MDS Alert

Reader Questions:

Remember ‘3 Midnights’

Question: A Medicare Part A beneficiary resident left my facility four days ago and returned today, before midnight. I’m a little confused by the requirements for an interrupted stay. Is this an interrupted stay or should I complete a new 5-day assessment?

New Hampshire Subscriber

Answer: Figuring out the “stay” and, thus, whether a resident needs a new 5-day assessment can be difficult. One trick that can help you remember is to think about midnights, instead of counting hours.

“The interruption window is a 3-day period, starting with the calendar day of Part A discharge and including the 2 immediately following calendar days, ending at midnight. In other words, the resident must return to the same SNF by 11:59 p.m. at the end of the third calendar day. The interruption window begins on the first non-covered day following a Part A-covered stay and ends at 11:59 p.m. on the third consecutive non-covered day following a Part A-covered stay,” says the RAI Manual on page 6-50.

If, for example, the resident left the facility on the 4th of the month and returned the 7th, you would need to complete a new 5-day assessment. The resident was gone for three “midnights,” on the 4th, the 5th, and the 6th, and so the resident’s return would mark the first day of their new stay.