CMS-10243. Explanation of Revisions between 60 & 30 day FR notices

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
Signature

Item
Attestation and Signatures of Persons who
Completed a Portion of the Assessment

New Item/Revised Item/Deleted Item
Item revised for clarity

Why it was changed
Internal review

Signature Page
I. Administrative Items
I. Administrative Items
I. Administrative Items
I. Administrative Items
I. Administrative Items

Date(s) of data collection
A2. Admission Date
A3. Assessment Reference Date
A4. Expired date
C2. Patient’s Middle Initial or Name
C12. Is English the patient’s primary
language?

Item revised for clarity
New item
New item
New item
Item revised for clarity
Item revised for clarity

Internal review
Internal review
Internal review
Internal review
Public comment
Public comment

I. Administrative Items

C12a. If English is not the patient’s primary
language, what is the patient’s primary
language?
C12b. Does the patient want or need an
interpreter (language or sign language) to
communicate with a doctor or health care
staff?

Item revised for clarity

Public comment

Item revised for clarity

Public comment

I. Administrative Items

I. Admission Information

Items C13 on July CARE Tool:
C13. Advance Care Directives
C13a. Are the patient’s choices concerning
future treatment documented in the medical
record?
C13b. Does the medical record document
who has authority to make decisions if the
patient is unable?
C13c. Does the medical record document
whether to resuscitate patient if
cardiopulmonary arrest occurs?

Deleted

Public comment
Internal review

I. Administrative Items
II. Admission
Information

D8. Current Payment Sources
A2. Admitted From. Immediately preceding
this admission, where was the patient?

Item revised for clarity
Item revised for clarity

Internal review
Public comment

II. Admission Information

A3. Primary diagnosis in previous setting

Item revised for clarity

Public comment

II. Admission Information

Items A3b on July CARE Tool: ICD-9 CM
Code

Deleted

Public comment
Internal review

II. Admission Information

|___|___|___|.|___|___|
A4a-A4i. Other Services in past 2 months

Item revised for clarity

Public comment

II. Admission Information

B3a-B3d. If in community, help used

Item revised for clarity

Public comment
Internal review

10/29/07

1

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
II. Admission Information
II. Admission Information

Item
B3aa-B3ad. If in the community,who did the
patient live with?
B4. Structural barriers

Addition of a response category

Why it was changed
Public comment
Internal review
Internal review

II. Admission Information

B5. Prior Functioning: Response categories

Addition of a response category

Public comment

II. Admission Information

B5a. Prior Functioning: self care

Item revised for clarity

Public comment

II. Admission Information

B6. Mobility Devices: Response categories

Addition of response categories

Public comment

II. Admission Information

B7. History of Falls

Item revised for clarity

Public comment

II. Admission Information

Items B8 on July CARE Tool:Prior Mental
Status. Is there any evidence of
an acute change in mental status from the
patient’s status prior to this current illness,
exacerbation, or injury?

Deleted

Public comment
Internal review

III. Current Medical
III. Current Medical
Information Part A:
Clinicians
III. Current Medical
Information Part A:
Clinicians
III. Current Medical
Information Part A:
Clinicians
III. Current Medical
Information

III. Current Medical Information
Clinican directions

Item revised for clarity
Item revised for clarity

Public comment
Public comment
Internal review

III. Current Medical
Information Part B
Clinicians
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information

10/29/07

New Item/Revised Item/Deleted Item
Item revised for clarity

Items A2 on July CARE Tool:ICD-9 CM Code Deleted
|___|___|___|.|___|___|

Public comment
Internal review

A. Primary and Other Diagnoses,
Comorbidities, and Complications Directions

Item revised for clarity

Public comment
Internal review

Diagnoses: B1-B15

Items renumbered

Internal review

C. Procedures (Diagnostic, Surgical and
Therapeutic Interventions)

Item revised for clarity

Public comment
Internal review

C1. Major procedures (diagnostic, surgical,
and therapeutic interventions)
C2-C15. Direction to List major procedures

New item

Public comment
Internal review
Public comment
Internal review
Internal review

Major Procedure Columns:
C1a-C15a. Procedure
C1b-C15b. Left
C1c-C15c. Right
C1d.-C16d. N/A

Item revised for clarity
Item revised for clarity

2

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information

Item

D11c. Specify most intensive frequency of
suctioning during stay.

Item revised for clarity

Why it was changed
Public comment
Internal review
Internal review

D20. Complex Wound Management

Item revised for clarity

Public comment

D24. Specialty Surface or Bed

Item revised for clarity

Public comment

D26. IV Vaso-actors

Item revised for clarity

Public comment

D. Major Treatments

New Item/Revised Item/Deleted Item
Item revised for clarity

Items on July CARE Tool:
Deleted
D29. Indwelling Urinary Catheter
D30. Intermittent Urinary Catheterization
D31. Ostomy
D29. Indwelling Bowel Catheter Management Item revised for clarity
System
D30. Other Major Treatments
New Item

Internal review

G1. Pressure Ulcer Risk

Item revised for clarity

Public comment

G2. Any Stage 2+ Pressure Ulcers?

Item revised for clarity

Internal review

Item revised for clarity

Public comment

III. Current Medical Items

G2a-G2d Column headings:
Number present at assessment
Number with onset during this service
G2a. Stage 2 Pressure Ulcer

Item revised for clarity

Public comment

III. Current Medical Items

G2b. Stage 3 Pressure Ulcer

Item revised for clarity

Public comment

III. Current Medical Items

G2c. Stage 4 Pressure Ulcer

Item revised for clarity

Public comment

III. Current Medical Items

G2d. Unstageable Pressure Ulcer

Item revised for clarity

Public comment

III. Current Medical Items

G3c. Date of measurement

Item revised for clarity

Public comment

III. Current Medical Items

G4. If Stage 3 or 4, Tunneling

Item revised for clarity

Public comment

III. Current Medical Items

G5a. Delayed healing of surgical wound

Item revised for clarity

Public comment

III. Current Medical Items

G5e. Other Type of Wound

Item revised for clarity

Public comment

III. Current Medical Items

G6. Turning surfaces

Response categories revised

Public comment

III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information

10/29/07

3

Internal review
Public comment

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information
III. Current Medical
Information

Item
H. Physiologic Factors Instructions

New Item/Revised Item/Deleted Item
Item revised for clarity

Why it was changed
Internal review

H22-H29. Physiologic Factors

Items renumbered

Internal review

H23d-H29c. Arterial Blood Gases (ABGs)

New item

Internal review

H31-H42. Pulmonary Function Tests

New item

Public Comment
Internal review

IV. Cognitive

IV. Cognitive Status, Mood, and Pain

Section title revised for clarity

IV. Cognitive
IV. Cognitive
IV. Cognitive
IV. Cognitive
IV. Cognitive

Section title revised for clarity
Item revised for clarity
Item revised for clarity
Directions revised for clarity
Item renumbered

IV. Cognitive

B. Temporal Orientation/Mental Status
B1a. Interview attempted
B1b. Reason interview not attempted
B2. Temporal orientation
B2a. Ask patient: “Please tell me what year it
is right now.”
B2b. Ask patient: “What month are we in
right now?
B3. BIMS Complete only for PAC admission.

Public Comment
Internal review
Internal review

IV. Cognitive
IV. Cognitive

IV. Cognitive

IV. Cognitive
IV. Cognitive
IV. Cognitive
IV. Cognitive

Internal review

Item renumbered

Internal review

Directions revised for clarity

Internal review

B3a. Repetition of Three Words

Item revised for clarity

Internal review

B3b.1. Ask patient: “Please tell me what year
it is right now.”
B3b.2. Ask patient: “What month are we in
right now?
B3b.3. Ask patient: “What day of the week is
today?”
B3c1-B3c3. Recall
Item on July CARE Tool:
C1. Short-term memory

New item

Internal review

New item

Internal review

New item

Internal review

Item revised for clarity and renumbered
Deleted

Internal review
Public Comment
Internal review

IV. Cognitive

Items on July CARE Tool:
C2. Long-term memory

Deleted

Public Comment
Internal review

IV. Cognitive

C. Observational Assessment of Cognitive
Status
C1. Memory/recall ability

Item revised for clarity

Internal review

IV. Cognitive

Response categories revised and item renumbered Internal review

IV. Cognitive

Item on July CARE Tool:
C4. Cognitive skills for daily decision making

Deleted

Public Comment
Internal review

IV. Cognitive

D. Confusion Assessment Method

Directions revised for clarity

Internal review

10/29/07

4

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
IV. Cognitive
IV. Cognitive
IV. Cognitive

Item
E. Behavioral Signs & Symptoms
F. Mood
F1. Interview attempted

New Item/Revised Item/Deleted Item
Directions revised for clarity
Directions revised for clarity
Response categories revised

Why it was changed
Internal review
Internal review
Internal review

IV. Cognitive
IV. Cognitive
IV. Cognitive

F2. Patient Health Questionnaire (PHQ2)
F3. Feeling Sad
G3. Pain Severity

Item revised for clarity
Item revised for clarity
Response categories revised

Internal review
Internal review
Internal review

IV. Cognitive

Item on July CARE Tool:
G4. Pain Severity verbal descriptor scale

Deleted

Public Comment
Internal review

IV. Cognitive

G4. Pain Effect on Function

Item revised for clarity

IV. Cognitive

G6. Pain Observational Assessment

Item revised for clarity

V. Impairments
V. Impairments
Bladder and Bowel
V. Impairments
Bladder and Bowel

A. Bowel and Bladder Management
A1. Any Impairments?

Section title revised for clarity
New Item

Columns:
Bladder B1a-B4a
Bowel B1b-B4b
A5. Incontinent prior to current illness

Item numbering change

Public Comment
Internal review
Public Comment
Internal review
Public Comment
Public Comment
Internal review
Internal review

Item revised for clarity

Internal Review

B1. Any Impairments?

New Item

Internal review

B1a-B1g. Swallowing signs and symptoms

Response categories revised

Internal review

B2a-B2c. Swallowing: usual ability

Item numbering change

Internal review

C. Hearing, Vision, Communication, &
Comprehension

Section title revised for clarity

Internal review

C1. Impairments with hearing, vision,
communication, and comprehension?

New item

Internal review

C1a. Understanding Verbal Content

Item and response categories revised for clarity

Internal review

C1b. Expression of Ideas and Wants

Item and response categories revised for clarity

Internal review

C1c. Ability to see in adequate light

Item numbering change

Internal review

V. Impairments
Bladder and Bowel
V. Impairments
Swallowing
V. Impairments
Swallowing
V. Impairments
Swallowing
V. Impairments
Hearing, Vision,
Communication
V. Impairments
Hearing, Vision,
Communication
V. Impairments
Hearing, Vision,
Communication
V. Impairments
Hearing, Vision,
Communication
V. Impairments
Hearing, Vision,
Communication

10/29/07

5

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
V. Impairments
Hearing, Vision,
Communication
V. Impairments
Upper Extremity Range of
Motion
V. Impairments
Weight-bearing
V. Impairments
Weight-bearing
V. Impairments
Weight-bearing

V. Impairments
Grip Strength
V. Impairments
Grip Strength
V. Impairments
Grip Strength
V. Impairments
Respiratory Status
V. Impairments
Respiratory Status
V. Impairments
Respiratory Status
V. Impairments
Endurance
V. Impairments
Endurance
V. Impairments
Endurance
V. Impairments
Endurance
V. Impairments
Endurance
VI. Functional Status
Section A
VI. Functional Status
Part A
VI. Functional Status
Part B
VI. Functional Status
Part B

10/29/07

Item

New Item/Revised Item/Deleted Item
Item numbering change

Why it was changed
Internal review

Item on July CARE Tool:
E. Upper Extremity Range of Motion

Delete

Internal Review

D. Weight-bearing

Item numbering change

Internal review

D1. Any impairments?

New Item

Public Comment

D1a-D1d. Upper Extremity and Lower
Extremity

Item numbering change

Internal review

E. Grip Strength

Item numbering change

Internal review

E1. Any impairments?

New item

Public Comment

E1a-E1b. Grip strength right and left hands

Item numbering change

Internal review

F. Respiratory Status

Item numbering change

Internal review

F1. Any impairments?

New item

Public Comment

F1a-F1b. Respiratory status

Item and response categories revised for clarity

Public Comment

G. Endurance

Item numbering change

Internal review

G1a. Mobility Endurance

Item and response categories revised for clarity

Public Comment

G1b. Sitting Endurance

Item and response categories revised for clarity

Public Comment

H. Mobility Devices and Aids Needed

Section title revised for clarity

Public Comment

H1. Indicate all mobility and aids needed

Item and response categories revised for clarity

Public Comment

VI. Functional Status: Usual Performance

Section title revised for clarity

Public Comment

A6. Lower body dressing

Item revised for clarity

Public Comment

B1. Lying to Sitting on Side of Bed

Item revised for clarity

Public Comment

B2. Sit to Stand

Item revised for clarity

Public Comment

C1d. Ability to hear

6

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
VI. Functional Status
Part B
VI. Functional Status
Part B
VI. Functional Status
Part B
VI. Functional Status
Part B
VI. Functional Status
Part C
VI. Functional Status
Part C

Item
B3. Chair/Bed-to-Chair Transfer

New Item/Revised Item/Deleted Item
Item revised for clarity

Why it was changed
Public Comment

B4. Toilet Transfer

Item revised for clarity

Public Comment

B5a. Longest distance patient can walk

Item and response categories revised for clarity

Internal

B5b. Longest distance patient can wheel

Item and response categories revised for clarity

Public Comment
Review
Internal Review

C. Supplemental Functional Ability

Section title and directions revised for clarity

Internal

C. Functional Ability Coding Options

Response categories revised

Public Comment
Review
Public Comment

VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VI. Functional Status
Part C
VIII. Engagement

C1. Wash Upper Body

Item revised for clarity

Public Comment

C3. Roll left and right

Item revised for clarity

Internal review

C5. Picking up object

Item revised for clarity

C6. Putting on/taking off footwear

New item

Public Comment
Review
Internal review

C7c. 12 steps-interior

Item revised for clarity

Public Comment

C7d. Four steps-exterior

Item revised for clarity

Public Comment

C7e. Walking 10 feet on uneven surfaces

Item revised for clarity

Public Comment

C7g. Wheel short ramp

Item revised for clarity and renumbered

Internal review

C7h. Wheel long ramp

Item revised for clarity and renumbered

Internal review

C7f. Car transfer

Item revised for clarity and renumbered

C17. Use public transportation

Item revised for clarity

Item on July CARE Tool:
A. Engagement

Deleted

Public Comment
Review
Public Comment
Review
Public Comment
Review

VII. Overall Plan of
Care/Advance
Care Directives

VII. Overall Plan of Care/Advance Care
Directives

Section title revised for clarity

10/29/07

7

Internal Review

Internal

Internal
Internal
Internal

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
VII. Overall Plan of
Care/Advance
Care Directives

Item
New Item/Revised Item/Deleted Item
Item on July CARE Tool:
Deleted
A1. Would you be surprised if the patient was
readmitted to an acute care hospital in the
next 6 months?

Why it was changed
Public Comment
Internal
Review

VII. Overall Plan of
Care/Advance
Care Directives

Item on July CARE Tool:
A2. Would you be surprised if the patient
were to die in the next 12 months?

Deleted

Public Comment
Review

VII. Overall Plan of
Care/Advance
Care Directives
VII. Overall Plan of
Care/Advance
Care Directives
VII. Overall Plan of
Care/Advance
Care Directives
IX. Discharge Status
VIII. Discharge Status

A1. Documented agreed-upon care goals

New item

Internal Review

A2. Description of overall status

New item

Public Comment
Review

Internal

A3. Documented care decisions

New item

Public Comment
Review

Internal

VIII. Discharge Status
A2. Attending Physician

Item numbering change
New item

VIII. Discharge Status

A3. Discharge Location

VIII. Discharge Status

A4. Frequency of Assistance at Discharge

Item and response categories revised for clarity,
and item renumbered
Response categories revised

Internal review
Public Comment
Review
Internal review

VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status

A5. Caregiver Availability
A6. Willing Caregiver(s)
A7. Types of Caregiver(s)
B. Residential Information
B1. Patient Lives With at Discharge

Item numbering change
New item
Item numbering change
Directions revised for clarity
Response categories revised

VIII. Discharge Status

Item on July CARE Tool:
B2. Caregiver(s) Availability at Discharge

Deleted

VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status

C. Support Needs/Caregiver Assistance
Caregiver Needs/Assistance Directions
C1a-C1h. Patient needs this
C2a-C2g. Caregiver able
C3a-C3g. Caregiver needs training or other
supportive services
C4a-C4g. Caregiver not likely to be able
C5a-C5g. Caregiver ability unclear
D. Discharge Care Options Instructions
D. Type of Service
E. Discharge Location Information

Section title and directions revised for clarity
New item
New item
New item
New item

Internal review
Internal review
Internal review
Internal review
Internal review

New item
New item
Directions revised for clarity
Item revised for clarity and renumbered
Section title revised for clarity

Internal review
Internal review

VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status

10/29/07

8

Internal

Internal

Internal review
Internal review
Internal review
Internal review
Public Comment
Review
Public Comment
Review

Internal review
Internal review

Internal
Internal

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status
VIII. Discharge Status

Item
E1. Discharged with referral
E2. Provider’s Name
E3. Provider Type
E4. Provider City
E5. Provider State
E6. Medicare Provider’s Identification Number

IX. Discharge Status

E9. Information not to be shared with the next Item renumbered
provider
IX. Medical Coding Information
New item

Public Comment
Review
Internal review

A. Principal Diagnosis

New item

A1. ICD-9 CM Principal Diagnosis

New item

A1a. Principal Diagnosis at Assessment

New item

Public comment
Internal review
Public comment
Internal review
Internal review

IX. Medical Coding
Information
IX. Medical Coding
Information
IX. Medical Coding
Information
IX. Medical Coding
Information
IX. Medical Coding
Information

New Item/Revised Item/Deleted Item
New item
Item renumbered
Item renumbered
Item renumbered
Item renumbered
Item renumbered

Why it was changed
Internal review
Internal review
Internal review
Internal review
Internal review
Internal review

A2. ICD-9 CM Code for Principal Diagnosis if New item
it was a V-code

Internal review

IX. Medical Coding
Information

A2a. If principal diagnosis was a V-code was New item
was the primary medical condition or injury
being treated

Internal review

IX. Medical Coding
Information

B. Other Diagnoses, Comorbidities, and
Complications

New item

Internal review

IX. Medical Coding
Information

B1a-B15a: ICD-9 CM Code

New item

Internal review

IX. Medical Coding
Information

B1b-B15b: Diagnoses

New item

Internal review

IX. Medical Coding
Information

B16. Is this list complete?

New item

Internal review

IX. Medical Coding
Information

C. Major Procedures (Diagnostic, Surgical,
and Therapeutic Interventions)

New item

Internal review

10/29/07

9

Internal

Explanation of CARE TOOL Changes Following Public Comment Period, October 29, 2007
Section
IX. Medical Coding
Information

Item
New Item/Revised Item/Deleted Item
C1. Did the patient have one or more major New item
procedures (diagnostic, surgical, and
therapeutic interventions) during this
admission?
List up to 15 ICD-9 CM Codes and associated New item
procedures (diagnostic, surgical, and
therapeutic interventions) performed during
this admission.
C1a-C15a ICD-9 CM Code
New item

Internal review

IX. Medical Coding
Information

C1b-C15b: Procedures

New item

Internal review

IX. Medical Coding
Information

C16. Is this list complete?

New item

Internal review

IX. Medical Coding
Information

IX. Medical Coding
Information

10/29/07

10

Why it was changed
Internal review

Internal review