The new Section GG will be in effect on October 1, 2016 for Long Term Care Facilities using the MDS 3.0 for payment. Although the new Resident Assessment Instrument (RAI) manual has not been released, we are able to extrapolate the majority of the information from our LTAC cousins who are already using this new section. The purpose of the new section is to make it possible to measure the function of a resident across the entire post-acute care continuum. In order to do this it was necessary for the questions being asked to be worded in the same way to provide consistency. The new Section GG item set will be added to the 5 Day PPS Assessment as well as the Discharge Assessment for all traditional Medicare A residents. There will also be a new assessment for those traditional Medicare A residents who are discontinued from skilled services, but remain in the long term care facility. This assessment will be called a “Discharge Form Medicare Assessment.”

One of the unique aspects of section GG is the 3 day lookback. This 3 day lookback will be utilized for Section GG in its entirety. When completing the 5 Day PPS Assessment you will be looking at days 1 to 3. This will remain the same no matter what date you use for your Assessment Reference Day (ARD). When completing the Discharge Assessment, you will use the three day lookback again. This time the last three days of the resident stay will be used.

Section GG will also incorporate more of the mid-loss ADLs. These answers will then be used in the calculation of several of the new Quality Measures. The following is a list of items that will be included in the 5 Day PPS Assessment and the Discharge Assessment.

Included in the 5 Day PPS Assessment and the Discharge Assessment

• Eating: The ability to use suitable utensils to bring food to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency.
• Oral hygiene: The ability to use suitable items to clean teeth. [Dentures (if applicable): The ability to remove and replace dentures from and to the mouth, and manage equipment for soaking and rinsing them.]
• Toileting hygiene: The ability to maintain perineal hygiene, adjust clothes before and after using the toilet, commode, bedpan, or urinal. If managing an ostomy, include wiping the opening but not managing equipment.
• Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.
• Lying to sitting on side of bed: The ability to safely move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support.
• Sit to stand: The ability to safely come to a standing position from sitting in a chair or on the side of the bed.
• Chair/bed-to-chair transfer: The ability to safely transfer to and from a bed to a chair (or wheelchair).
• Toilet transfer: The ability to safely get on and off a toilet or commode.

• Does the resident walk?

• Walk 50 feet with two turns: Once standing, the ability to walk at least 50 feet and make two turns:

• Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space.

• Does the resident use a wheelchair/scooter?

• Wheel 50 feet with two turns: Once seated in wheelchair/scooter, can wheel at least 50 feet and make two turns.

• Indicate the type of wheelchair/scooter used?

• Wheel 150 feet: Once seated in wheelchair/scooter, can wheel at least 150 feet in a corridor or similar space.

• Indicate the type of wheelchair/scooter used.

When completing Section GG upon admission, you will notice there will be two columns to complete. Column 1 is for Admission Performance and column 2 is for Discharge Goals. Remember, discharge planning should begin on day 1 of admission. When coding for Section GG, you will be coding “usual performance”, which is very different that how we currently code for section G. Section GG is asking a very different question. ‘What is the resident most of the time?”  This question will require an in depth look at the residents ADL’s as well as interviewing staff on 3 shifts and multiple disciplines in order to answer the questions completely. It is imperative that you fully complete the Discharge Goal column for the purpose of Quality Measures. One of the new Quality Measures will specifically ask whether the resident goals were set on admission. The information will be gathered directly to Section GG of the MDS.

Another big change with Section GG will be the use of a six point scale for coding performance and an additional three codes for “did not occur.” Also worth mention is the coding itself. You will need to reverse your thinking from Section G where the higher the number the more dependent. When coding in Section GG, the higher the number, the more independent. “06” will be independent, and “01” will be dependent. There is also the addition of 3 codes for “activity was not attempted, code reason.”  It is also important to note the use of the word “helper.”  The RAI often uses the word “staff”, and we’ve been given a clear definition of what it means in terms of the MDS assessment. We will have to wait until the new RAI is released to get clarification on the word “helper.”

Whilst we are still several months away from the October 1, 2016 rollout of Section GG, it is important that you start preparing now. Begin by including these new measures into your staff’s documentation so that they can familiarize themselves with the new 6 point system. You will also want to put together a policy and procedure for how your facility is going to incorporate Section GG into the MDS and facility processes.