Adm MDS completion

Can someone please clarify the completion timeframe for an admission assessment if the resident goes out to the hospital with the first 14 days?

I have a resident who was admitted then went out to the hospital on day 2 - was in the building approx 20 hours. We discharged him return anticipated since he was expected to return to us.

Resident returned on day 14.

Does my admission assessment still need to be completed by day 14? I would only have 20 hours of documentation to complete my MDS with. But per a recent MDS audit my company had, if the resident is in the building on day 14, the MDS must be completed.

What if he had returned on day 16? When would my MDS be due then?

[Talino]

If the resident is discharged prior to day 14th, the Adm MDS is not required. When resident returns, you have a "new" 14 days to complete the Adm MDS from day of ReEntry.

[glm777, BSN, RN]

That is how we have always interpreted the RAI manual. However in a recent focused MDS survey, we received deficiencies for late Admission MDSes and were told that the manual states that the admission MDS must be completed within 14 days without condition and that only AFTER the admission assessment is complete does the "new 14 day" rule apply if the resident is MLOA during an assessment period.

Per the manual:

If a resident had an OBRA Admission assessment completed and then goes to the

hospital(discharge return anticipated and returns within 30 days) and returns during an assessment period and most of the assessment was completed prior to the hospitalization, then the nursing home may wish to continue with the original assessment, provided the resident does not meet the criteria for a SCSA. In this case, the ARD remains the same and the assessment must be completed by the completion dates required of the assessment type based on the timeframe in which the assessment was started. Otherwise, the assessment should be reinitiated with a new ARD and completed within 14 days after reentry from the hospital. The portion of the resident's assessment that was previously

completed should be stored on the resident's record with a notation that the assessment

was reinitiated because the resident was hospitalized.

Also:

• Federal statute and regulations require that residents are assessed promptly upon

admission (but no later than day 14) and the results are used in planning and providing

appropriate care to attain or maintain the highest practicable well-being. This means it is

imperative for nursing homes to assess a resident upon the individual's admission. The

IDT may choose to start and complete the Admission comprehensive assessment at any

time prior to the end of day 14.

[Talino]

The resident must be in the facility for 14 consecutive days in order for the comprehensive assessment to be required. If the Admission MDS has been started but the resident is discharged prior to day 14th, it is optional to complete the MDS.

Example:

• Admission 12/1
  
• Adm MDS ARD 12/5
  
• DCRA 12/10
  
• Reentry 12/13
  

If the facility chooses to continue w/ the Adm MDS ARD 12/5, you are still required to complete the MDS by 12/14. What if the resident's status is different from 12/5? You will complete the Adm MDS still by 12/14 then you will need to do an SCSA within 14 days after.

You haven't started the Admission MDS when the resident left. Therefore you meet this guideline -

Otherwise, the assessment should be reinitiated with a new ARD and completed within 14 days after reentry from the hospital.

That said, even if you have started the Adm, just store the incomplete assm't and document why it wasn't completed. Start anew is what I always recommend.