A small change in the rules for completing entry tracking forms has caused many MDS Coordinators (MDSC) confusion and concern.
Because the rule changes are scattered throughout the coding instructions, it is easy to read one section and come away with incorrect assumptions about how it all fits together.
Let’s start with what hasn’t changed.
The OBRA Admission assessment (A0310A = 01) requirements found on page 2-18 of the RAI manual have not changed at all:
The admission assessment is a comprehensive assessment for a new resident and, under some circumstances, a returning resident that must be completed by the end of day 14, counting the date of admission to the nursing home as day 1 if:
- This is the resident’s first time in this facility, OR
- The resident had been in this facility previously and was discharged prior to completion of the OBRA Admission assessment, OR
- The resident has been admitted to this facility and was discharged return not anticipated, OR
- The resident has been admitted to this facility and was discharged return anticipated and did not return within 30 days of discharge.
If the resident is discharged prior to midnight on day 14 of the stay, the admission assessment is not required.
What Has Changed
Now, let’s take a look at what has changed.
Before October 1, 2014, if a resident was discharged prior to day 14 and returned, we would complete an entry tracking record coded as “Admission” in A1700.
Since October 1, the presence or absence of the OBRA Admission assessment is not relevant to the type of entry tracking record completed.
This is from page 2-33:
There are two types of entries – admission and reentry. [Author’s note: This is only referring to what is coded in A1700 of the entry tracking record. This does not affect the requirements for the OBRA Admission Assessment at all.]
Admission (Item A1700=1)
Entry tracking record is coded an Admission every time a resident:
- Is admitted for the first time to this facility OR
- Is readmitted after a discharge return not anticipated OR
- Is readmitted after a discharge return anticipated when return was not within 30 days of discharge.
Reentry (Item A1700=2)
Entry tracking record is coded Reentry every time a person:
- Is readmitted to this facility, and was discharged return anticipated from this facility, and returned within 30 days of discharge.
Example: Resident who was not in a Medicare Part A Skilled Nursing Facility Stay:
Mrs. Jones was admitted on Feb. 4, 2015. She was emergently discharged to the hospital on 2/9/15 and was readmitted on Feb. 15, 2015, and remained in the facility long term.
Required assessments:
- Entry Tracking Record for Feb. 4, 2015, with A1700 = 1: Admission.
- Discharge Return Anticipated Assessment for Feb. 9, 2014.
- Entry Tracking Record for Feb. 15, 2015, with A1700 = 2: Reentry.
- OBRA Admission Assessment completed no later than Feb. 28. 2014, day 14 of the current stay.
- Continue the OBRA schedule
Example: Resident who was in a Medicare Part A Skilled Nursing Facility Stay:
Required assessments:
- Entry Tracking Record for Feb. 4, 2015, with A1700 = 1: Admission.
- PPS 5 day/Discharge Return Anticipated Assessment for Feb. 9, 2014.
- Entry Tracking Record for Feb. 15, 2015, with A1700 = 2: Reentry.
- OBRA Admission/PPS 5 day with ARD no later than day 8 of the stay, completed no later than 2/28/14, day 14 of the current stay.
- Continue the OBRA and PPS schedule per requirements of Chapter 2 of the RAI manual.