ARD for annual

[ejpip1]

I guess this just hasn't happened before because I am not sure what to do. I have a resident who went into the hospital. He is returning on hospice so a significant change assessment will need to be done. He returned today and his annual is due by 7/20 (in 2 days). What happens when someone has been in the hospital and comes back that close to a due date for OBRA MDS? Do I need to try to do a annual now or can I wait for a week and just do a significant change? The annual assessment would be late. Thanks.

[Bella'sMyBaby]

Go ahead & schedule the resident for the sig change.

The fact that the resident was hospitalized can't be helped.

You will get an error when you transmit that the annual is overdue but that's OK.

This scenario is quite common, especially with residents who are frequent flyers to the hospital. :)

[katoline]

I was taught that when a sig change was needed, it was the fact that it was a comprehensive assessment that mattered and that the quarterly count would start again from that point forward. On our software, the OBRA assessment chosen, can only be one or the other. You can combine with a PPS, but that's it, other than a discharge. Once it was determined a sig change was needed it would override the annual, besides they were in the hospital and if there is change enough for a sig change, i would say that would trump and you have 14 days to determine. that's my story and i'm sticking to it. love the questions and responses. have been away too too long. sharon

[andy3k]

You are dealing with two separate requirements:

1. Resident went hospice, so sig change is required.

2. A comprehensive is due every 366 days.

You have two choices which meet both requirements:

1. Set ARD of sig change for 2 days after reentry, or

2. Set ARD of annual for 2 days after reentry, and then do the sig change the following week (2 comprehensive assessments total).

Either way, a comprehensive assessment is due 2 days after reentry and a surveyor could tag you for sending a late comprehensive.

[silverbat]

I would do the sig change ARD 2 days after re-entry...kill 2 birds with one stone, so-to-speak. Sig changes always re-set the assessment calendar.

[katoline]

Say if someone is a mcd resident and goes in the hospital, has at least a three day stay, returns MCR. You would have completed a discharge return anticipated, a reentry, now a sig change, 5 day pps would be due. Does the fact they were admitted to the hospital change the OBRA schedule? What if they were hospitalized for a month and the comprehensive (or quarterly) was due while they were in the hospital? Does the fact that they were hospitalized change things? Or is it the return anticipated vs not anticipated? sharon

[katoline]

I just went to CMS site for manual and in chapter 3 my question is answered. If the OBRA assessment was due while the resident was hospitalized, if not a sig change, you still have 13 days from readmission to do the next scheduled assessment.

This situation just occurred at our facility and some of the team wanted to go ahead with the annual assessment and careplan mtg with the resident in the hospital. Made no sense to me. He came back MCR/Sig Change anyway having declined and needing therapy.

[andy3k]

You found the answer in Chapter 2, not Chapter 3, but yes, you are correct. Additionally ...

Does the fact they were admitted to the hospital change the OBRA schedule?

Not unless the scheduled OBRA ARD is interrupted by the hospital stay or a sig change is required.

What if they were hospitalized for a month and the comprehensive (or quarterly) was due while they were in the hospital?

In addition to what you already uncovered, keep in mind that someone out for more than 30 days must be Admitted as if they were discharged - return not anticipated.

[lisaRN37]

You can't have an observation period for someone who was in the hospital and 3.0 no longer allows 14day look back to the hospital. The patient is being admitted to hospice which means a Sig Change is required, over-riding the Annual. The final validation will come back as assessment being done late but that is only because the CMS program has not been fixed to recognize discharge summaries. We've had this happen several times at my facility and this is what we did.

[lisaRN37]

Say if someone is a mcd resident and goes in the hospital, has at least a three day stay, returns MCR. You would have completed a discharge return anticipated, a reentry, now a sig change, 5 day pps would be due. Does the fact they were admitted to the hospital change the OBRA schedule? What if they were hospitalized for a month and the comprehensive (or quarterly) was due while they were in the hospital? Does the fact that they were hospitalized change things? Or is it the return anticipated vs not anticipated? sharon

Are you doing a Sig Change every time a MCD patient has a 3 day hospital stay and comes back Medicare? If you are, why? You only do a sig change if the decline is permanent. If your doing it because they are now receiving therapy your making a lot of unnecessary work for yourself.

[katoline]

I guess that's just how i was taught to do it. If they were ill enough to go in the hospital and return needing therapy or maybe wounds, etc., they would have declined enough to require a sig change. Usually someone that comes back to the facility after hospitalization is Mcr for more than two weeks, so i guess that wouldn't be self limiting. I have done a few where a total care resident went to the hospital and returned only to have therapy pick them up for positioning. I didn't do sig changes for those.

Wow, thanks for all the thoughts and replies.