MDS Item

Description of Medical Services

Aide

Licensed

RN

LPN

Social Service

Program Base

25

11

1

1

25

G1a=2

Hygiene 1

8

1

1

3

G1=3

Hygiene 2

12

1

1

3

G1b=3 or G1c=3

Mobility 1

12

1

1

1

G1b=4 or G1b=5 or G1c=4 or G1c=5

Mobility 2

17

1

1

1

G1d=2

Toilet 1

10

1

1.5

1

G1d=3

Toilet 2

14

1

1

1

1

G1e=2

Eating 1

10

1

2

Gle=3

Eating 2

16

1

1

1

1

G1f=2

Bathing 1

10

2

3

G1f=3

Bathing 2

14

1

1

1

2

H1=2 or H1=3

Hearing 1

3

1

3

H2=2

Vision 1

3

1

3

H2=3 or H2=4

Vision 2

3

1

1

3

H3=2 or H3=3

Expression 1

6

2

4

H3=4

Expression 2

8

2

7

H4=2 or H4=3

Understanding 1

6

2

4

H4=4

Understanding 2

8

2

7

ICD-9=250 to 250.9

Diabetes 1

8

2

4

2

N2a=1 or N2b=1 or N2c=1 or N2d=1 or Hyperlipidemia (ICD-9=272.0 to 272.9)

Nutrition 1

5

1

1

2

2

N3a=1 or N3b=1 or N3c=1 or N4=1

Eating Disorders 1

5

3

1

2

3

L2a=1 or L2b=1 or L2c=1

Nursing Interventions 1

2

0.5

0.5

L2a=2 or L2b=2 or L2c=2

Nursing Interventions 2

2.5

1

0.5

0.5

1

L2a=3 or L2b=3 or L2c=3

Nursing Interventions 3

3.5

1

1.5

1.5

1

L2a=4 or L2b=4 or L2c=4

Nursing Interventions 4

4.5

1

1.5

1.5

2

L2a=5 or L2b=5 or L2c=5

Nursing Interventions 5

5.5

1

2

2

2

L2a=6 or L2b=6 or L2c=6

Nursing Interventions 6

6

2

2

2

2

L2a=7 or L2b=7 or L2c=7

Nursing Interventions 7

7

2

3

2

2

CPS=3 or 4

Cognitive Problems 1

4

2

5

CPS=5 or 6

Cognitive Problems 2

6

3

7

Number of E1a to E1g scoring >1=1 or 2

Behavior Disturbance 1

5

2

5

Number of E1a to E1g scoring >1=3 or 4

Behavior Disturbance 2

10

2

8

Number of E1a to E1g scoring >1=5 or more

Behavior Disturbance 3

15

3

10

D1a=1

Self Injury 1

2

2

D1a=2

Self Injury 2

3

2

5

D1a=3 or D1a=4

Self Injury 3

10

5

1

2

10

D1b=1

Intent to Kill Self 1

2

5

D1a=0 and D1c=1

Considered Self Injurious Act 1

5

2

1

D1a=0 and D1d=1

At Risk for Self Injury 1

2

2

5

D2a=1

Violence 1

2

2

D2a=2

Violence 2

3

2

5

D2a=3 or D2a=4

Violence 3

10

5

1

2

10

D2b=1

Intimidation Threats to Others 1

2

2

D2b=2

Intimidation Threats to Others 2

3

2

5

D2b=3 or D2b=4

Intimidation Threats to Others 3

10

5

10

D2c=2

Violent Ideation 1

2

1

D2c=3 or D2c=4

Violent Ideation 2

4

2

7

K2b=1

Medication Support 1

6

1

1

1

5

K5>0

Acute Control Medications 1

2

1

2

2

5

M3a>0

Required Staff Accompaniment

5

2

A5a=1 or 2

Hx Crim Justice Viol 1

2

3

A5a=3 or 4

Hx Crim Justice Viol 2

4

5

A5b=1 or 2

Hx Crim Justice Nonviol 1

1

2

A5b=3 or 4

Hx Crim Justice Nonviol 2

2

4

M2a>0 or M2b>0

Close or Constant Observation 1

15

5

5

M2c>0 or M2d>0 or M2e>0

Close or Constant Observation 2

30

10

10

P3≤ 5 and L4a>1

Discharge Planning 1

10

25

L1i≥ 3

PRS Director or Coordinator Counseling

5

L3a or L3b=2 or 3 and L4aA=2 or 3 and P3<5

Community Reintegration

3

3

5

L3b=2 or 3 and L4bA=2 or 3

Social/Family Functioning

3

3

12

L3b or L3d + 2 or 3 and L4cA=2 or 3

Psych Rehab/ Recover Readiness and Support

3

4

15

L3b=2 or 3 and L4dA=2 or 3

Skills Training and Generalization

5

5

20

L3a, L3b or L3d=2 or 3 and L4eA=2 or 3 and C1>1 or C2=2

Substance Use/Abuse Management

6

5

15

L3a or L3b=2 or 3 and L4fA=2 or 3

Vocational/ Academic Development

2

3

12

L3a or L3b + 2 or 3 and L4gA=2 or 3 and D2a=2 or D2b=3 or D2c=3 or Elc>1

Aggression/Anger Management

5

15

L3a or L3b=2 or 3 and L4hA=2 and E1b or E1d or E1e>0

Behavior Management

2

3

13

L3b=2 and L4iA=2

Enhanced Activity Program

5

3

12

L3a or L3b=2 and L4jA=2

Work Program (Department of Labor Compliant)

5

25

L3b=2 or 3 and L4kA=2 or 3

Illness Self-Management (SAMHSA Toolkit)

5

5

20

L3a and L3b=2 or 3 and L41A=2 or 3

Specialized Therapies (DBT)

5

25

L5=1

Adherence with Programs 1

10

4

10

L6≥1

Required staff accompaniment to medical appointment mandated by the outside medical provider

10

Psychotropic Medications as Listed in Section R

Psychotropic Medication Monitoring

7

8

8

Compute Cognition Category Using Cognitive Performance Scale (CPS)

Compute Intermediate Cognition Variables

Count of Non-Independence Items for CPS (Cog1)

If (F1a=1) add 1 to Cog 1

If (F2=1 or 2 or 3) add 1 to Cog 1

If (H3=1 or 2 or 3 or 4) add 1 to Cog 1

Count of Moderate to Severe Impairments for CPS (Cog 2)

If (F2=2 or 3) add 1 to Cog 2

If (H3=3 or 4) add 1 to Cog 2

Compute CPS

Compute CPS Level 1

If (Cog 1=1) CPS=1

Compute CPS Level 2

If (Cog 1=2 or 3 and Cog 2=0) CPS=2

Compute CPS Level 3

If (Cog 1=2 or 3 and Cog 2=1) CPS=3

Compute CPS Level 4

If (Cog 1=2 or 3 and Cog 2=2) CPS=4

Compute CPS Level 5

If (F2=4 or 5 and G1e <6) CPS=5

Compute CPS Level 6

If (F2=4 or 5 and G1e=6 or 8) CPS=6

Convert CPS to Cognition Reimbursement Categories