MDS Alert

Published on Fri Jun 07, 2019 PDF

Pay attention to the changes involved in utilizing Section GG.

You’ve had nearly three years to adjust to Section GG (Functional Abilities and Goals), but the patient-driven payment model (PDPM) will be utilizing Section GG data instead of Section G (Functional Status) for determining payment.

While the move to Section GG will not affect how Section GG is coded, there are some important changes that you’ll need to understand before establishing the new habits that will carry your assessments and coding.

One major difference between Section G (Functional Status) and Section GG (Functional Abilities and Goals) is the effective meaning of residents’ functional scores.

“Under Section G, increasing score means increasing dependence … Under Section GG, increasing score means increasing independence,” says the Centers for Medicare and Medicaid Services (CMS).

Another big change concerns how a resident’s dependence or independence level affects payment. Under PDPM, there’s no longer any direct correlation between the resident’s need or lack of need of assistance and the payment a facility receives.

“Under RUG-IV, increasing dependence, within a given RUG category, translates to higher payment … Under PDPM, there is not a direct relationship between increasing dependence and increasing payment,” CMS says.

PDPM is going to use a lot of math to try to shake out accurate payment for each individual resident’s care, from averages to algorithms.

“Unlike Section G, Section GG measures functional areas with more than one item. This results in substantial overlap between the two bed mobility items, the three transfer items, and the two walking items. Because of this overlap, a simple sum of all scores for each item may inappropriately overweight functional areas measured by multiple items. Therefore, to adjust for this overlap, we calculate an average score for these related items,” CMS says.

The data recorded in Section GG will be utilized for a resident’s physical therapy and occupational therapy function score, as well as the nursing function score. A resident’s mobility and ability to provide self-care are the specific determining aspects.