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Ask the payment expert
Ask the payment expert
Can we provide restorative nursing to residents receiving skilled therapy?

Yes. In fact, in some cases such as Rehab Low or the Alternative Rehab Category for Medicaid, you must have both components.

However, you must clearly define what is the skilled component of care with specific goals and interventions for the skilled therapy. In addition, you must clearly differentiate what restorative nursing is doing and have specific goals and interventions for that service.

For Rehab Low for Medicare and the Alternative Rehab criteria for Medicaid, skilled therapy must be given at least 45 minutes and three days in the seven-day “look-back” period. Restorative nursing must include two programs given at least six out of seven days. Rehab Low is a great transitional level of therapy to utilize when the resident is unable to tolerate higher levels of therapy or when the resident is being discharged to a lesser care setting. 

The Alternative Rehab Criteria can be utilized to capture the appropriate payment when a resident starts on Part B therapy services due to a decline in function. Both of these criteria are underutilized in our industry. 

What is the biggest change in the newest version of the MDS 3.0 draft?

The main item that changed is the return of the seven-day “look-back” period for most MDS items. In the initial draft, the five-day “look-back” period was used and we saw the probable change back to seven days when the crosswalk was published a few months ago. That carried through to the new draft. 

We still maintain the 14-day “look-back” for the critical factors of IV medications, suctioning, tracheostomy care and ventilators. However, we now have to designate if the services were given in the facility or prior to admission. This may become a factor when the RUGs alignment is completed with the MDS 3.0. Watch for many more changes over the next year.