You do an OMRA after d/c from Rehab if there is a skilled nursing need.
You don't need an OMRA after d/c from skilled nursing UNLESS there is a significant change. In this case an artrhitic "flare-up" is not a valid reason for a significant change, moreso if recovery is favorable in just 2 weeks of PT (as defined in RAI manual p2-8). Otherwise, you may need to do another SCSA in 2 weeks when the condition improves.
The 30-day would apply if the lapse in assessment would be more than 5 days of the grace period allowed of the next PPS assm't. In which case, restarting the 5-day is no problem.
In this scenario, wherein change in RUGs occured within the ARD window of the 14-day incldg. the grace days, the most logical reason is to restart the 5-day Medicare since you can use the projected dates of therapy, even tho P1b will only capture 1 day of rx.
However, would you consider an arthritic flare-up related to pneumonia (the actual reason for skilled need) even tho the incident appeared more than 2 weeks after hosp return?
Thanks for all the replies.