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MDS Long Term Care

Page history last edited by PBworks 16 years, 11 months ago

Functional Assessment Instrument Attributes

 


 

Description:

 

The MDS assessment provides a core set of screening, clinical and functional status elements for residents residing in long-term care facilities certified to participate in the Medicare or Medicaid programs. The items in the MDS standardize communication about resident problems and conditions within facilities, between facilities, and between facilities and outside agencies. The MDS (Minimum Data Set) is one of three components of the Resident Assessment Instrument (RAI) developed to be an interdisciplinary standardized assessment tool used to identify resident strengths and weaknesses, develop and revise goals, and to develop an individualized plan of care for the resident with the ultimate objective being to assist the resident in achieving or maintaining her or her highest practicable level well being.

 

 

Author/Sponsor:

 

The original impetus for the MDS was the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) which called for the development of a comprehensive assessment tool to provide the foundation for planning and delivering care to nursing home residents. The MDS was developed in 1995 under CMS contract with the Hebrew Rehabilitation Center for Aged (HRCA). CMS (Centers for Medicare & Medicaid Services) maintains, updates and provides guidance on the use of this tool.

 

 

Prevalence:

 

Use of the MDS is required throughout the United States (under OBRA regulations) by all long-term care facilities that are certified to provide care and services to Medicare and/or Medicaid recipients, regardless of the resident’s level of care. Under the OBRA program, CMS defines the frequency for completing the assessment as follows -

• Admission (completed by 14th day of resident’s stay)

• Annually (completed within 366 days of the most recent comprehensive assessment)

• Significant Change (completed by the end of the 14th calendar day following determination that a significant change has occurred).

• Quarterly (completed every 92 days)

In addition, the MDS is utilized by the Medicare program for any resident receiving Medicare Part A Skilled Nursing Facility (SNF) level of care, to classify the residents into a Resource Utilization Group (RUG-III), for purposes of reimbursement.

Under the Medicare PPS (Prospective Payment Schedule) assessments are required to be completed with 14 days of the defined Assessment Reference Date (ARD) for each assessment –

• 5 Day

• 14 Day

• 30 Day

• 60 Day

• 90 Day

 

 

Population:

 

The MDS was designed to be utilized as an assessment tool for residents residing in long-term care facilities certified by Medicare and/or Medicaid. Any resident occupying a Medicare or Medicaid bed for longer than 14 days, regardless of payor source, age or diagnosis will have an MDS completed based on a defined assessment schedule. Subsequently, use of the MDS has expanded to be used by the Medicare reimbursement system, by many State Medicaid reimbursement systems and to monitor the quality of care provided to nursing facility residents. A unique 2-page MDS has also been adapted for use by the hospital swing bed program.

 

 

Subject:

 

The MDS is completed by a facility’s interdisciplinary team as part of a comprehensive assessment of any resident residing in a Medicare or Medicaid certified long term care facility.

 

Provider Setting:

 

The MDS is used in the long term care setting to assess a resident’s functional status throughout their stay in the facility. Discharge and/or Reentry Tracker Forms are completed to notify the State of a resident’s movement in and out of the Medicare system and to track their location among other Medicare certified providers.

 

Derived:

 

The MDS is not derived, nor a component of another instrument.

 

Validity and Reliability Testing:

 

The MDS is not open to peer review, except that CMS is committed to ongoing evaluation and refinement of the tool and collaborates with the various end users in the development and revision of future versions.

 

Specific vs Multiple Domain:

 

The MDS address a resident’s functional status through assessment of –

• the resident’s prior living situation

• Cognitive Patterns

• Communication/Hearing and Vision Patterns

• Mood, Behavior and Psychosocial Patterns

• Physical Functioning and Structure Problems (including ADLs – bathing dressing, feeding, grooming, ambulation and range of motion)

• Continence

• Disease and Health Conditions

• Oral, Nutritional and Dental Status

• Skin Condition

• Activity Pursuit Patterns

• Medications, Special Treatments and Procedures

 

 

Verbal or Observation based:

 

The MDS assessment may be completed utilizing any/or all of the following sources –

• Review of a resident’s clinical record

• Communication with and observation of the resident

• Communication with direct-care staff from all shifts

• Communication with licensed professionals

• Communication with the resident’s attending physician

• Communication with the resident’s family

 

 

Are calculated scores included:

 

Quality Indicators and Resource Utilization Groups are determined based upon the scoring of various data elements of the MDS.

 

Extended use:

 

Quality Indicators and Resource Utilization Groups are determined based upon the scoring of various data elements of the MDS.

 

Versions:

 

Various versions of the MDS assessment tool include –

• Comprehensive assessment – this assessment includes all required MDS data items along with RAPs’ and Utilization Guidelines. A comprehensive assessment is required within 14 days of admission, annually when there has been a significant change in clinical status and when the facility does a Significant Correction of a Prior Full Assessment.

• Full Assessment – includes federally MDS required data items, plus any State-required items. RAPs and care planning are not required when the full assessment is completed for a Medicare assessment.

• Quarterly assessment – includes a CMS mandated subset of MDS items. States may opt to require a full assessment on a quarterly basis.

• Discharge and Reentry Trackers – are used to notify the State when a resident is “discharged” or “reenters” the MDS system. The Discharge and Reentry Trackers include a subset of items.

• MPAF (Medicare Prospective Payment System Assessment Form) – this is an optional version of the MDS used for residents in a Medicare Part A stay and includes a subset of items including items for resident identification, items necessary to complete a RH classification and items needed to calculate the Quality Indicators (QIs).

• Swing Bed – The Swing Bed MDS Assessment is a customized 2-page assessment used to determine payment levels for Medicare beneficiaries occupying a hospital

 

 

Public Domain:

 

The MDS is in the public domain and CMS provides free access to an electronic MDS software program called RAVEN.

 

 

References:

 

 

Comments:

 

The MDS is mandated for any stay in a long-term care facility that accepts T18/T19. This includes all payor categories, respite, short term rehab and private pay

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