How many COT's?

crazyforthis · Oct 2, 2011

banghead:

hi pixie, i am too new at mds to give advice, even after being in it for 6 months, as someone on this board once said, i still feel brand new! i am going to soon look into classes even if on my own dime. i don’t ever like just doing things on an adequate level and mds is just soooo dang complex. i do have to grin though looking back to realize how much i know that 6 months ago was just 'greek'! i work with a fabulous pt/ot department, the head of which has taught me a lot. they are quite supportive at looking at ways to help with the latest changes. that said, our understanding is that you could potentially have a cot every 7 days. i hope you though are correct and i am way off base. i am anxious to see what others have to say here, cause i have been actually depressed some thinking that there is no way i will ever keep up. i am thus far the only mds person where i work. fingers, toes all crossed

Ruas61, BSN, RN · Oct 2, 2011

It is every 7 days unless there is a new ARD and that resets it.

montecarlo64, ASN, BSN, LPN · Oct 2, 2011

I was also trained that there will be a COT assessment period EVERY 7 days throughout their stay & if the COT coincides with the PPS can be combo...I hope it will not be as bad as what it seems...

Ruas61, BSN, RN · Oct 2, 2011

Yes every 7 days starting with the first ARD in October.

pixie120 · Oct 4, 2011

Yes every 7 days starting with the first ARD in October.

SO it would go like this: day one, then 5 day, 14 day, 21 day possible COT, day 28 (30 day would fit here), day 35 possible COT, day 42 possible COT.....thru day 100.

I though I read that a COT has to be reviewed for and done 7 days AFTER that last ARD date of an MDS,...if thereis no COT at 35, then why would we look at a COT for day 42? (I do understand the idea that we are to look at their "rug" level every 7 days...but it is associated with an assessment date/period/ARD? So.. if no COT (cuz therapy still RU on day 35, we still look on day 42?). Kinda makes the grace days obsolete then?

andy3k · Oct 4, 2011

RAIM3 (RAI Manual MDS 3.0) pg 2-41 says, "The requirement to complete a change of therapy is reevaluated with additional 7-day COT observation periods ending on the 14th, 21st, and 28th days after the most recent Medicare payment assessment ARD and a COT OMRA is to be completed if the RUG-IV category changes."

In other words, the COT is repeatedly reevaluated every 7 days starting from the most recent PPS assessment ARD.

pixie120 · Oct 5, 2011

RAIM3 (RAI Manual MDS 3.0) pg 2-41 says, "The requirement to complete a change of therapy is reevaluated with additional 7-day COT observation periods ending on the 14th, 21st, and 28th days after the most recent Medicare payment assessment ARD and a COT OMRA is to be completed if the RUG-IV category changes."
In other words, the COT is repeatedly reevaluated every 7 days starting from the most recent PPS assessment ARD.

Ok,good to know. Next question, the PPS folks that were "grandfathered in", they do NOT have to be looked at continously every seven days? (The folks that admitted and had their 5 day, 14 day Assessments,or even their 30 day or 60 day.. rehab is saying, based on their company training, we do NOT have to evaluate them, just those that admit after 10/1/2011).

andy3k · Oct 5, 2011

Any assessment with an ARD starting 10/1/2011 must be evaluated for COTs. If the 5-day is 9/27/2011 and the 14-day is 10/6/2011 then no COT is needed for the 5-day but COTs are required for the 14-day.

imkaren2 · Oct 18, 2011

The COTs doesn't make the grace days obsolete exactly, depends on where they fall. If the RUG drops, you would want to set an ARD if possible in the window on a day before the COT to capture the downgrade, providing you can anticipate this. Lets say this is a 14 day MDS, you would have one day at the downgraded RUG and 13 days at the better RUG. The COT clock starts over, then the next clock gets you into the grace days and hopefully you are maintaining the RUG, if not, you've set a 30 day MDS.