What qualifies for a significant change in MDS? Your guide to CMS criteria

According to CMS, a significant change in a resident's condition requires careful assessment to ensure proper care planning. This guide clarifies exactly what qualifies for a significant change in MDS, detailing the critical criteria for both major declines and improvements.

Quick Summary

A significant change for MDS is a major decline or improvement impacting two or more areas of a resident's health that won't resolve naturally and requires an interdisciplinary care plan review. It is a serious alteration of a resident's baseline status, not a minor or self-limiting condition.

Key Points

• Definition: A significant change is a major decline or improvement impacting multiple health areas that won't resolve without intervention.

• Triggers: Specific events like hospice enrollment, or a pattern of change affecting two or more MDS areas, trigger an SCSA.

• Exclusions: Not all changes are significant; minor illnesses, predictable cycles, or steady improvement are not.

• Examples: Declines can include worsening ADLs, weight loss, or pressure ulcers, while improvements can include better ADL function or mood.

• IDT Role: The Interdisciplinary Team, not a single person, is responsible for collaboratively identifying and documenting significant changes.

• Timeliness: The Significant Change in Status Assessment (SCSA) must be completed within 14 days of the determination.

Understanding the MDS Assessment

The Minimum Data Set (MDS) is a federally mandated process for assessing residents in Medicare- and Medicaid-certified nursing homes. It's used upon admission, quarterly, and annually. A critical part of the MDS process is the Significant Change in Status Assessment (SCSA), triggered when a resident experiences a major shift in condition. Correctly identifying what qualifies for a significant change in MDS is vital for resident safety, care planning, and regulatory compliance.

Official Criteria for a Significant Change

CMS outlines criteria for determining if a significant change has occurred:

1. Major Decline or Improvement: The change must be a substantial shift in the resident's physical or mental state, not a minor fluctuation.
2. Not Self-Limiting: The change requires staff intervention or clinical interventions and isn't expected to resolve on its own within two weeks.
3. Multiple Health Areas Impacted: The change must affect two or more areas of the resident's health.
4. Care Plan Revision Required: The change must necessitate an interdisciplinary team (IDT) review or revision of the resident's care plan.

Certain events, like hospice enrollment or a consistent pattern of change in two or more areas, can trigger an SCSA. Examples of significant declines and improvements and a comparison between significant and non-significant changes are detailed in the resources provided.

The Role of the Interdisciplinary Team

The IDT is responsible for collaboratively determining a significant change. Once determined, the RN Assessment Coordinator has 14 calendar days to complete the SCSA. For more information, refer to the official CMS RAI manual documentation at {Link: CMS website https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/nursinghomequalityinits/mds30raimanual.html}.

Frequently Asked Questions

What is the primary purpose of a Significant Change in Status Assessment (SCSA) in MDS?

The primary purpose is to ensure that residents who experience a major shift in their health status receive a comprehensive reassessment. This allows the Interdisciplinary Team to review and revise the care plan to meet the resident’s updated needs.

How do I know if a resident's decline is 'self-limiting' and not a significant change in MDS?

A change is considered 'self-limiting' if the condition is expected to resolve on its own, with or without minor staff interventions, and the resident is expected to return to their baseline within two weeks. A mild fever from a cold, for instance, is typically self-