Appendix B: LTCH Version 4.0 Change Table

#

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00

1.
2.

Item Set(s)
Affected
All
All

Item / Text
Affected
N/A
Footer

3.

All

N/A

N/A

4.

All

White and gray font

Black and bold font

5.

Planned
Discharge

Section
Headings
and Titles
A2500

N/A – delete item

Deleted to reduce
provider burden.

6.

Unplanned
Discharge

A2500

N/A – delete item

Deleted to reduce
provider burden.

7.

Planned
Discharge,
Unplanned
Discharge

A2510

A2500. Program Interruption(s)
Program Interruptions
0. No  Skip to B0100. Comatose
1. Yes  Continue to A2510. Number of
Program Interruptions During This Stay
in This Facility
A2500. Program Interruption(s)
Program Interruptions
0. No  Skip to C1610. Signs and
Symptoms of Delirium (from CAM©)
1. Yes  Continue to A2510. Number of
Program Interruptions During This Stay
in This Facility
A2510. Number of Program
Interruptions During This Stay in This
Facility. Code only if A2500 equals to 1.

N/A – delete item

Deleted to reduce
provider burden.

LTCH CARE Data Set V 3.00
Version 3.00
Effective April 1, 2016

(Note: Proposed modifications to existing items
highlighted in yellow)

Version 4.00
Proposed LTCH CARE Data Set Version 4.00,
Admission/Planned Discharge/Unplanned
Discharge/Expired - Effective April 1, 2018
Punctuation and style revisions applicable
throughout the instrument

Rationale for
Change / Comments
Updated version number.
Updated effective date.
Punctuation and style
revisions to be consistent
with MDS and IRF-PAI.
Updated font formatting
for better contrast.

Page 1 of 32

#

8.

9.

Item Set(s)
Affected
Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
A2525

Admission

B0200

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
A2525. Program Interruption Dates.
Code only if A2510 is greater than or
equal to 01.
A1. First Interruption Start Date
A2. First Interruption End Date
B1. Second Interruption Start Date
Code only if A2510 is greater than 01.
B2. Second Interruption End Date
Code only if A2510 is greater than 01.
C1. Third Interruption Start Date
Code only if A2510 is greater than 02.
C2. Third Interruption End Date
Code only if A2510 is greater than 02.
D1. Fourth Interruption Start Date
Code only if A2510 is greater than 03.
D2. Fourth Interruption End Date
Code only if A2510 is greater than 03.
E1. Fifth Interruption Start Date
Code only if A2510 is greater than 04.
E2. Fifth Interruption End Date
Code only if A2510 is greater than 04.
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

N/A – delete item

B0200. Hearing (3-day assessment period)
Ability to Hear (with hearing aid or hearing
appliances if normally used)
0. Adequate: No difficulty in normal
conversation, social interaction, listening to TV.
1. Minimal difficulty: Difficulty in some
environments (e.g., when person speaks softly
or setting is noisy).
2. Moderate difficulty: Speaker has to
increase volume and speak distinctly.
3. Highly impaired: Absence of useful hearing

Rationale for
Change / Comments
Deleted to reduce
provider burden.

Added to assess Hearing
in Section B – Hearing,
Speech, and Vision. MDS
currently assesses this but
it is not present in
previous versions of the
LTCH CARE Data Set.

Page 2 of 32

Item Set(s)
#
Affected
10. Admission

11. Admission,
Planned
Discharge

Item / Text
Affected
B1000

BB0800

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

BB0800. Understanding Verbal Content
(3-day assessment period)
Understanding Verbal Content (with
hearing aid or device, if used and
excluding language barriers)
4. Understands: Clear comprehension
without cues or repetitions
3. Usually Understands: Understands
most conversations, but misses some
part/intent of message. Requires cues at
times to understand
2. Sometimes Understands:
Understands only basic conversations or
simple, direct phrases. Frequently
requires cues to understand
1. Rarely/Never Understands

(Note: Proposed modifications to existing items
highlighted in yellow)

B1000. Vision (3-day assessment period)
Ability to See in Adequate Light (with glasses
or other visual appliances).
0. Adequate: Sees fine detail, such as regular
print in newspapers/books.
1. Impaired: Sees large print, but not regular
print in newspapers/books.
2. Moderately impaired: Limited vision; not
able to see newspaper headlines but can
identify objects.
3. Highly impaired: Object identification in
question, but eyes appear to follow objects.
4. Severely impaired: No vision or sees only
light, colors or shapes; eyes do not appear to
follow objects.
BB0800. Understanding Verbal and NonVerbal Content (3-day assessment period)
Understanding Verbal and Non-Verbal
Content (with hearing aid or device, if used,
and excluding language barriers)

4. Understands: Clear comprehension without
cues or repetitions
3. Usually Understands: Understands most
conversations, but misses some part/intent of
message. Requires cues at times to
understand
2. Sometimes Understands: Understands only
basic conversations or simple, direct phrases.
Frequently requires cues to understand
1. Rarely/Never Understands

Rationale for
Change / Comments
Added to assess Vision in
Section B – Hearing,
Speech, and Vision. MDS
currently assesses this but
it is not present in
previous versions of the
LTCH CARE Data Set.

Added clarification that
Non-Verbal Content can
also be considered.
Added comma for
clarification.

Page 3 of 32

Item Set(s)
#
Affected
12. Admission

13. Admission

Item / Text
Affected
C0100

C0200

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

C0100. Should Brief Interview for Mental
Status (C0200-C0500) be Conducted?
Attempt to conduct interview with all
patients.
0. No (patient is rarely/never understood) 
Skip to C1310, Signs and Symptoms of
Delirium (from CAM ©)
1. Yes  Continue to C0200, Repetition of
Three Words
C0200. Repetition of Three Words.
Ask patient: “I am going to say three words for
you to remember. Please repeat the words
after I have said all three. The words are: sock,
blue, and bed. Now tell me the three words.”
Number of words repeated after first
attempt
0. None.
1. One.
2. Two.
3. Three.

Rationale for
Change / Comments
Added BIMS to Cognitive
Patterns section of the
LTCH CARE Data Set to
assess mental status.
Most public comments
supportive of including
BIMS. TEP supported use
of BIMS. Testing supports
use of MDS version of
BIMS.
Added BIMS to Cognitive
Patterns section of the
LTCH CARE Data Set to
assess mental status.
Most public comments
supportive of including
BIMS. TEP supported use
of BIMS. Testing supports
use of MDS version of
BIMS.

After the patient's first attempt, repeat the
words using cues ("sock, something to wear;
blue, a color; bed, a piece of furniture"). You
may repeat the words up to two more times.

Page 4 of 32

Item Set(s)
#
Affected
14. Admission

Item / Text
Affected
C0300
C0300A
C0300B
C0300C

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

C0300. Temporal Orientation (orientation to
year, month, and day).
Ask patient: "Please tell me what year it is
right now."
A. Able to report correct year
0. Missed by > 5 years or no answer
1. Missed by 2-5 years
2. Missed by 1 year
3. Correct

Rationale for
Change / Comments
Added BIMS to Cognitive
Patterns section of the
LTCH CARE Data Set to
assess mental status.
Most public comments
supportive of including
BIMS. TEP supported use
of BIMS. Testing supports
use of MDS version of
BIMS.

Ask patient: "What month are we in right
now?"
B. Able to report correct month
0. Missed by > 1 month or no answer
1. Missed by 6 days to 1 month
2. Accurate within 5 days
Ask patient: "What day of the week is today?"
C. Able to report correct day of the week
0. Incorrect or no answer
1. Correct

Page 5 of 32

Item Set(s)
#
Affected
15. Admission

Item / Text
Affected
C0400
C0400A
C0400B
C0400C

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

C0400. Recall
Ask patient: "Let's go back to an earlier
question. What were those three words that
I asked you to repeat?" If unable to
remember a word, give cue (something to
wear; a color; a piece of furniture) for that
word.
A. Able to recall "sock”
0. No - could not recall.
1. Yes, after cueing ("something to wear").
2. Yes, no cue required.

Rationale for
Change / Comments
Added BIMS to Cognitive
Patterns section of the
LTCH CARE Data Set to
assess mental status.
Most public comments
supportive of including
BIMS. TEP supported use
of BIMS. Testing supports
use of MDS version of
BIMS.

B. Able to recall "blue"
0. No - could not recall
1. Yes, after cueing ("a color")
2. Yes, no cue required

16. Admission

C0500

N/A – new item

C. Able to recall "bed"
0. No - could not recall
1. Yes, after cueing ("a piece of furniture")
2. Yes, no cue required
C0500. BIMS Summary Score
Add scores for questions C0200-C0400 and fill
in total score (00-15).
Enter 99 if the patient was unable to
complete the interview.

Added BIMS to Cognitive
Patterns section of the
LTCH CARE Data Set to
assess mental status.
Most public comments
supportive of including
BIMS. TEP supported use
of BIMS. Testing supports
use of MDS version of
BIMS.

Page 6 of 32

Item Set(s)
#
Affected
17. Admission

Item / Text
Affected
C1310
C1310A
C1310B
C1310C
C1310D
C1610
C1610A
C1610B
C1610C
C1610D
C1610E
C1610E1
C1610E2

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
C1610. Signs and Symptoms of Delirium
(from CAM©)
Confusion Assessment Method (CAM©)
Shortened Version Worksheet (3-day
assessment period)
Acute Onset and Fluctuating Course
A. Is there evidence of an acute change
in mental status from the patient's
baseline?
B. Did the (abnormal) behavior fluctuate
during the day, that is, tend to come
and go or increase and decrease in
severity?
Inattention
C. Did the patient have difficulty
focusing attention, for example, being
easily distractible or having difficulty
keeping track of what was being said?
Disorganized Thinking
D. Was the patient's thinking
disorganized or incoherent, such as
rambling or irrelevant conversation,
unclear or illogical flow of ideas, or
unpredictable switching from subject to
subject?
Altered Level of Consciousness
E. Overall, how would you rate the
patient's level of consciousness?
E1. Alert (Normal)
E2. Vigilant (hyperalert) or Lethargic
(drowsy, easily aroused) or Stupor
(difficult to arouse) or Coma
(unarousable)

(Note: Proposed modifications to existing items
highlighted in yellow)

C1310. Signs and Symptoms of Delirium
(from CAM©)
Code after completing Brief Interview for
Mental Status and reviewing medical record
(3-day assessment period).
A. Acute Onset Mental Status Change
Is there evidence of an acute change in mental
status from the patient's baseline?
0. No
1. Yes
Enter Codes in Boxes
B. Inattention - Did the patient have difficulty
focusing attention, for example, being easily
distractible or having difficulty keeping track
of what was being said?
C. Disorganized Thinking - Was the patient's
thinking disorganized or incoherent (rambling
or irrelevant conversation, unclear or illogical
flow of ideas, or unpredictable switching from
subject to subject)?
D. Altered Level of Consciousness - Did the
patient have altered level of consciousness as
indicated by any of the following criteria?
• vigilant – startled easily to any sound or
touch
• lethargic – repeatedly dozed off when
being asked questions, but responded to
voice or touch
• stuporous – very difficult to arouse and
keep aroused for the interview
• comatose – could not be aroused
Coding:
0. Behavior not present
1. Behavior continuously present, does not
fluctuate
2. Behavior present, fluctuates (comes and
goes, changes in severity)

Rationale for
Change / Comments
C1610 will be replaced by
C1310 so that item
numbers are standardized
between the LTCH CARE
Data Set and MDS. This
data element differs from
the Planned Discharge/
Unplanned Discharge data
element by specifying a
“3-day assessment
period.” TEP supportive
of CAM use.

Page 7 of 32

Item Set(s)
#
Affected
18. Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
C1310
C1310A
C1310B
C1310C
C1310D
C1610
C1610A
C1610B
C1610C
C1610D
C1610E
C1610E1
C1610E2

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
C1610. Signs and Symptoms of Delirium
(from CAM©)
Confusion Assessment Method (CAM©)
Shortened Version Worksheet (3-day
assessment period)
Acute Onset and Fluctuating Course
A. Is there evidence of an acute change
in mental status from the patient's
baseline?
B. Did the (abnormal) behavior fluctuate
during the day, that is, tend to come
and go or increase and decrease in
severity?
Inattention
C. Did the patient have difficulty
focusing attention, for example, being
easily distractible or having difficulty
keeping track of what was being said?
Disorganized Thinking
D. Was the patient's thinking
disorganized or incoherent, such as
rambling or irrelevant conversation,
unclear or illogical flow of ideas, or
unpredictable switching from subject to
subject?
Altered Level of Consciousness
E. Overall, how would you rate the
patient's level of consciousness?
E1. Alert (Normal)
E2. Vigilant (hyperalert) or
Lethargic (drowsy, easily
aroused) or Stupor (difficult to
arouse) or Coma (unarousable)

(Note: Proposed modifications to existing items
highlighted in yellow)

C1310. Signs and Symptoms of Delirium
(from CAM©) (within the last 7 days).

A. Acute Onset Mental Status Change
Is there evidence of an acute change in mental
status from the patient's baseline?
0. No
1. Yes
Enter Codes in Boxes
B. Inattention - Did the patient have difficulty
focusing attention, for example, being easily
distractible or having difficulty keeping track
of what was being said?
C. Disorganized thinking - Was the patient's
thinking disorganized or incoherent (rambling
or irrelevant conversation, unclear or illogical
flow of ideas, or unpredictable switching from
subject to subject)?
D. Altered level of consciousness - Did the
patient have altered level of consciousness as
indicated by any of the following criteria?
• vigilant – startled easily to any sound
or touch
• lethargic – repeatedly dozed off when
being asked questions, but responded
to voice or touch
• stuporous – very difficult to arouse
and keep aroused for the interview
• comatose – could not be aroused

Rationale for
Change / Comments
C1610 will be replaced by
C1310 so that item
numbers are standardized
between the LTCH CARE
Data Set and MDS. This
data element differs from
the Admission version of
this data element by
specifying the assessment
time period to be “within
the last 7 days.” TEP
supportive of CAM use.

Coding:
0. Behavior not present
1. Behavior continuously present, does not
fluctuate
2. Behavior present, fluctuates (comes and
goes, changes in severity)
Page 8 of 32

Item Set(s)
#
Affected
19. Admission,
Planned
Discharge,
Unplanned
Discharge

20. Admission,
Planned
Discharge

Item / Text
Affected
CAM ©
Footnote

Section D

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
Adapted with permission from: Inouye
SK et al, Clarifying confusion: The
Confusion Assessment Method. A new
method for detection of delirium.
Annals of Internal Medicine. 1990; 113:
941-948. Confusion Assessment
Method: Training Manual and Coding
Guide, Copyright 2003, Hospital Elder
Life Program, LLC. Not to be reproduced
without permission.
N/A – new section

(Note: Proposed modifications to existing items
highlighted in yellow)

Confusion Assessment Method. ©1988, 2003,
Hospital Elder Life Program. All rights
reserved. Adapted from: Inouye SK et al. Ann
Intern Med. 1990; 113:941-8. Used with
permission.

Section D. Mood

Rationale for
Change / Comments
The footnote associated
with C1610 will be
replaced by the footnote
associated with C1310.

Added new section to
accommodate the Patient
Health Questionnaire 2
(PHQ-2) item.

Page 9 of 32

Item Set(s)
#
Affected
21. Admission,
Planned
Discharge

Item / Text
Affected
D0150
D0150A1
D0150A2
D0150B1
D0150B2

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

D0150. Patient Health Questionnaire 2 (PHQ2 ©)
Say to patient: "Over the last 2 weeks, have
you been bothered by any of the following
problems?"
If symptom is present, enter 1 (yes) in column
1, Symptom Presence.
If yes in column 1, then ask the patient:
"About how often have you been bothered by
this?"
Read and show the patient a card with the
symptom frequency choices. Indicate
response in column 2, Symptom Frequency.

22. Admission,
Planned
Discharge
23. Admission,
Planned
Discharge

PHQ-2 ©
Footnote

N/A – new footnote associated with
new item

1. Symptom Presence.
0. No (enter 0 in column 2).
1. Yes (enter 0-3 in column 2).
9. No response (leave column 2 blank).
2. Symptom Frequency.
0. Never or 1 day.
1. 2-6 days (several days).
2. 7-11 days (half or more of the days).
3. 12-14 days (nearly every day)
.
Enter scores in boxes
A. Little interest or pleasure in doing things?
B. Feeling down, depressed, or hopeless?
Copyright © Pfizer Inc. All rights reserved.
Reproduced with permission.

Section E

N/A – new section

Section E. Behavioral Symptoms

Rationale for
Change / Comments
Public comments
supportive of using less
burdensome PHQ-2 rather
than PHQ-9. Suggested
screening for depression
symptoms to ensure that
this important condition is
captured as early as
possible, increasing the
likelihood of being able to
prevent development of
severe depression. TEP
satisfied with reliability,
validity, and utility of the
PHQ-2 as a brief screener
for depressive symptoms.

Added footnote
associated with new PHQ2 item.
Added new section to
accommodate new
behavioral symptoms
items.

Page 10 of 32

Item Set(s)
#
Affected
24. Admission,
Planned
Discharge

Item / Text
Affected
E0200
E0200A
E0200B
E0200C

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

E0200. Behavioral Symptom – Presence &
Frequency
Note presence of symptoms and their
frequency.

Enter Codes in Boxes
A. Physical behavioral symptoms directed
toward others (e.g., hitting, kicking, pushing,
scratching, grabbing, abusing others sexually).
B. Verbal behavioral symptoms directed
toward others (e.g., threatening others,
screaming at others, cursing at others).
C. Other behavioral symptoms not directed
toward others (e.g., physical symptoms such
as hitting or scratching self, pacing,
rummaging, public sexual acts, disrobing in
public, throwing or smearing food or bodily
wastes, or verbal/vocal symptoms like
screaming, disruptive sounds).

Rationale for
Change / Comments
Added Behavioral
Symptoms to LTCH CARE
Data Set. Expert input
suggested that
documenting the
occurrence of these
behaviors and their
frequency would be
important for care
planning.

Coding:
0. Behavior not exhibited
1. Behavior of this type occurred 1 to 3
days
2. Behavior of this type occurred 4 to 6
days, but less than daily
3. Behavior of this type occurred daily

Page 11 of 32

Item Set(s)
#
Affected
25. Admission

26. Admission

Item / Text
Affected
GG0100

GG0110

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
GG0100. Prior Functioning: Everyday
Activities. Indicate the patient's usual
ability with everyday activities prior to
the current illness, exacerbation, or
injury.
3. Independent - Patient completed the
activities by him/herself, with or
without an assistive device, with no
assistance from a helper.
2. Needed Some Help - Patient needed
partial assistance from another person
to complete activities.
1. Dependent - A helper completed the
activities for the patient.
8. Unknown
9. Not Applicable
GG0110. Prior Device Use. Indicate
devices and aids used by the patient
prior to the current illness,
exacerbation, or injury.
Check all that apply
A. Manual wheelchair
B. Motorized wheelchair or scooter
C. Mechanical lift
Z. None of the above

(Note: Proposed modifications to existing items
highlighted in yellow)

GG0100. Prior Functioning: Everyday
Activities. Indicate the patient's usual ability
with everyday activities prior to the current
illness, exacerbation, or injury.

Coding:
3. Independent - Patient completed the
activities by him/herself, with or without an
assistive device, with no assistance from a
helper.
2. Needed Some Help - Patient needed partial
assistance from another person to complete
activities.
1. Dependent - A helper completed the
activities for the patient.
8. Unknown
9. Not Applicable
GG0110. Prior Device Use. Indicate devices
and aids used by the patient prior to the
current illness, exacerbation, or injury.

Rationale for
Change / Comments
Added “Coding” to
GG0100 instructions for
consistency.

Added “and/” for
clarification.

Check all that apply
A. Manual wheelchair
B. Motorized wheelchair and/or scooter
C. Mechanical lift
Z. None of the above

Page 12 of 32

Item Set(s)
#
Affected
27. Admission

28. Admission,
Planned
Discharge

29. Admission,
Planned
Discharge

Item / Text
Affected
GG0130
Discharge
goal coding

GG0130
Coding
options

GG0130
Coding
options

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
Code the patient's usual performance
at admission for each activity using the
6-point scale. If activity was not
attempted at admission, code the
reason. Code the patient's discharge
goal(s) using the 6-point scale. Do not
use codes 07, 09, or 88 to code
discharge goal(s).
From 6-point scale

(Note: Proposed modifications to existing items
highlighted in yellow)

Code the patient's usual performance at
admission for each activity using the 6-point
scale. If activity was not attempted at
admission, code the reason. Code the
patient's discharge goal(s) using the 6-point
scale. Use of codes 07, 09, 10 or 88 is
permissible to code discharge goal(s).
From 6-point scale

Rationale for
Change / Comments
Added instructions
indicating that the activity
not attempted codes may
be used to code goal
items.

05. Setup or clean-up assistance Helper SETS UP or CLEANS UP; patient
completes activity. Helper assists only
prior to or following the activity.

05. Setup or clean-up assistance - Helper sets
up or cleans up; patient completes activity.
Helper assists only prior to or following the
activity.

Added “contact guard”
and changed “or” to
“and/or” for clarification
in code 04. Removed
capitalization from code
05.

04. Supervision or touching assistance Helper provides VERBAL CUES or
TOUCHING/STEADYING assistance as
patient completes activity. Assistance
may be provided throughout the activity
or intermittently.
If activity was not attempted, code the
reason:

04. Supervision or touching assistance Helper provides verbal cues and/or
touching/steadying and/or contact guard
assistance as patient completes activity.
Assistance may be provided throughout the
activity or intermittently.
If activity was not attempted, code the
reason:

Added definition of 09 for
clarification.

07. Patient refused
09. Not applicable
88. Not attempted due to medical
condition or safety concerns

07. Patient refused
09. Not applicable – Not attempted and the
patient did not perform this activity prior to
the current illness, exacerbation, or injury.
10. Not attempted due to environmental
limitations (e.g. lack of equipment, weather
constraints)
88. Not attempted due to medical condition
or safety concerns

Added new code to allow
reporting of
environmental limitations.

Page 13 of 32

Item Set(s)
#
Affected
30. Admission,
Planned
Discharge

Item / Text
Affected
GG0130A

31. Admission,
Planned
Discharge

GG0130B

32. Admission,
Planned
Discharge

GG0130C

33. Admission

GG0170
Discharge
goal coding

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
A. Eating: The ability to use suitable
utensils to bring food to the mouth and
swallow food once the meal is
presented on a table/tray. Includes
modified food consistency.
B. Oral hygiene: The ability to use
suitable items to clean teeth. [Dentures
(if applicable): The ability to remove and
replace dentures from and to the
mouth, and manage equipment for
soaking and rinsing them.]
C. Toileting hygiene: The ability to
maintain perineal hygiene, adjust
clothes before and after using the toilet,
commode, bedpan or urinal. If
managing an ostomy, include wiping the
opening but not managing equipment.
Code the patient's usual performance
at admission for each activity using the
6-point scale. If activity was not
attempted at admission, code the
reason. Code the patient's discharge
goal(s) using the 6-point scale. Do not
use codes 07, 09, or 88 to code
discharge goal(s).

(Note: Proposed modifications to existing items
highlighted in yellow)

Rationale for
Change / Comments
Revised wording of the
item definition for
clarification.

B. Oral hygiene: The ability to use suitable
items to clean teeth. Dentures (if applicable):
The ability to insert and remove dentures into
and from the mouth, and manage denture
soaking and rinsing with use of equipment.

Revised wording of the
item definition for
clarification.

C. Toileting hygiene: The ability to maintain
perineal hygiene, adjust clothes before and
after voiding or having a bowel movement. If
managing an ostomy, include wiping the
opening but not managing equipment.

Revised wording of the
item definition for
clarification.

Code the patient's usual performance at
admission for each activity using the 6-point
scale. If activity was not attempted at
admission, code the reason. Code the
patient's discharge goal(s) using the 6-point
scale. Use of codes 07, 09, 10 or 88 is
permissible to code discharge goal(s).

Added instructions
indicating that the activity
not attempted codes may
be used to code goal
items.

A. Eating: The ability to use suitable utensils
to bring food and/or liquid to the mouth and
swallow food and/or liquid once the meal is
placed before the patient.

Page 14 of 32

Item Set(s)
#
Affected
34. Admission,
Planned
Discharge

Item / Text
Affected
GG0170
Coding
option

35. Admission,
Planned
Discharge

GG0170
Coding
option

36. Admission,
Planned
Discharge

GG0170A

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00

(Note: Proposed modifications to existing items
highlighted in yellow)

LTCH CARE Data Set V 3.00
From 6-point scale

From 6-point scale

05. Setup or clean-up assistance Helper SETS UP or CLEANS UP; patient
completes activity. Helper assists only
prior to or following the activity.

05. Setup or clean-up assistance - Helper sets
up or cleans up; patient completes activity.
Helper assists only prior to or following the
activity.

04. Supervision or touching assistance Helper provides VERBAL CUES or
TOUCHING/STEADYING assistance as
patient completes activity. Assistance
may be provided throughout the activity
or intermittently.
If activity was not attempted, code the
reason:

04. Supervision or touching assistance Helper provides verbal cues and/or
touching/steadying and/or contact guard
assistance as patient completes activity.
Assistance may be provided throughout the
activity or intermittently.
If activity was not attempted, code the
reason:

07. Patient refused
09. Not applicable
88. Not attempted due to medical
condition or safety concerns

07. Patient refused
09. Not applicable – Not attempted and the
patient did not perform this activity prior to
the current illness, exacerbation, or injury.
10. Not attempted due to environmental
limitations (e.g. lack of equipment, weather
constraints)
88. Not attempted due to medical condition
or safety concerns
A. Roll left and right: The ability to roll from
lying on back to left and right side, and return
to lying on back on the bed.

A. Roll left and right: The ability to roll
from lying on back to left and right side,
and return to lying on back.

Rationale for
Change / Comments
Added “contact guard”
and changed “or” to
“and/or” for clarification
in code 04.
Removed capitalization
from code 05.

Added definition of 09 for
clarification.
Added new code to allow
reporting of
environmental limitations.

Added “on the bed” for
clarification.

Page 15 of 32

Item Set(s)
#
Affected
37. Admission,
Planned
Discharge

Item / Text
Affected
GG0170C

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
C. Lying to sitting on side of bed: The
ability to safely move from lying on the
back to sitting on the side of the bed
with feet flat on the floor, and with no
back support.
D. Sit to stand: The ability to safely
come to a standing position from sitting
in a chair or on the side of the bed.

(Note: Proposed modifications to existing items
highlighted in yellow)

C. Lying to sitting on side of bed: The ability
to move from lying on the back to sitting on
the side of the bed with feet flat on the floor,
and with no back support.
D. Sit to stand: The ability to come to a
standing position from sitting in a chair,
wheelchair, or on the side of the bed.

38. Admission,
Planned
Discharge

GG0170D

39. Admission,
Planned
Discharge

GG0170E

E. Chair/bed-to-chair transfer: The
ability to safely transfer to and from a
bed to a chair (or wheelchair).

E. Chair/bed-to-chair transfer: The ability to
transfer to and from a bed to a chair (or
wheelchair).

40. Admission,
Planned
Discharge

GG0170F

F. Toilet transfer: The ability to safely
get on and off a toilet or commode.

F. Toilet transfer: The ability to get on and off
a toilet or commode.

Rationale for
Change / Comments
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items.
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items.
Added “wheelchair” for
clarification.
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items.
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items.

Page 16 of 32

Item Set(s)
#
Affected
41. Admission

Item / Text
Affected
GG0170H1

42. Planned
Discharge

GG0170H3

43. Admission

GG0170I

44. Planned
Discharge

GG0170I

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
H1. Does the patient walk?
0. No, and walking goal is not clinically
indicated  Skip to GG0170Q1. Does
the patient use a wheelchair/scooter?
1. No, and walking goal is clinically
indicated  Code the patient's
Discharge Goal(s) for items GG0170I, J,
and K. For Admission Performance, skip
to GG0170Q1. Does the patient use a
wheelchair/ scooter?
2. Yes  Continue to GG0170I. Walk 10
feet
H3. Does the patient walk?
0. No  Skip to GG0170Q3. Does the
patient use wheelchair/scooter?
2. Yes  Continue to GG0170I. Walk 10
feet
I. Walk 10 feet: Once standing, the
ability to walk at least 10 feet in a room,
corridor or similar space.

I. Walk 10 feet: Once standing, the
ability to walk at least 10 feet in a room,
corridor or similar space.

(Note: Proposed modifications to existing items
highlighted in yellow)

N/A – delete item

Rationale for
Change / Comments
The skip pattern is
associated with the item
Walk 10 feet.

N/A – delete item

The skip pattern is
associated with the item
Walk 10 feet.

I. Walk 10 feet: Once standing, the ability to
walk at least 10 feet in a room, corridor, or
similar space.
If admission performance is coded 07, 09, 10,
or 88  Skip to GG0170Q1, Does the patient
use a wheelchair and/or scooter?
I. Walk 10 feet: Once standing, the ability to
walk at least 10 feet in a room, corridor, or
similar space.
If discharge performance is coded 07, 09, 10,
or 88  Skip to GG0170Q3, Does the patient
use a wheelchair and/or scooter?

Added skip pattern that
was previously associated
with GG0170H1.
Added comma for
clarification.
Added skip pattern that
was previously associated
with GG0170H3.
Added comma for
clarification.

Page 17 of 32

Item Set(s)
#
Affected
45. Admission

Item / Text
Affected
GG0170Q1

46. Planned
Discharge

GG0170Q3

47. Admission

GG0170RR1

48. Planned
Discharge

GG0170RR3

49. Admission

GG0170SS1

50. Planned
Discharge

GG0170SS3

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00

(Note: Proposed modifications to existing items
highlighted in yellow)

Rationale for
Change / Comments
Added for clarification.

Q3. Does the patient use a wheelchair and/or
scooter?
0. No  Skip to H0350, Bladder Continence
1. Yes  Continue to GG0170R, Wheel 50 feet
with two turns

Added for clarification.

RR1. Indicate the type of wheelchair or
scooter used.
1. Manual
2. Motorized
RR3. Indicate the type of wheelchair or
scooter used.
1. Manual
2. Motorized

Added for clarification.

SS1. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized

SS1. Indicate the type of wheelchair or
scooter used.
1. Manual
2. Motorized

Added for clarification.

SS3. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized

SS3. Indicate the type of wheelchair or
scooter used.
1. Manual
2. Motorized

Added for clarification.

LTCH CARE Data Set V 3.00
Q1. Does the patient use a
wheelchair/scooter?
0. No  Skip to H0350. Bladder
Continence
1. Yes  Continue to GG0170R. Wheel
50 feet with two turns
Q3. Does the patient use a
wheelchair/scooter?
0. No  Skip to H0350. Bladder
Continence
1. Yes  Continue to GG0170R. Wheel
50 feet with two turns
RR1. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
RR3. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized

Q1. Does the patient use a wheelchair and/or
scooter?
0. No  Skip to H0350, Bladder Continence
1. Yes  Continue to GG0170R, Wheel 50 feet
with two turns

Added for clarification.

Page 18 of 32

Item Set(s)
#
Affected
51. Admission
52. Admission

Item / Text
Affected
I0050
I0103
I0104
I0605
I5455
I5480
I7100
I7101
I7102
I7103
I7104

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
5. Other medical condition If “other
medical condition”, enter the ICD code
in the boxes. I0050A.
N/A – new items

(Note: Proposed modifications to existing items
highlighted in yellow)

5. Other medical condition If “other medical
condition,” enter the ICD code in the boxes.
I0050A.
Comorbidities and Co-existing Conditions
↓ Check all that apply
I0103. Metastatic Cancer
I0104. Severe Cancer
I0605. Severe Left Systolic/Ventricular
Dysfunction (known ejection fraction ≤ 30%)
I5455. Other Progressive Neuromuscular
Disease
I5480. Other Severe Neurological Injury,
Disease, or Dysfunction
Post-Transplant
I7100. Lung Transplant
I7101. Heart Transplant
I7102. Liver Transplant
I7103. Kidney Transplant
I7104. Bone Marrow Transplant
N/A – delete item

53. Admission

I0101

I0101. Severe and Metastatic Cancer

54. Planned
Discharge

J1800

J1800. Any Falls Since Admission
Has the patient had any falls since
admission?

J1800. Any Falls Since Admission
Has the patient had any falls since admission?

0. No  Skip to M0210. Unhealed
Pressure Ulcer(s)
1. Yes  Continue to J1900. Number of
Falls Since Admission

0. No  Skip to K0520, Nutritional Approaches
1. Yes  Continue to J1900, Number of Falls
Since Admission

Rationale for
Change / Comments
Moved comma
New items added to
collect data for the
proposed ventilator
weaning quality
measures.

I0101 will be replaced by
I0103 and I0104.
Revised to correct skip
pattern.

Page 19 of 32

Item Set(s)
#
Affected
55. Unplanned
Discharge

56. Expired

57. Admission

Item / Text
Affected
J1800

J1800

K0520
K0520A1
K0520B1
K0520C1
K0520D1
K0520Z1

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00

J1800. Any Falls Since Admission
Has the patient had any falls since admission?

Rationale for
Change / Comments
Revised to correct skip
pattern.

0. No  Skip to M0210. Unhealed
Pressure Ulcer(s)
1. Yes  Continue to J1900. Number of
Falls Since Admission
J1800. Any Falls Since Admission
Has the patient had any falls since
admission?

0. No  Skip to M0210, Unhealed Pressure
Ulcers/Injuries
1. Yes  Continue to J1900, Number of Falls
Since Admission
J1800. Any Falls Since Admission
Has the patient had any falls since admission?

Revised to correct skip
pattern.

0. No  Skip to O0250. Influenza
Vaccine
1. Yes  Continue to J1900. Number of
Falls Since Admission
N/A – new item

0. No  Skip to N2005, Medication
Intervention
1. Yes  Continue to J1900, Number of Falls
Since Admission
K0520. Nutritional Approaches Check all of
the following nutritional approaches that were
performed during the first 3 days of admission.

LTCH CARE Data Set V 3.00
J1800. Any Falls Since Admission
Has the patient had any falls since
admission?

(Note: Proposed modifications to existing items
highlighted in yellow)

1. Performed during the first 3 days of
admission
↓ Check all that apply
A. Parenteral/IV feeding
B. Feeding tube – nasogastric or abdominal
(e.g., PEG)
C. Mechanically altered diet – require change
in texture of food or liquids (e.g., pureed food,
thickened liquids)
D. Therapeutic diet (e.g., low salt, diabetic,
low cholesterol)
Z. None of the above

Included to align with
MDS’ assessment of
nutritional status. Total
parenteral nutrition
appears in Section O of
LTCH CARE Data Set V
3.00 but other nutritional
approaches are not
assessed, so for
completeness and crosssetting standardization,
item K0520 will mirror the
MDS.

Page 20 of 32

Item Set(s)
#
Affected
58. Planned
Discharge

Item / Text
Affected
K0520

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

K0520A2
K0520B2
K0520C2
K0520D2
K0520Z2

(Note: Proposed modifications to existing items
highlighted in yellow)

K0520. Nutritional Approaches
Check all of the following nutritional
approaches that were performed during the
last 7 days.
2. Performed during the last 7 days
↓ Check all that apply

A. Parenteral/IV feeding
B. Feeding tube – nasogastric or abdominal
(e.g., PEG)
C. Mechanically altered diet – require change
in texture of food or liquids (e.g., pureed food,
thickened liquids)
D. Therapeutic diet (e.g., low salt, diabetic,
low cholesterol)
Z. None of the above
59. Admission,
Planned
Discharge,
Unplanned
Discharge

Section M
heading

Report based on highest stage of
existing ulcer(s) at its worst; do not
“reverse” stage

Report based on highest stage of existing
ulcers/injuries at their worst; do not
“reverse” stage

Rationale for
Change / Comments
Included to align with
MDS’ assessment of
nutritional status. Total
parenteral nutrition
appears in Section O of
LTCH CARE Data Set V
3.00 but other nutritional
approaches are not
assessed, so for
completeness and crosssetting standardization,
“Total parental nutrition”
will be moved from
Section O and renamed
“Parenteral/IV feeding” to
become a response
option in the new item
K0520, which will mirror
the MDS.
Added the term “injuries”
to be inclusive of updated
terminology supported by
the National Pressure
Ulcer Advisory Panel
(NPUAP).

Page 21 of 32

Item Set(s)
#
Affected
60. Admission

Item / Text
Affected
M0210

61. Planned
Discharge,
Unplanned
Discharge

M0210

62. Admission,
Planned
Discharge,
Unplanned
Discharge

M0300

63. Admission,
Planned
Discharge,
Unplanned
Discharge

M0300A

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
M0210. Unhealed Pressure Ulcer(s)
Does this patient have one or more
unhealed pressure ulcer(s) at Stage 1 or
higher?
0. No  Skip to O0100. Special
Treatments, Procedures, and Programs
1. Yes  Continue to M0300. Current
Number of Unhealed Pressure Ulcers at
Each Stage

(Note: Proposed modifications to existing items
highlighted in yellow)

M0210. Unhealed Pressure Ulcers/Injuries
Does this patient have one or more unhealed
pressure ulcers/injuries?
0. No  Skip to N2001, Drug Regimen Review
1. Yes  Continue to M0300, Current Number
of Unhealed Pressure Ulcers/Injuries at Each
Stage

M0210. Unhealed Pressure Ulcer(s)
Does this patient have one or more
unhealed pressure ulcer(s) at Stage 1 or
higher?
0. No  Skip to O0100. Special
Treatments, Procedures, and Programs
1. Yes  Continue to M0300. Current
Number of Unhealed Pressure Ulcers at
Each Stage
M0300. Current Number of Unhealed
Pressure Ulcers at Each Stage

M0210. Unhealed Pressure Ulcers/Injuries
Does this patient have one or more unhealed
pressure ulcers/injuries?

Number of Stage 1 pressure ulcers

1. Number of Stage 1 pressure injuries

0. No  Skip to N2005, Medication
Intervention
1. Yes  Continue to M0300, Current Number
of Unhealed Pressure Ulcers/Injuries at Each
Stage
M0300. Current Number of Unhealed
Pressure Ulcers/Injuries at Each Stage

Rationale for
Change / Comments
Deleted text to clarify.
Added the term “injury”
to be inclusive of updated
terminology supported by
NPUAP.

Deleted text to clarify.
Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP.

Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP.
Added the number one to
be consistent with other
items in the section.
Replaced the term
“ulcers” with “injuries” as
the term “injuries”
indicates intact skin which
better aligns with criteria
for Stage 1.
Page 22 of 32

Item Set(s)
#
Affected
64. Planned
Discharge,
Unplanned
Discharge
65. Admission

66. Planned
Discharge,
Unplanned
Discharge

67. Admission

Item / Text
Affected
M0300D1

M0300E
M0300E1

M0300E
M0300E2

M0300G
M0300G1

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
D1. Number of Stage 4 pressure ulcers If 0  Skip to M0300E. Unstageable Non-removable dressing

(Note: Proposed modifications to existing items
highlighted in yellow)

D1. Number of Stage 4 pressure ulcers - If 0
 Skip to M0300E, Unstageable - Nonremovable dressing/device

Rationale for
Change / Comments
Added the word “device”
for clarity.

E. Unstageable - Non-removable
dressing: Known but not stageable due
to non-removable dressing/device

E. Unstageable - Non-removable
dressing/device: Known but not stageable due
to non-removable dressing/device

Added the word “device”
for clarity.

1. Number of unstageable pressure
ulcers due to non-removable
dressing/device
E. Unstageable - Non-removable
dressing: Known but not stageable due
to non-removable dressing/device

1. Number of unstageable pressure
ulcers/injuries due to non-removable
dressing/device
E. Unstageable - Non-removable
dressing/device: Known but not stageable due
to non-removable dressing/device

1. Number of unstageable pressure
ulcers due to non-removable
dressing/device - If 0 Skip to M0300F.
Unstageable - Slough and/or eschar

1. Number of unstageable pressure
ulcers/injuries due to non-removable
dressing/device - If 0  Skip to M0300F,
Unstageable - Slough and/or eschar

2. Number of these unstageable
pressure ulcers that were present upon
admission - enter how many were
noted at the time of admission
G. Unstageable - Deep tissue injury:
Suspected deep tissue injury in
evolution.

2. Number of these unstageable pressure
ulcers/injuries that were present upon
admission - enter how many were noted at
the time of admission
G. Unstageable - Deep tissue injury

1. Number of unstageable pressure
ulcers with suspected deep tissue
injury in evolution

1. Number of unstageable pressure injuries
presenting as deep tissue injury

Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP.
Added the word “device”
for clarity.
Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP.

Removed the term
“suspected deep tissue
injury in evolution” and
replaced with “deep
tissue injury” to be
consistent with updated
NPUAP terminology.

Page 23 of 32

Item Set(s)
#
Affected
68. Planned
Discharge,
Unplanned
Discharge

69. Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
M0300G
M0300G1
M0300G2

M0800

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
G. Unstageable - Deep tissue injury:
Suspected deep tissue injury in
evolution.

(Note: Proposed modifications to existing items
highlighted in yellow)

G. Unstageable - Deep tissue injury

1. Number of unstageable pressure
ulcers with suspected deep tissue
injury in evolution - If 0 Skip to
M0800. Worsening in Pressure Ulcer
Status Since Admission

1. Number of unstageable pressure injuries
presenting as deep tissue injury - If 0  Skip
to N2005, Medication Intervention

2. Number of these unstageable
pressure ulcers that were present upon
admission - enter how many were
noted at the time of admission
M0800. Worsening in Pressure Ulcer
Status Since Admission
Indicate the number of current pressure
ulcers that were not present or were at
a lesser stage on admission. If no
current pressure ulcer at a given stage,
enter 0
A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable - Non-removable
dressing
E. Unstageable - Slough and/or eschar
F. Unstageable - Deep tissue injury

2. Number of these unstageable pressure
injuries that were present upon admission enter how many were noted at the time of
admission
N/A – delete items

Rationale for
Change / Comments
Removed the term
“suspected deep tissue
injury in evolution” and
replaced with “deep
tissue injury” to be
consistent with updated
NPUAP terminology.

Deleted to reduce
provider burden.

Page 24 of 32

Item Set(s)
#
Affected
70. Admission,
Planned
Discharge,
Unplanned
Discharge,
Expired
71. Admission

72. Admission

Item / Text
Affected
Section N

N2001

N2003

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new section

N/A – new item

N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

Section N. Medications

N2001. Drug Regimen Review
Did a complete drug regimen review identify
potential clinically significant medication
issues?
0. No - No issues found during review  Skip
to O0100, Special Treatments, Procedures, and
Programs
1. Yes - Issues found during review 
Continue to N2003, Medication Follow-up
9. NA - Patient is not taking any
medications Skip to O0100, Special
Treatments, Procedures, and Programs
N2003. Medication Follow-up
Did the facility contact a physician (or
physician-designee) by midnight of the next
calendar day and complete prescribed/
recommended actions in response to the
identified potential clinically significant
medication issues?

Rationale for
Change / Comments
New section added on
admission and discharge
to accommodate the drug
regimen review quality
measure items N2001,
N2003, and N2005.
New items added to
collect data for the drug
regimen review quality
measure.

New item added to collect
data for the drug regimen
review quality measure.

0. No
1. Yes

Page 25 of 32

Item Set(s)
#
Affected
73. Planned
Discharge,
Unplanned
Discharge,
Expired

74. Admission

Item / Text
Affected
N2005

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

N2005. Medication Intervention

Did the facility contact and complete
physician (or physician-designee) prescribed/
recommended actions by midnight of the
next calendar day each time potential
clinically significant medication issues were
identified since the admission?

O0100F3
O0100F4

O0100F3. Invasive Mechanical
Ventilator: weaning
O0100F4. Invasive Mechanical
Ventilator: non-weaning

0. No
1. Yes
9. NA - There were no potential clinically
significant medication issues identified since
admission or patient is not taking any
medications
N/A – delete items

Rationale for
Change / Comments
New item added to collect
data for the drug regimen
review quality measure.

Invasive mechanical
ventilation, whether
weaning or non-weaning
will now be assessed
using data collected as
part of the proposed
ventilator weaning quality
measures (including
O0150 and O0200).

Page 26 of 32

Item Set(s)
#
Affected
75. Admission

76. Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
O0100

O0100

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
O0100. Special Treatments,
Procedures, and Programs
Check all the treatments at admission.
For dialysis, check if it is part of the
patient’s treatment plan.

N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

O0100. Special Treatments, Procedures, and
Programs
Check all of the following treatments,
procedures, and programs that were
performed during the first 3 days of admission.
For chemotherapy and dialysis, check if it is
part of the patient’s treatment plan.
3. Performed during the first 3 days of
admission
↓ Check all that apply
O0100. Special Treatments, Procedures, and
Programs
Check all of the following treatments,
procedures, and programs that were
performed during the last 14 days.
4. Performed during the last 14 days
↓ Check all that apply

77. Admission,
Planned
Discharge
(Note: ‘3’
denotes
admission
and ‘4’
denotes
discharge)

O0100A3
N/A – new item
O0100A4
O0100A2a3
O0100A2a4
O0100A3a3
O0100A3a4
O0100A10a3
O0100A10a4

A. Chemotherapy (if checked, please specify
below)
A2a. IV
A3a. Oral
A10a. Other

Rationale for
Change / Comments
The assessment time
period was changed for
internal consistency
within the rest of the
LTCH CARE Data Set.

The 14-day assessment
time period was chosen
to achieve
standardization with the
MDS’ 14-day assessment
time period.

Included to respond to
public comment and
subject matter experts
support breaking the
parent item
“chemotherapy” into type
of chemotherapy to
distinguish patient
complexity/burden of
care.

Page 27 of 32

Item Set(s)
#
Affected
78. Admission,
Planned
Discharge
79. Admission,
Planned
Discharge

Item / Text
Affected
O0100B3
O0100B4

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new item

(Note: Proposed modifications to existing items
highlighted in yellow)

Rationale for
Change / Comments
Included to align with the
MDS.

C. Oxygen Therapy (if checked, please specify
below)

Included to respond to
public comment and
subject matter experts
support breaking the
parent item “oxygen
therapy” into continuous
or intermittent to
distinguish patient
complexity/burden of
care.
Included to respond to
and public comment and
subject matter experts
support breaking the
parent item “suctioning”
into frequency of
suctioning to distinguish
patient complexity/
burden of care.
Included for cross-setting
standardization with the
MDS.

B. Radiation

O0100C3
O0100C4
O0100C2a3
O0100C2a4
O0100C3a3
O0100C3a4

N/A – new item

80. Admission,
Planned
Discharge,
Unplanned
Discharge

O0100D3
O0100D4
O0100D2a3
O0100D2a4
O0100D3a3
O0100D3a4

N/A – new item

81. Admission,
Planned
Discharge,
Unplanned
Discharge
82. Admission,
Planned
Discharge

O0100E3
O0100E4

N/A – new item

E. Tracheostomy Care

O0100G3
O0100G4
O0100G2a3
O0100G2a4
O0100G3a3
O0100G3a4

Admission:
G. Non-invasive Ventilator (BIPAP, CPAP)

G. Non-invasive Mechanical Ventilator
(BiPAP/CPAP) (if checked, please specify
below)

C2a. Continuous
C3a. Intermittent

D. Suctioning (if checked, please specify
below)
D2a. Scheduled
D3a. As needed

Planned Discharge:
N/A – new item

G2a. BiPAP
G3a. CPAP

In public comment, there
was support for breaking
the parent item into 2
response options (BiPAP
and CPAP).

Page 28 of 32

Item Set(s)
#
Affected
83. Admission,
Planned
Discharge

84. Admission,
Planned
Discharge
85. Admission,
Planned
Discharge

86. Admission

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00

Item / Text
Affected
LTCH CARE Data Set V 3.00
O0100H3
N/A – new item
O0100H4
O0100H2a3
O0100H2a4
O0100H3a3
O0100H3a4
O0100H4a3
O0100H4a4
O0100H10a3
O0100H10a4
O0100I3
N/A – new item
O0100I4
O0100J3
O0100J4
O0100J2a3
O0100J2a4
O0100J3a3
O0100J3a4

O0100N

Admission:
J. Dialysis
Planned Discharge:
N/A – new item

O0100N. Total Parenteral Nutrition

(Note: Proposed modifications to existing items
highlighted in yellow)

H. IV Medications (if checked, please specify
below)
H2a. Vasoactive medications (i.e.,
continuous infusions of vasopressors
or inotropes)
H3a. Antibiotics
H4a. Anticoagulation
H10a. Other
I. Transfusions
J. Dialysis (if checked, please specify below)
J2a. Hemodialysis
J3a. Peritoneal dialysis

N/A – delete O0100N

Rationale for
Change / Comments
In public comment, there
was support for further
delineating types of IV
medications (and the new
vasoactive medication
item, O0100H2a, is
included for the proposed
ventilator weaning quality
measures).
Included for cross-setting
standardization with the
MDS.
Item added to Planned
Discharge.
In public comment, there
was support for breaking
out the parent item
“dialysis” into type of
dialysis.
New dialysis items also
added to collect data for
the proposed ventilator
weaning quality
measures.
Total parental nutrition
will be assessed as part of
new item in Section K,
K0520, to align with the
MDS.

Page 29 of 32

Item Set(s)
#
Affected
87. Admission,
Planned
Discharge

88. Planned
Discharge,
Unplanned
Discharge
89. Admission

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00

Item / Text
Affected
LTCH CARE Data Set V 3.00
O0100O3
N/A – new item
O0100O4
O0100O2a3
O0100O2a4
O0100O3a3
O0100O3a4
O0100O4a3
O0100O4a4
O0100O10a3
O0100O10a4
Planned Discharge:
O0100Z3
O0100Z4
N/A- new item
Unplanned Discharge:
N/A- new item
O0150
N/A – new items
O0150A
O0150B
O0150C
O0150D
O0150E

(Note: Proposed modifications to existing items
highlighted in yellow)

O. IV Access (if checked, please specify below)
O2a. Peripheral IV
O3a. Midline
O4a. Central line (e.g., PICC, tunneled,
port)
O10a. Other

Rationale for
Change / Comments
In public comment, there
was support for breaking
out the parent item
(which appears on the
MDS) into types of IV
access.

Z. None of the above

Item added to Planned
Discharge and Unplanned
Discharge.

O0150. Spontaneous Breathing Trial (SBT)
(including Tracheostomy Collar (TCT) or
Continuous Positive Airway Pressure (CPAP)
Breathing Trial) by Day 2 of LTCH Stay

New items added to
collect data for the
proposed ventilator
weaning quality
measures.

A. Invasive Mechanical Ventilation Support
upon Admission to the LTCH
0. No, not on invasive mechanical ventilation
support  Skip to O0250, Influenza Vaccine
1. Yes, weaning  Continue to O0150B,
Assessed for readiness for SBT by Day 2 of the
LTCH stay
2. Yes, non-weaning  Skip to O0250,
Influenza Vaccine
(continued)

Page 30 of 32

#

Item Set(s)
Affected

Item / Text
Affected

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00

(Note: Proposed modifications to existing items
highlighted in yellow)

B. Assessed for readiness for SBT by day 2 of
the LTCH stay (Note: Day 2=Date of Admission
to the LTCH (Day 1) + 1 calendar day)
0. No  Skip to O0250, Influenza Vaccine
1. Yes  Continue to O0150C, Deemed
medically ready for SBT by Day 2 of the LTCH
stay

Rationale for
Change / Comments

C. Deemed medically ready for SBT by day 2
of the LTCH stay
0. No  Continue to O0150D, Is there
documentation of reason(s) in the patient's
medical record that the patient was deemed
medically unready for SBT by day 2 of the LTCH
stay?
1. Yes  Continue to O0150E, SBT performed
by day 2 of the LTCH stay
D. Is there documentation of reason(s) in the
patient’s medical record that the patient was
deemed medically unready for SBT by day 2
of the LTCH stay?
0. No  Skip to O0250, Influenza Vaccine
1. Yes  Skip to O0250, Influenza Vaccine
E. SBT performed by day 2 of the LTCH stay
0. No
1. Yes

Page 31 of 32

Item Set(s)
#
Affected
90. Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
O0200
O0200A

Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018
Proposed LTCH CARE Data Set V 4.00
LTCH CARE Data Set V 3.00
N/A – new items

(Note: Proposed modifications to existing items
highlighted in yellow)

O0200. Ventilator Liberation Rate

A. Invasive Mechanical Ventilator: Liberation
Status at Discharge

Rationale for
Change / Comments
New items added to
collect data for the
proposed ventilator
weaning quality
measures.

0. Not fully liberated at discharge (i.e., patient
required partial or full invasive mechanical
ventilation support within 2 calendar days
prior to discharge)
1. Fully liberated at discharge (i.e., patient did
not require any invasive mechanical
ventilation support for at least 2 consecutive
calendar days immediately prior to discharge)
9. NA (code only if the patient was nonweaning or not ventilated on admission
[O0150A=2 or 0 on Admission Assessment])

Page 32 of 32