October 1st RAI Manual Changes

Effective for all MDS’ with ARD 10/1/14 and after, there are changes to some of the very rules you and I just got used to! Really? Yes, really…

In particular, the COT OMRA (Change of Therapy Other Medicare Required Assessment), that we have all come to know and love, now can be used for additional circumstances. The COT OMRA will now be able to reclassify the resident into a RUG-IV therapy group from a RUG-IV non-therapy group. Notice… RE-Classify. This means that a Rehab RUG must have been achieved on a prior assessment.

Here’s an example:

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Ms. Sparkle scores a RH RUG on the 30 day MDS. Then at the next COT checkpoint 7 days after the 30 day ARD, Ms. Sparkle received 340 minutes of therapy but scores a PD1 “Nursing RUG” because she did not have 5 calendar days of therapy due to a missed session in the middle of the week. The COT now becomes necessary due to the change in RUG and is completed. At the next COT checkpoint 7 days later, Ms. Sparkle scores RH. Now, a COT can be completed to re-capture the Rehab RUG and will continue paying at the Rehab RUG until the next scheduled or unscheduled assessment.

So…

A COT OMRA may be completed IF:

1- The resident was classified in a Rehab RUG on a prior assessment (since Day 1 of the current Med A stay) and then dropped out of the Rehab RUG

AND

2-Therapy has been ongoing–meaning NO EOT (End of Therapy) OMRA has been done due to a 3 day miss or a planned therapy discharge for this current Med A stay

Oh, and using the COT in situations described above it still optional. All old COT rules still apply!

To read about all of the changes in the RAI Manual effective October 1, click here.  MDS 3.0 RAI Manual v.1.12 Replacement Manual Page Changes October 2014

To access the entire RAI Manual click here. RAI Manual Home Page

If you have any questions, don’t hesitate….Just Ask

In YOUR corner,

Dolores

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