SNF QRP Part 5 – Introduction to MDS 3.0 Section GG

The majority of patients/residents who receive Post-Acute Care (PAC) services, such as care provided by SNFs, LTCHs and IRFs, have functional limitations. Many of these patients/residents are at risk for further decline in function due to limited mobility and ambulation. Each of these PAC providers currently collects functional data via the use of various different assessment tools.

In order to standardize functional data collection, CMS is implementing a new Section GG for PAC providers, including SNFs.  Collection of standardized functional assessment data across SNFs, LTCHs, and IRFs, using standardized data items, would establish a common language for patient/resident functioning.  This may facilitate communication and care coordination as patients/residents transition from one type of provider to another.

The functional assessment items included in the Functional Status quality measure were originally developed and tested as part of the Post-Acute Care Payment Reform Demonstration (PAC PRD) version of the Continuity Assessment Record and Evaluation (CARE) Item Set.  The demonstration was designed to standardize assessment of patients/residents status across acute and post-acute providers, including SNFs, HHAs, LTCHs, and IRFs.

In the SNF setting, Section GG will be implemented as a new section of the MDS 3.0 on 10/1/2016and will be used to calculate the Function Quality Measure in the Quality Reporting Program (QRP).

Section GG will consist of the following functional status items:

Self-Care Items

  • Eating
  • Oral Hygiene
  • Toileting Hygiene

Mobility Items

  • Sit to lying
  • Lying to sitting on side of bed
  • Sit to stand
  • Chair/bed-to-chair transfer
  • Toilet Transfer
  • Walk 50 feet with two turns, if ambulatory
  • Walk 150 feet, if ambulatory
  • Wheel 50 feet with two turns, if applicable
  • Wheel 150 feet, if applicable

Section GG Coding Requirements

Section GG will be required to be completed at the beginning of a resident’s Medicare SNF PPS Part A stay as well as the end of the Medicare SNF PPS Part A stay. For this reason, Section GG is will only be required on MDS Assessments where A0310B = 1 (5-day Assessment) and on the Discharge (End of Medicare Stay) assessment where A0310H = 1.

The Discharge End (End of Medicare Stay) is a new assessment and item set that will be implemented as well on 10/1/2016.

Coding: Educational Needs

The implementation of Section GG will require facility staff to understand the proper coding of this section and to not confuse coding instructions between Section G and Sections GG. CMS has yet to release the RAI Manual coding instructions for Section GG, this is anticipated to be released in Spring 2016.

Even without the coding instructions we can still identify some of the major differences in coding of Section G vs GG on this table:

Coding of MDS 3.0 Section G vs GG Comparisons

Section G

  • Completed on all assessments, except End of Medicare Assessment.
  • Uses 7-day look back period.
  • Follows “Rule of 3” for coding of column 1.
  • Has 5-point coding system to identify functional status:

    • Independent
    • Supervision
    • Limited Assistance
    • Extensive Assistance
    • Total Dependence

Section GG

  • Completed on PPS 5-day Assessments and End of Medicare Assessments only.
  • Based on first 3 days of SNF PPS stay or last 3 days of SNF PPS stay.
  • Coding of column 1 will be based on “usual” performance during 3-day period.
  • Has 6-point coding system to identify functional status:

    • Independent
    • Setup or Clean Up Assistance
    • Supervision or Touching Assistance
    • Partial/Moderate Assistance
    • Substantial/Maximal Assistance
    • Dependent

Those responsible for coding Section GG will have to be able to distinguish between the two different sets of coding rules to ensure accuracy of both Sections, Section G and Section GG.

AIS will provide further coding guidance on this new Section once it is published by CMS.

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