In the original situation, the resident came in without a skilled service but with IV therapy in the hospital. This IV can be captured on the 5-day assessment to qualify the resident for Part A through the ARD of the 5-day assessment under the presumption of coverage. After that date, the chart must reflect a daily skilled service or coverage must stop. The presumption of coverage does not apply to the 14-day assessment, so even if the facility captures the IV therapy in the lookback period on that assessment, it cannot be used to qualify the resident for Part A coverage. For the 14-day assessment, the medical record must reflect daily skilled services for any days billed to Part A. See my e-mail from yesterday for the regulatory citation.
With regard to doing an OMRA: The only time and OMRA is completed is after all therapies have been discontinued and the resident will continue to receive non-rehab skilled services. At that time, it must be completed with an ARD of day 8-10 after all therapies have been discontinued. This would not be appropriate in the case that started this discussion thread.
A Significant Change in Status Assessment should be completed at any time that a resident's status meets the criteria for a SCSA as outlined in the RAI User's Manual. If a resident is on Part A and a SCSA is indicated, it can be combined with a scheduled PPS assessment (AA8a=3/AA8b=scheduled assessment code). The RUG level may change as a result of the assessment in AA8b.
If the need for a SCSA occurs for a PPS resident outside of the window of a scheduled PPS assessment, then it should be coded as a SCSA/OMRA (AA8a=3/AA8b=8) in order for the system to "know" that it is a PPS assessment. (See p. 2-39 of the RAI User's Manual). The timing requirements for this assessment do not fall under the OMRA rules - they fall under the SCSA rules.
A SCSA should not be performed to change the RUG level unless the resident's status meets the criteria for a SCSA as outlined in the RAI User's Manual.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Skill or not
Date: 1/17/04 6:02:08 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
I am sorry I misunderstood.I would skill and
[as someone said}capture the IV on both the 5 and 14 day.In the situation you mention,I would do an omra sig chance when therapy starts.I don't see how you could say that a sig change is not necessary
[if you meet the criteria]
as the person has never had therapy in your building.I agree when rehab starts one expects improvement but in this case rehab hasn't started yet.
