Understanding the New Care Area Assessments

First a quick note about last week's CMS SNF Open Door Forum: Regarding the Hybrid RUG-III System vs. RUG-IV, CMS is paying close attention to any acts of Congress aimed at repealing the RUG-IV delay. If the repeal does not go through then CMS will have to institute the Hybrid RUG-III system. CMS has begun development of the Hybrid RUG-III grouper in the case that the Senate does not pass the repeal. As we wait for the Senate to make a final decision, Harmony recommends the SNF continue to reserve funds from RUG-IV payments to offset Hybrid RUG-III adjustments in the Spring of 2011.  

Care Area Assessments: The CAA is similar to a Resident Assessment Protocol (RAP) from MDS 2.0.

The CAA process is a decision facilitator, which means it should lead to a more thorough understanding of the areas of concern that have been triggered by the MDS for further review. The MDS alone is not a comprehensive assessment. The MDS is used for preliminary screening to identify potential resident issues, conditions, strengths, and preferences. The CAA represents the assessment based on what was triggered by the MDS for the CAA for review. The CAA expands your assessment findings from the MDS, and then "charts your thinking."

The first step in the process of completing a CAA is to identify what MDS items triggered and the CAA and why. This can be done through review of Chapter 4, although frequently MDS software will detail these items. It is helpful to determine why these MDS items triggered the CAA in order to focus your assessment and ensure that what triggered is actually assessed. Different types of triggers can change the focus of the CAA review. There are four types of triggers:

1.      Potential Problems: These factors suggest the presence of a problem that warrants additional assessment and consideration of a care plan intervention.

2.      Broad Screening Triggers: These factors assist staff in identifying hard-to-diagnose problems. Because some problems are often difficult to assess in the elderly nursing home population, certain triggers have been broadly defined and consequently may have a fair number of false positives (i.e., the resident may trigger a CAA that is not automatically representative of a problem for the resident).

3.      Prevention of Problems: These factors assist staff in identifying residents at risk of developing particular problems.

4.      Rehabilitation Potential: These factors are aimed at identifying candidates with rehabilitation potential.