Significant change criteria

Q: I am a little confused on the significant change criteria and need some clarification. In MDS 2.0 the division of changes was 0,1,2 to a 3,4 and vice versa. Now with MDS 3.0 the division of changes is not clear. I know that it is always the team’s decision if the residents have changed enough to impact their need for care but has there been an ADL division. It seems doing a significant change for someone that goes from a 0 to 1 when even we can fluctuate in a day is redundant. Any clarification will be greatly appreciated.

A: Improvement or decline in two or more areas, such as decision-making or ADLs, are guidelines of types of common changes in residents for your team to use to evaluate a situation rather than a mandate to always code as a significant change. More important for you and your team is to determine the impact of such changes on the resident’s condition.  In Chapter 2 of the MDS 3.0 User’s Manual, there are several pages and many examples of what may constitute a significant change of condition.  A significant change in status assessment (SCSA) is not mandated just because ADLs improve or decline. SCSA decisions are not based on concrete criteria, but more broad-based criteria.

Guidelines for when a change in resident status in not significant (Note: this is not an exhaustive list):

  • Instances in which the resident continues to make steady progress under the current course of care. Reassessment is required only when the condition has stabilized.
  • Instances in which the resident has stabilized but is expected to be discharged in the immediate future. The facility has engaged in discharge planning with the resident and family, and a comprehensive reassessment is not necessary to facilitate discharge planning.
  • Improvement in two or more of the following such as decision-making, ADL are guidelines of types of common changes in residents for your team to use to evaluate a situation rather than a mandate to always code as a significant change.

4 Comments

  1. Becki Pierson

    Thank you for answering this question and for the one who asked it!! My system is one who tells you when they think it should be a significant change and often times I acknowledge it and continue on because it is not significant for that one. I feel much better knowing it is ultimately the teams decision.

  2. julie newman

    Thank you for your excellent guidance, Diane. Have you heard anything to suggest that the Prior Authorization for MED B therapy is extended past Phase III, or is it over on 12/31/12. Thank you.

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