Section G is Missing
What is Changing with Section G?
MDS 3.0 changes for October 2023 removed section G completely. This leaves many questions yet to be answered, including:
- How will the quality measures be affected?
- How will reimbursement rates be calculated?
- What are the criteria for the ADL function CAA worksheet?
Will all these things change and be adjusted to section GG, or will some be eliminated all together?
Many states still use section G to calculate RUG scores to determine their reimbursement rates. This will need to change. Providers in these states are waiting for more guidance regarding state Medicaid reimbursement.
For example, will an OSA have to be completed in those states to reflect the late loss ADLs or will the Case Mix requirements be changed all together?
Disclaimer. This information is current as of November 23, 2022
About This Series
October 1, 2023 will bring a new MDS for us all to manage. While there's still many details to finalize, the MDS Consultants team has gone through the known changes in Item Set version 1.18.11 to share with you these section-by-section primers.
What do the Changes Mean?
Going from a 7- day look-back period to a 3-day look- back period.
Will CNA documentation and coding determine the GG function for the Medicaid residents or will nursing staff be capturing GG as they do for Medicare assessments?
Will we miss a vital day of documentation where the resident had a significant decline in a certain area that could help our reimbursement?
Quality Measures driven by Section G
The three QM’s driven by section G include:
- Percent of Residents Who Made Improvements in Function (SS)
- Percent of Residents Whose Ability to Move Independently Worsened (LS)
- Percent of Residents Whose Need For Help With Activities of Daily living Has Increased (LS)
Section GG is coded differently from section G. Documentation strategies will need updated according to the Guidelines in section GG.
How will the facility’s quality measures be impacted by the removal of section G? For now, it is still a mystery.
A benefit of removing section G will be the documented discrepancies of coding by the Rule of 3 algorithm.
Recommendations from MDS Consultants
As we eagerly await further details or changes from CMS to guide our coding strategies, there are things that we can do to prepare. We recommend to:
- Use a team approach
- Review GG system documentation and what works now. Create an implementation plan for all residents regardless of payor source
- Educate staff regarding the updates to capture Section GG for all residents
Taking these steps now gets us into the practice of care planning with this new information available.