PDPM Coding Question – What MDS assessments need to be completed when newly skilling a current resident who develops COVID? Is a Significant Change required?

A:

Presuming skilled care requirements outlined in Chapter 8 of the Medicare Benefit Policy Manual have been met, a PPS 5-day assessment will need to be scheduled with an ARD set for days 1 through 8 of the Part A covered stay. A Significant Change in Status Assessment (SCSA) may or may not be required based on the individual resident’s condition. A “significant change” is a major decline or improvement in a resident’s status that:

• • • Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, the decline is not considered “self-limiting”;
    • Impacts more than one area of the resident’s health status; and
    • Requires interdisciplinary review and/or revision of the care plan.

An SCSA is appropriate when:

• • • There is a determination that a significant change (either improvement or decline) in a resident’s condition from his/her baseline has occurred as indicated by comparison of the resident’s current status to the most recent comprehensive assessment and any subsequent Quarterly assessments; and
    • The resident’s condition is not expected to return to baseline within two weeks.

If the IDT determines a SCSA is appropriate, it may be combined with the PPS 5-day. Please review the RAI for further guidance beginning on page 2-22.