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Accurately Assessing Functional Status and the MDS 3.0 iii

Accurately Assessing Functional Status and the MDS 3.0 was developed as an educational program

and reference for long-term care professionals. To the best of our knowledge, it reects current

federal regulations and practices. However, it cannot be considered absolute and universal. e

information in this manual must be considered in light of the individual organization and state

regulations.

e authors and publisher disclaim responsibility for any adverse eect resulting directly

or indirectly from the use of this manual, from any undetected errors, and from the user’s

clarications by CMS. e instructor commentary related to coding the MDS 3.0 contains the

latest information released by CMS by the time of publication of this manual.

Accurately Assessing Functional Status and the MDS 3.0

Rena R. Shephard, MHA, RN, RAC-MT, C-NE

Judy Wilhide Brandt, RN, BA, RAC-MT, C-NE

IMPORTANT NOTICE

Copyright © 2010, American Association of Nurse Assessment Coordination. All Rights Reserved.

No part of this publication, excluding any government source documents, may be reproduced

or transmitted in any form or by any means (electronic or mechanical, by photocopying or

www.aanac.org

Table of Contents

About the Authors and Expert Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . v

AANAC and the Education/Certication Programs . . . . . . . . . . . . . . . . . . . . . vii

Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Course Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Pretest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Scope of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

SNF Regulatory Mandate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

OBRA ’87 6

Assessment of Musculoskeletal Problems 15

Quiz 2: Evaluation 17

MDS 3.0 Section G: Functional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Instructor Commentary—Intent 18

Supporting Documentation 20

G0110: Activities of Daily Living (ADL) Assistance 21

Quiz 3: Health-Related Quality of Life and Planning for Care 24

Quiz 4: ADL Coding Rules 49

G0120: Bathing 50

Quiz 5: Bathing 54

G0900: Functional Rehabilitation Potential 76

Quiz 9: Functional Rehabilitation Potential 78

Care Planning for Functional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

e Survey Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89

Activities of Daily Living 89

Range of Motion 93

Prospective Payment System Implications . . . . . . . . . . . . . . . . . . . . . . . . . . .96

Pretest and Quiz Answer Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

Resources and References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100

iv Accurately Assessing Functional Status and the MDS 3.0 Accurately Assessing Functional Status and the MDS 3.0 v

About the Authors

Rena is the president of RRS Healthcare Consulting Services, providing LTC consulting

and training services to facilities, corporations, and attorneys nationwide. She is the execu-

tive editor and the founding chair of AANAC and serves on the Master Teacher Edito-

rial Advisory Board. Just since 2007, she has taught 17 of AANAC’s Resident Assessment

Coordinator–Certied (RAC-CT®) workshops, presented at six AANAC national confer-

ences, and authored or coauthored 26 of AANAC’s educational courses on MDS coding

and nursing leadership. Nationally, Rena is a highly recognized expert in the RAI process

tion Groups (RUG-IV) and the MDS 3.0, OBRA Timing and Scheduling for the MDS 3.0,

and Care Planning and the MDS 3.0, in addition to being the coauthor of this course. She

is a nationally recognized MDS/Medicare consultant and educator. Previously, she held

positions as the RAI manager for Virginia and as a surveyor for Virginia. Judy has consult-

ed CMS on several MDS projects and served on the CMS panel that authored and taught

three national Webinars for providers and surveyors on MDS coding.

Source Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

MDS 3.0—Nursing Home Comprehensive (NC) Item Set 103

Care Area General Resources 141

Review of Indicators of ADLs—Functional Status/Rehabilitation Potential 142