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Discharge Assessment Completion

Discharge assessments (A0310F=10 or 11) are required Minimum Data Set (MDS) assessments that must be completed within but not later than 14 days after the date of discharge. Current guidelines allow skilled nursing facility/nursing facility (SNF/NF) and Swing Bed facility staff to set the Assessment Reference Date (ARD) in item A2300 the same as the date of discharge in item A2000 on the MDS, as long as it is set within 14 days after the date of discharge. According to the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument User's Manual MDS 3.0 (RAIM3), once more than 14 days has elapsed since discharge, there is no provision to set an ARD for a discharge assessment and therefore, no method to complete a discharge assessment.

From page 2-34 of the RAIM3:

• Discharge Assessment – Return Not Anticipated (A0310F=10)
  • Must be completed when the resident is discharged from the facility and the resident is not expected to return to the facility within 30 days.
  • Must be completed (Item Z0500B) within 14 days after the discharge date (A2000 + 14 calendar days).

From page 2-35 of the RAIM3:

• Discharge Assessment – Return Anticipated (A0310F=11)
  • Must be completed when the resident is discharged from the facility and the resident is expected to return to the facility within 30 days.
  • Must be completed (Item Z0500B) within 14 days after the discharge date (Item A2000) (i.e., discharge date (A2000) + 14 calendar days).

From page 2-36 of the RAIM3:

• Assessment Management Requirements and Tips for Discharge Assessments:
  • Must be completed when the resident is discharged from the facility (see definition of Discharge on page 2-10).
  • Must be completed when the resident is admitted to an acute care hospital.
  • Must be completed when the resident has a hospital observation stay greater than 24 hours.
  • Must be completed on a respite resident every time the resident is discharged from the facility.
  • May be combined with another OBRA required assessment when requirements for all assessments are met.
  • May be combined with a PPS Medicare required assessment when requirements for all assessments are met.
  • Discharge date (Item A2000) must be the ARD (Item A2300) of the Discharge assessment.

CMS staff is aware that failure to complete discharge assessments skews facility data, including resident census and quality measure data. Therefore, CMS staff stress it is extremely important for discharge assessments to be coded and completed as required. The state of Texas has no additional rules or guidelines on discharge assessment completion; therefore, CMS rules for discharge assessments must be followed as written. If the SNF/NF or Swing Bed facility is located outside of Texas, please contact that state's MDS Resident Assessment Instrument (RAI) Coordinator to find out if additional or more stringent state rules apply.

Posted: 7/24/2012