL tracking tool:
a. Example - ADL self-performance key definitions that are taped on the wall near the kiosk(s) will no longer be sufficient.
2) All four (4) late-loss ADLs (Bed Mobility, Transfer, Eating, and Toileting) must be specifically addressed on the care plan. Late-loss ADLs that are not on the care plan will not be supported for the case mix review. The ADL(s) may be in conjunction with another area, but MUST be specific as to the late-loss ADL being addressed.
a. Example - A general statement saying “Assistance with ADLs as required” will not be sufficient.

The state is making these changes as a higher level of detail in individualize care plans is being required.  Indiana Medicaid states that “care plans are to be individualized and should be based on an accurate assessment of the resident’s self-performance and the amount and type of support being provided to the resident. Since residents’ functional performance of the four late-loss ADLs vary from task-to-task, it would not be appropriate to “blend” this information in a care plan, but to specify the resident’s needs and how the nursing home plans to meet those needs for each individual late-loss ADL.”