Assessment Typing

OBRA
ASSESSMENT ASSESSMENT COMPLETION DATE CAA COMPLETION CARE PLAN COM-
ASSESSMENT NAME ASSESSMENT REQUIREMENTS TRANSMISSION
IDENTIFIER COMBINATION (Z0500B) (V0200B2) PLETION (V0200C2)

The resident: has never been admitted to the

Admission (Comprehensive)
facility; OR has been in the facility previously and May combine with any
was discharged prior to completion of the OBRA assessment except: Death in
DOA Z0500B Z0200C2
A0310A=01 assessment; OR previously a resident and discharged the Facility, SCSA, Annual, Same as Z0500B
+ 13 days + 7 days + 14 days
return not anticipated; OR previously a resident and Quarterly, Entry, PPS - 30 day,
was discharged return anticipated AND DID NOT return 60 day, 90 day
within 30 days of discharge

Discharge RNA A0310F=10 The resident: discharged to a private residence; N/A N/A
May combine with any other
OR discharged and admitted to a hospital or other
assessment with exception of D/C Date Z0500B
care setting; OR admitted to a hospital; OR hospital
entry tracking and death in the + 14 days + 14 days
observation stay > 24 hours regardless of hospital
Discharge RA A0310F=11 facility N/A N/A
admission

Death in the Facility Tracking May not be combined with any DOD DOD
A0310F=12 Death in the facility N/A N/A
Record other assessment + 7 days + 14 days

The resident: all residents admitted to the facility will

May not be combined with any A1600 A1600
Entry Tracking Record A0310F=01 have an entry tracking record regardless of length of N/A N/A
other assessment + 7 days + 14 days
stay

The resident: re-enters facility and was previously

admitted to this facility (i.e. OBRA admission
Re-entry Item A1700=2 N/A N/A N/A N/A N/A
assessment completed AND accepted) AND was D/C
RA AND returned within 30 days of D/C

May combine with any

assessment except: Death in A2300 Z0500B
Quarterly A0310A=02 The resident: Must be completed at least every 92 days N/A N/A
the Facility, SCSA, Admission, + 14 days + 14 days
Annual, Entry

May combine with any

The resident: Must be completed annually at least
assessment except: Death in A2300 Z0500B Z0200C2
Annual (Comprehensive) A0310A=03 every 366 days unless a SCSA has been completed Same as Z0500B
the Facility, SCSA, Admission, + 14 days + 7 days + 14 days
since the most recent Comprehensive Assessment
Quarterly, Entry

The resident has declined in ≥ 2 of the following:

decision making worsens; onset or increase in
frequency of mood item; onset or increase in frequency
May combine with any Determination
of behavior item; any newly coded ADL as extensive
Significant Change (SCSA) assessment except: Death + 14 days Z0500B Z0200C2
A0310A=04 or total dependence; placement of indwelling catheter; Same as Z0500B
Decline in the Facility, Admission, (determination date + 7 days + 14 days
increased incontinence; unplanned weight loss =
Quarterly, Annual, Entry is the ARD)
5%/30d or 10%/180d; new pressure ulcer ≥ stage II or
worsening in pressure ulcer; new restraint use; overall
deterioration; newly assigned to hospice

The resident has improved in ≥ 2 of the following: Any

May combine with any Determination
newly coded ADL as independent, Supervision, Limited
Significant Change (SCSA) assessment except: Death in + 14 days Z0500B Z0200C2
A0310A=04 Assistance; decrease in presence or frequency of Same as Z0500B
Improvement the Facility, Admission, Annual, (determination date + 7 days + 14 days
behavior item; decision making changes for the better;
Quarterly, Entry is the ARD)
decreased incontinece; overall improvement

Note: When combining assessments, the ARD criteria for ALL assessment types must be met.
 Assessment Typing
Medicare Payment Assessments
ASSESSMENT ASSESSMENT COMPLETION DATE CAA COMPLETION CARE PLAN COM-
ASSESSMENT NAME ASSESSMENT REQUIREMENTS TRANSMISSION
IDENTIFIER COMBINATION (Z0500B) (V0200B2) PLETION (V0200C2)

A2300 N/A unless combined N/A unless combined Z0500B

ARD (Item A2300) must be set on days 1 through 8 of the Part A May combine with any OBRA
+ 14 Days with admission assess- with admission assess- + 14 days
SNF covered stay and authorizes payment from days 1 through assessement and any OMRA; with the
5 Day A0310B=01 (unless combined ment. See requirements ment. See requirements unless combined
14 of the stay, as long as the resident meets all criteria for Part A exception of Death in the Facility, entry
with an admission for OBRA admission for OBRA admission with admission
SNF-level services. tracking, or other PPS assessment
assessment) assessment assessment assessement

A2300 N/A unless combined N/A unless combined Z0500B

ARD (Item A2300) must be set on days 11 through 19 of the Part May combine with any OBRA
+ 14 Days with admission assess- with admission assess- + 14 days
A SNF covered stay and authorizes payment from days 15 through assessement and any OMRA; with the
14 Day A0310B=02 (unless combined ment. See requirements ment. See requirements unless combined
30 of the stay, as long as all the coverage criteria for Part A SNF- exception of Death in the Facility, entry
with an admission for OBRA admission for OBRA admission with admission
level services continue to be met. tracking, or other PPS assessment
assessment) assessment assessment assessement

N/A unless combined

N/A unless combined with
ARD (Item A2300) must be set on days 21 through 34 of the Part May combine with any OBRA with an annual assess-
an annual assessment or Z0500B + 14 days unless
A SNF covered stay and authorizes payment from days 31 through assessement and any OMRA; with the A2300 ment or SCSA. See
30 Day A0310B=03 SCSA. See requirements combined with annual or
60 of the stay, as long as all the coverage criteria for Part A SNF- exception of Death in the Facility, entry + 14 Days requirements for OBRA
for OBRA annual assess- SCSA
level services continue to be met. tracking, or other PPS assessment annual assessment and
ment and SCSA
SCSA
N/A unless combined
N/A unless combined with
ARD (Item A2300) must be set on days 50 through 64 of the Part May combine with any OBRA with an annual assess-
an annual assessment or Z0500B + 14 days unless
A SNF covered stay and authorizes payment from days 61 through assessement and any OMRA; with the A2300 ment or SCSA. See
60 Day A0310B=04 SCSA. See requirements combined with annual or
90 of the stay, as long as all the coverage criteria for Part A SNF- exception of Death in the Facility, entry + 14 Days requirements for OBRA
for OBRA annual assess- SCSA
level services continue to be met. tracking, or other PPS assessment annual assessment and
ment and SCSA
SCSA

May combine with any OBRA N/A unless combined

N/A unless combined with
ARD (Item A2300) must be set on days 80 through 94 of the Part assessement and any OMRA; with the with an annual assess-
an annual assessment or Z0500B + 14 days unless
A SNF covered stay and authorizes payment from days 91 through exception of Death in the Facility, entry A2300 ment or SCSA. See
90 Day A0310B=05 SCSA. See requirements combined with annual or
100 of the stay, as long as all the coverage criteria for Part A SNF- tracking, or other PPS assessment (90 + 14 Days requirements for OBRA
for OBRA annual assess- SCSA
level services continue to be met. day payment typically combined with a annual assessment and
ment and SCSA
OBRA quarterly) SCSA

ARD (Item A2300) must be set on days 1 through 8 of the Part

Medicare required Readmission/
Return Assessment
A SNF covered stay and completed when a resident whose SNF N/A unless combined N/A unless combined
stay was being reimbursed by Medicare Part A is hospitalized, May combine with any OBRA with an annual, with an annual,
A2300 + 14 Days (un- Z0500B + 14 days unless
A0310B=06 discharged return anticipated, and then returns to the SNF from the assessement and any OMRA; with admission or SCSA. See admission or SCSA. See
less combined with an combined with annual,
A1700=2 hospital within 30 days and continues to require and receive Part the exception of Death in the Facility, requirements for OBRA requirements for OBRA
admission assessment) admission or SCSA
A SNF-level care services and authorizes payment from days 1 entry tracking annual, admission and annual, admission and
through 14 of the stay, as long as all the coverage criteria for Part A SCSA SCSA
SNF-level services continue to be met.

"Optional” ARD (Item A2300) must be set on days 5-7 after the start
May combine with any OBRA, Pay-
of therapy and completed only to classify a resident into a RUG-IV
A0310B=07 ment Assessment and EOT OMRA;
Start of Therapy OMRA Rehabilitation Plus Extensive Services or Rehabilitation group
A0310C=1 or 3 with the exception of Death in the
completed only if the resident is not already classified into a RUG-
Facility, entry tracking N/A unless com- N/A unless combined
IV Rehabilitation Plus Extensive Services or Rehabilitation group” A2300
bined with an annual, with an annual, Z0500B
+ 14 Days
admission or SCSA. See admission or SCSA. See + 14 days
(unless combined
requirements for OBRA requirements for OBRA unless combined with an-
“ARD must be set on day 1, 2, or 3 after all rehabilitation therapies with an admission
annual, ad-mission and annual, admission and nual, admission or SCSA
have been discontinued and is required when the resident was assessment)
May combine with any OBRA, Pay- SCSA SCSA
classified in a RUG-IV Rehabilitation Plus Extensive Services
A0310B=07 ment Assessment and SOT OMRA;
End of Therapy OMRA or Rehabilitation group and continues to need Part A SNF-level
A0310C=2 or 3 with the exception of Death in the
services after the discontinuation of all rehabilitation therapies.
Facility, entry tracking
Establishes a new non-therapy RUG classification and Medicare
payment rate”

Note: When combining assessments, the ARD criteria for ALL assessment types must be met.