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Texas MDS 3.0
A Review of Section GG: Functional Abilities and Goals
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THANK YOU FOR ALL YOUR WORK AND FOR ALL YOU DO EVERY DAY FOR SNF AND NF RESIDENTS IN TEXAS!
Thank You
Texas MDSSusan Edgeman BSN, RN, RAC-CTState RAI CoordinatorCell (210) [email protected]
Shimron (Shim) Gill, Data Management & AnalysisMDS Automation CoordinatorCell [email protected]
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Acronyms• AFO – Ankle - Foot Orthosis • APU – Annual Payment Update • ARD – Assessment Reference Date • CMS – Centers for Medicare & Medicaid
Services • HHA – Home Health Agency • HIPPS Code –Health Insurance
Prospective Payment System rate codes
• IMPACT Act – Improving Medicare Post - Acute Care Transformation Act
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Acronyms• IRF - Inpatient Rehabilitation Facility • IRF - PAI – Inpatient Rehabilitation
Facility Patient Assessment Instrument • IPA – Interim Payment Assessment • LTCH – Long - Term Care Hospital • LTCMI (Long-term Care Medicaid
Information)• MDS – Minimum Data Set • NQF – National Quality Forum • OBRA – Omnibus Budget Reconciliation
Act of 1987 • PDPM – Payment - Driven Payment
Model 5
Acronyms• PAC – Post - Acute Care • PN – Parenteral Nutrition • PPS – Prospective Payment System • QM – Quality Measure • QRP – Quality Reporting Program • RAI – Resident Assessment Instrument • SNF – Skilled Nursing Facility • QIES ASAP – CMS Quality Improvement
and Evaluation System Assessment Submission and Processing
• QM – Quality – Measures• SNF QRP SNF Quality Monitoring Program• VBP – Value Based Purchasing Program
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Disclaimer• The information in this presentation is current
at the time it was written
• CMS and Texas Medicaid Requirements are subject to change
• Visit the CMS Long-term Care website for MDS Item sets updates and additional information
• Subscribe to HHSC information alerts or visit Texas MDS Alerts
• Consult the Texas Medicaid Partnership (TMHP), Long-term Care site for Texas Medicaid info
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Sources
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• Current RAI Manual, Version 1.1.7Section GG Pages 1-67
• CMS SNF QRP MDS 3.0 Training, CMS YouTube Channel
• CMS Skilled Nursing Facility Quality Monitoring Program Section GG, SNF QRP Training Aug13,2019
• CMS Section GG Cross-Setting Training(Post Acute Care-Spring 2019)
Sources Continued
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• CMS Section GG: Functional Abilities and Goals – YouTube Inpatient Rehabilitation Facility (IRF) QRP Provider Training, May 18 and 19, 2016Anne Deutsch, RN Ph.D.
Objectives
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• Understand the growing importance of GG and across PAC settings
• Use in many programs
• Potential future applications for LTC
• Review of Section GG concepts:
• Self Care and Mobility Items
• Data Collection and assessment
Objectives Continued
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• Understand resources and training available
• Importance of educating ALL staff on the Section GG
• Understand some key differences between Section G and Section GG
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Please list your role in the chat box
Please let us know if your facility is Medicaid only and you are new to GG
Please let us know if you are a SNF but therapy normally takes care of Section GG
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Section GG Background and Importance
Background
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• Requires Standardized Patient Assessment Data that will enable:
• Data Element uniformity• Quality care and improved outcomes • Comparison of quality and data across
post-acute care (PAC) settings• Improved discharge planning• Exchangeability of data• Coordinated care
• Source: CMS’s MLN Connects: The Impact Act of 2014 and Data Stabilization (Oct 21, 2015
IMPACT ACT 2014
The Importance of Section GG
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• In 2016 CMS began data collection of Section GG for Medicare Part A residents in Skilled Nursing Facilities as part of the SNF Quality Reporting Program.
• Importance in SNF QRP
• Section GG items are hugely important
• In the SNF QRP including importance of calculating covariates and PDPM
Section GG and SNF QRP
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Measures Use Section GG data:1. Application of Percent of LTCH Patients
with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function
2. Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients
GG and Quality Measures
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3. Application of IRF Functional Outcome Measure: Change in MobilityScore for Medical Rehabilitation Patients
4. Application of IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients
5. Application of IRF Functional Outcome Measure: Discharge MobilityScore for Medical Rehabilitation Patients
SNFs, GG and VBP • SNFs- One discharge goal in column 2
(self-care or mobility)
• Other MDS items are also used for the calculations—specifically data from MDS sections H, I, J, K, M, N
• SNFs must submit no less than 80% of the MDS assessments with 100% completion of the required SNF QRP or a 2%-point reduction in the SNF’s APU will result
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Section GG, Importance in SNF PDPM
GG SNF PDPM and Function Scores
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• Under PDPM for SNF Care, 2 function Scores are Calculated:
• A PT and OT Function Score (10 items)
• And Nursing Function Score (7 items)
PT and OT Function Score
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GG0130A Self-care: Eating
GG0130B Self-care: Oral hygiene
GG0130C Self-care: Toileting hygiene
GG0170B Mobility: Sit to lying
GG0170C Mobility: Lying to sitting on side of bed
GG0170D Mobility: Sit to stand
GG0170E
Mobility: Chair/ be d- to-chair transfer
GG0170F Mobility: Toilet transfer
GG0170J
Mobility: Walk 50 feet with 2 turns
GG0170K Mobility: Walk 150 feet
Nursing Function Score
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GG0130A Self-care : Eating
GG0130C Self-care : Toileting hygiene
GG01708 Mobility: Sit to lying
GG0170C
Mobility: Lying to sitting on side of bed. The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support
GG0170D1 Mobility: Sit to stand
GG0170E1 Mobility: Chair / bed-to- chair transfer
GG0170F1 Mobility: Toilet transfer
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CMS Announcements
CMS Announcements
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• March 19, 2020 CMS Announced MDS 3.0 V1.18.1 would be delayed
• And that staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update IT systems .
• There was no new publication of the RAI manual
• Item set 1.17.2. in effect 10/01/2020
• CMS has announced the delay of MDS 3.0 V1.18.1 and PAC Shared Data Elements (SPADES)
• Any changes to the RAI manual and new publications would be delayed until two years post public health emergency
• CMS reports there may be a addendum coming out in October since there is no new manual.
CMS May 15 2020
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• In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications.
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PDPM and OBRA Assessments
Performance Periods• For OBRAS combined with a 5-day PPS
assessment, Medicare rules would apply and the ARD would be
• For OBRA assessments the performance period is the ARD and 2 prior calendar days.
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PDPM Info on OBRAs
• Three major pieces were added to the OBRA assessment to allow for PDPM HIPPS codes to be established
• Items from section GG0130 Self-Care and GG0170 Mobility
• Items I0020A and B Primary Medical Condition Category
• Item J2100 Recent Surgery Requiring Active SNF Care related to Primary Diagnosis
• Follow up items for Surgical Procedures Categories at J2300-J5000
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OBRA and PDPM• For states who decide to collect PDPM
data on OBRA assessments when notcombined with a PPS 5-Day:
• The performance period window is ARD and 2 prior calendar days
• When combined with a 5 day (Medicare rules apply and the ARD is day 1-3 of the start of the stay)
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Section GG Concepts
GG100 Prior Functioning –Everyday Activities
GG110 Prior Device Use
GG130 Self Care
GG 170 Mobility Items
Section GG
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Section GGSteps for Assessment
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GG0100. Prior Functioning: Everyday Activities
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Section GG
• Qualified clinician: Healthcare professionals practicing within their scope of practice and consistent with Federal, State, and local law and regulations
• Resident should be allowed to perform activities as independently as possible as long as they are safe
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G0110 Prior Device Use
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Section GG Examples
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Section GG• Assess the resident’s self-care performance
based on direct observation incorporating resident self-reports reports from qualified clinicians care staff, or family documented in the resident’s medical record during the 3-day assessment period.
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GG Usual Performance• Make sure direct care staff participate in data
collection
• Do not make conclusions about potential capability if an item wasn’t assessed
• Beware of software auto-populating GG (the raw clinical record data needs to be interpreted)
• A clinical judgment is made about overall usual performance (especially when performance varies)
• Collaboration between nursing and therapy (if the resident is receiving therapy) is essential
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Section GG• Data Collection
• Aim for thorough documentation by all shifts during the performance period
• Good Communication is Key
• Make sure everyone is on the same page and knows when the ARD is and understands performance periods
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Usual Performance• While CMS expects multiple data
sources for GG information• Section GG is an assessment• Usual performance requires clinical
judgement and would need to be done by a qualified clinician
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GG Completion• “The IDT can assimilate the data to determine
‘usual performance’ after day three as long as they only utilize data/information from the 3 day assessment window or before therapeutic intervention.
• Section Z0400 for Section GG is signed in the same manner as all other items on the MDS (except resident interviews), that is when the MDS coding is determined and entered on the MDS, Z0400 reflects that date.”
Source: email communication from CMS to State RAI Coordinators April 15, 2021
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GG A Team of Qualified Clinicians• CMS anticipates that an interdisciplinary team
of qualified clinicians is involved in assessing the resident during the three-day assessment period.
• For Section GG SNF stays, the admission assessment period is the first three days of the Part A stay starting with the date in A2400B
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Documentation
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• Activity Not attempted—Section GG coding doesn’t stand alone
• Chart in the clinical record
• Please provide documentation when using any codes
• Ask probing questions—why did the resident refuse?
• Clinicians please explain more about the safety concern and why 88 was used
• If 10 is used, explain the environmental of
• If CNAs and LVNs are assisting with data collection, please have them provide detailed documentation and communicate to the MDS coordinator.
Section GG TIPS• Think about each GG activity and
components involved –suggest readers review CMS videos/SNF QRP training where they break down each part
• Remember: probing questions, clarify document in the clinical record
• Clinicians explain your rational
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Usual Performance
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• A resident’s functional status can be impacted by the environment or situations encountered at the facility.
• Do not record the resident’s best performance and do not record the resident’s worst performance, but rather record the resident’s usual performance.
Probing Questions: Examples
GG0170: Mobility (RAI Page GG-66)
• Wheel 150 feet: Example of a probing conversation between a nurse determining a resident’s score for wheel 150 feet and a certified nursing assistant regarding the resident’s mobility:
• Nurse: “I understand that Mr. G usually uses an electric scooter for longer distances. Once he is seated in the scooter, does he need any help to mobilize himself at least 150 feet?”
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Probing Questions: Examples• Certified nursing assistant: “He
drives the scooter himself … he’s very slow.”
• Nurse: “He uses the scooter himself without any instructions or physical help?”
• Certified nursing assistant: “That is correct.”
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Some Differences Between Section GG and Section G
• Section GG measures how independent a resident is (greater points means greater independence)
• Section GG uses a 3-day look back and the Section GG Decision Tree
• Section G measures how dependent a resident (greater points being used to account for staff resource time)
• Section G uses a 7-day lookback and “rule of 3”
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Some Differences Between Section GG and Section G
• Section GG breaks activities info constituent components and looks and each one separately
• Section GG allows residents to use an assistive device with no effect on coding
• Section GG does not include any nutrition by artificial means for eating
• Section GG does not include the transfer component of ever activity
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Recap
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We’ve discussed:
• A general review of section GG
• GG’s growing importance in different settings
• Some of CMS announcements
• Potential application of PDPM items for OBRA assessments if elected by states
• Coding instructions and tips
• Available resources for facility staff
Recap Resources:
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• Current RAI Manual, Section GG Pages 1-67
• CMS SNF QRP MDS 3.0 Training, CMS YouTube Channel
• CMS Skilled Nursing Facility Quality Monitoring Program SNF QRP Training Aug13,2019
• CMS Section GG Cross-Setting Training (Post Acute Care-Spring 2019)
• TMHP
Additional MDS Resources:
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Information on MDS, Section GG and Post Acute Care Nursing is available:
Please do a web search: links to non-CMS, non-Texas HHS affiliated sites are not provided
This is not an all-inclusive list (sites may require member-ship or fees)• The American Association of Post-Acute Care
Nursing (AAPACN)• allnurses.com/mds-coordinator-information• Simple LTC
The resources shared on this slide are for informational & educational use only. No recommendation, or endorsement by the Texas SRAI Coordinator, HHSC Long term-Care Regulation, or Texas HHS should be inferred.
THANK YOU!
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Susan Edgeman BSN, RN, RAC-CTState RAI Coordinator,Policy & Rules, Long-term Care [email protected]
