MDS 3.0 Assessment Process
for
Social Workers
OKHASA
2011
First you need to Understand the
Process
• The new Assessment Process is very different
and requires many new tasks and
documentation.
• Look at the data set format – yes I said data
set format – no more MDS “forms”
• Newly organized data formats, definitions and
look back periods
• New rules impact everyone
• New data and new uses of the data
• Definitions that will impact many members of
the IDT
• Many new assessment assignments – both for
assessment and care planning tasks
• Look at the need for training, resources and
skills for the social service department.
• What does it take to get the assessment tasks
done?
TAKE A LOOK AT THE DATA SET
PAY ATTENTION TO THE RED AND GREEN
ITEMS – HIGH IMPACT DATA FOR PAYMENT
AND CARE PLANNING.
• DO NOT ASSUME – READ THE MANUAL –
MANY NEW PROCESSES AND DEFINITIONS
• BE CAREFUL BECAUSE SURVEYORS ARE
LOOKING AT NEW DATA NOW
LOOK AT THE MANUAL FOR THE
SECTIONS YOU ARE CODING
• POLICIES AND PROCEEDURES
• PAY ATTENTION TO THE STEPS FOR THE
ASSESSMENT – IT IS IMPORTANT
• DEFINITIONS ARE IMPORTANT AND WILL
INFLUENCE THE DATA OUTCOMES
• NUMERICAL DEFINITIONS – THIS IS NEW –
VERY DANGEROUS – EVERYONE IS IDENTIFIED
BY A NUMERICAL SCORE
Section B
• Combination of assessment tasks from the
2.0 process.
• B-700 – most important code as it could
influence the interview activity. – code
carefully.
• Vision test and visual appliances – very
important
• Combine clinical and social service tasks
Section C
• Technically not an interview – it is a test – very
structured.
• Brief Interview for Mental Status
• One page assessment – 34 pages of directions
in the manual
• Read the Steps for Assessment – be certain
that training is focused on RAI manual
resources.
• Appendix D and Appendix E
• The BIMS test is not only very scripted it
needs to be introduced consistently – See the
Steps for the Assessment section C of the RAI
Manual.
• If the elder does not answer certain questions
then a small amount of help can be given per
the instructions in the RAI Manual and
Appendix E .
• Before you do the BIMS read Appendix D
Scoring the BIMS
• Write the elder’s answers on the work sheet
and then score after the test is completed.
• No family or significant others are to be
present
• Be certain the elder is comfortable and can
see and hear you. Use ampflication device if
necessary
• If elder can not speak use special test in
Appendix E of the RAI Manual
• BIMS Test is done on all assessments and
scores each test with a number.
• The IDT must consider the BIMS scores as they
plan and conduct utilization review meetings.
• Can be completed by any staff member with
training and proper documentaiton
• On admission doing the first BIMS close to the
admission date assesses the elder’s ability as a
base line.
• VERY IMPORTANT – ALL BIMS TESTS SHOULD
BE DONE THE SAME AND SCORED THE SAME
SO THE SCORES ARE ACCURATE AND
RELATIVE. THESE SCORES WILL BE USED BY
MANY OUTSIDE SOURCES TO EVALUATE THE
RESIDENT AND YOUR FACILITY POPULATION.
REMEMBER EVERY RESIDENT GETS A
NUMERICAL SCORE FOR EACH MDS
ASSESSMENT.
Section D – Mood Interview
• This must be done on the ARD or the day
before the ARD
• Read the Steps for the Assessment in the RAI
Manual
• Introductory statement is very important and
the scoring of the intensity or frequency of the
issues must be done carefully
• Ask the questions in order
• 14 day look back on all cases
• Do not explain items –let elder answer what
they think the items mean
• Record the resident’s response –
• Score the Mood Severity Score from the
frequency of the indicators
• Refer to scoring guides in Appendix E of the
RAI Manual – very important
• This interview is very converstaional
• Use the VIVE DVD produced for CMS for
training
• Write the elder’s responses on the interview
record and score after the interview is
completed.
• Use the scoring rules and examples in
Appendix E
• Record of the interview, date of the interview
and the person doing the interview should be
kept in the medical record as substaniation of
compliance with the RAI process.
• Score of the Mood interview of 10 or higher
can impact payment levels for Nursing
Categories and could be part of fiscal audit.
Section E
• Behavior coding and outcomes
• This is a redesigined section with many
outcome codes included
• Read the manual carefully and note the
definitions and time lines carefully
• Tracking of behaviors is very specific during
the ARP = be sure to use definitions in the RAI
manual
• If you code behaviors you must answer
outcome questions.
• Be careful – What is the meaning of
“Significant” to your team. Outcome answers
will be very important to the surveyors.
• Refusal of Care – New Item – 10 pages of
instructions in the manual with examples.
This includes all care – therapy, physician visits
, treatments etc.
• Wandering – Very dangerous code – What is
your definition. Best definition – “
Locomotion with no rational discernable
purpose” Do not over code !!!!!
• Outcome coding for wandering behavior –
code carefully and be sure clinical staff are
aware of codes.
• Surveyors will monitor these codes at all
surveys – take action to be sure elders are
safe.
• Behaviors that occur in therapy or at activities
are included here – need for excellent
communication. Code from 24 - 7
Section Q
• All new coding –
• Manual instructions and Intent statements are
very important
• Coding examples are important to read to see
what CMS is looking for
• Mini interview on admission – identify the
goal of the elder - needs to be documented
• Return to the community – high impact – read
instructions and follow the guidance in the
manual.
Care Planning
• Which areas of the planning are you
responsible for?
• First Step is to look at the red trigger items in
your coding sections.
• Look at triggers in the other sections.
• Read the concepts and Care Planning Process
guidelines in chapter 4 of the RAI Manual
• Read the guidance and triggers for the CAA
areas you are responsible for.
Care Area Assessments
• Appendix C of the RAI Manual
• You need hard copies of these documents to
review
• Now we have 20 CAAs – two new areas on
Pain and Return to the Community
• Look at what is triggered – Work the CAA –
Document the result of the CAA with a
proceed or not proceed to care planning
statement.
• Locate the documentation in the record in
column 4 of Section V of the MDS
• When your section of the care plan is
completed then check column B of Section V.
• Sequencing is very important
• Documentation is very important
• You must sign for the areas of the assessment
you complete in Section Z on all assessments
and complete CAA documentation on all
comprehensive assessments.
• Many parts of this process are new !!!!!
Chapter 4
Very important – spend the time to read it
carefully – surveyors have been training on
the CAA process and the documentation
requirements. The entire IDT should read it
and talk about the changes in the
requirements. Make copies of the CAAs from
Appendix C of all the areas you are care
planning for – Many new items
Timelines for Assessments
• Many have changed
• The timelines for transmission have also
changed and are going to impact your need to
have the sections completed in a shorter time.
• More assessments will need to be done – big
problem start and stop of therapy and the
discharge return anticipated and reentry
forms. This is a big change to the process and
impacts everyone.
• You need to check with the MDS manager in
your facility to discuss all the things that have
changed with the MDS 3.0.
• The BIMS and Mood Severity Scores will be
part of the case review now. Monitor the
scores throughout the stay. This includes the
Utilization Review meeting.
Summary
• Look at the total scope of the MDS 3.0 Change to your
practice as a Social Worker
• Read the RAI Manual for the sections you are responsible for
and the care planning process that is involved.
• The interviews need to be completed on the schedule in the
RAI Manual and documented in the medical record.
• Instructions are in the Steps for the Assessment section of the
manual.
• BIMS and Mood Interview create a numerical score for each
resident and become part of the resident and faciltiy data
base. Score carefully and communicate scores with
appropriate meetings and departments.
AND
Section Q is all new
• Read instructions and CAAs content. – There is a lot
of important new information. Surveyors will be
evaluating the care planning and documentation
process.
• Discuss discharge planning and the resident’s
awareness and goals with the IDT and the Utilization
Review meeting.
• The MDS 3.0 has more new than old information –
you must be aware !!
QUESTIONS ?????