This example really shows that the assessment is a Significant Change
assessment done off cycle. It is not truly an OMRA, just coded as AA8b=8
so shows that it is a Medicare assessment. The resident must meet the
criteria for Significant change before this type of assessment is
completed. It cannot be done simply because therapy has been started so
that payment can be started. Also, if the SCSA was done right when therapy
was ordered, the assessment would not place the resident into a Rehab RUG.
----- Original Message -----
Sent: Tuesday, November 11, 2003 9:37
PM
Subject: Re: Question re OMRA - Excerpt
from the RAI MAnual
Just as an FYI, if it helps:
RAI User's Manual Chapter 2, Section 2.9, Factors
Impacting the SNF Medicare Assessment Schedule, pages 2-38 and
2-39:
Resident in a Part A Stay Begins
Therapy
Adding therapy services to the treatments furnished to a beneficiary in a
Part A stay does not automatically require a new assessment. However, if the
therapy was added because the beneficiary experienced a significant change, an
SCSA must be completed. In this case, the primary reason for assessment would
be a SCSA (A8a =3). If the SCSA is done during a Medicare assessment window, the SCSA can be combined with a regularly scheduled
Medicare assessment. If the SCSA is not within a Medicare assessment window,
the Medicare reason for assessment should be coded as AA8a =3 and AA8b
=8,Other Medicare Required assessment.
----- Original Message -----
Sent: Wednesday, November 12, 2003 11:35
PM
Subject: Re: Question re OMRA - Excerpt
from the RAI MAnual
Glenn, where in the RAI Manual can I find the underlined
quote? Thanks.
----- Original Message -----
Sent: Tuesday, November 11, 2003 3:48
AM
Subject: Question re OMRA - Excerpt from
the RAI MAnual
In a message dated 11/10/2003 10:49:12 PM Eastern Standard Time,
[EMAIL PROTECTED]
writes:
An OMRA is NOT done when therapy starts. OMRAs
are only appropriate when all therapies end and the previous RUGS score was
in a rehab RUGS group. An OMRA is done no sooner than 8 and no later
than 10 days after therapy ends and the resident continues to require
skilled services for something other than therapy.
If the resident is still on Medicare Part A services (has
completed therapies and D/C'ed and now is on a Nursing RUG), has a decline in
function, is screened by rehab services, and is appropriate for rehab
services, then an OMRA is done to place back onto a rehab RUG Level.
From the RAI MANUAL:
Other Medicare Required Assessment OMRA
An assessment required when a Medicare Part A resident that was
in a RUG-III Rehabilitation Classification, continues to require skilled care
after all therapy is discontinued. This assessment is to be done 8-10 days
after the cessation of therapies in order to re-calculate the RUG
Classification from a therapy RUG to a non-therapy group. An OMRA may
also be used in the situation where a significant change in status occurs for
a Medicare resident outside a Medicare assessment window. AA8b is coded 8 for
these assessments.
Glenn
Gorleski (Barnes) RAC-C
Case Manager, MDS Coordinator
Quality Assurance
Nurse
