HIPPS code	Code Effective From Date	Code Effective Through Date	Payment System Indicator	Description
AAA00	10/01/10		SNF	"Default, /No PPS (or OBRA) assessment due to one of the following: Stay is less than 8 days, or SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, beneficiary requested demand bill, SNF notified untimely of beneficiarys disenrollment from MA plan.
"
AAA01	10/01/10		SNF	"Default, /Stand-alone OBRA SCSA OR SCPA OR CCA."
AAA02	10/01/10		SNF	"Default, /Stand-alone SOT OMRA (not Medicare short stay)."
AAA03	10/01/10		SNF	"Default, /SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
AAA04	10/01/10		SNF	"Default, /EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
AAA05	10/01/10		SNF	"Default, /SOT OMRA (not Medicare short stay) AND EOT OMRA."
AAA06	10/01/10		SNF	"Default, /SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
AAA07	10/01/10		SNF	"Default, /Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
AAA10	10/01/10		SNF	"Default, /5-day or readmission return. "
AAA11	10/01/10		SNF	"Default, /5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
AAA12	10/01/10		SNF	"Default, /5-day or readmission return AND SOT OMRA (not Medicare short stay)."
AAA13	10/01/10		SNF	"Default, /5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
AAA14	10/01/10		SNF	"Default, /5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
AAA15	10/01/10		SNF	"Default, /5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
AAA16	10/01/10		SNF	"Default, /5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
AAA17	10/01/10		SNF	"Default, /5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
AAA20	10/01/10		SNF	"Default, /14-day. "
AAA21	10/01/10		SNF	"Default, /14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
AAA22	10/01/10		SNF	"Default, /14-day AND SOT OMRA (not Medicare short stay)."
AAA23	10/01/10		SNF	"Default, /14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
AAA24	10/01/10		SNF	"Default, /14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
AAA25	10/01/10		SNF	"Default, /14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
AAA26	10/01/10		SNF	"Default, /14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
AAA30	10/01/10		SNF	"Default, /30-day. "
AAA31	10/01/10		SNF	"Default, /30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
AAA32	10/01/10		SNF	"Default, /30-day AND SOT OMRA (not Medicare short stay)."
AAA33	10/01/10		SNF	"Default, /30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
AAA34	10/01/10		SNF	"Default, /30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
AAA35	10/01/10		SNF	"Default, /30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
AAA36	10/01/10		SNF	"Default, /30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
AAA40	10/01/10		SNF	"Default, /60-day. "
AAA41	10/01/10		SNF	"Default, /60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
AAA42	10/01/10		SNF	"Default, /60-day AND SOT OMRA (not Medicare short stay)."
AAA43	10/01/10		SNF	"Default, /60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
AAA44	10/01/10		SNF	"Default, /60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
AAA45	10/01/10		SNF	"Default, /60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
AAA46	10/01/10		SNF	"Default, /60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
AAA50	10/01/10		SNF	"Default, /90-day. "
AAA51	10/01/10		SNF	"Default, /90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
AAA52	10/01/10		SNF	"Default, /90-day AND SOT OMRA (not Medicare short stay)."
AAA53	10/01/10		SNF	"Default, /90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
AAA54	10/01/10		SNF	"Default, /90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
AAA55	10/01/10		SNF	"Default, /90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
AAA56	10/01/10		SNF	"Default, /90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
AAA60	10/01/10		SNF	"Default, /OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
BA101	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/Stand-alone OBRA SCSA OR SCPA OR CCA."
BA104	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
BA105	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA106	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BA110	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return. "
BA111	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
BA112	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
BA113	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
BA114	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
BA115	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA116	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BA117	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
BA120	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day. "
BA121	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
BA124	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
BA125	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
BA126	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BA130	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day. "
BA131	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
BA134	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
BA135	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA136	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BA140	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day. "
BA141	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
BA144	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
BA145	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA146	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
BA150	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day. "
BA151	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
BA154	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
BA155	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA156	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BA160	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
BA18A	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 120-day assessment "
BA18B	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 150-day assessment "
BA18C	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 180-day assessment "
BA18D	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 210-day assessment "
BA18E	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 240-day assessment "
BA18F	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 270-day assessment "
BA18G	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 300-day assessment "
BA18H	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 330-day assessment "
BA18I	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 360-day assessment "
BA18X	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE Post 360-day assessments with 30-day interval "
BA201	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/Stand-alone OBRA SCSA OR SCPA OR CCA."
BA204	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
BA205	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA206	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BA210	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return. "
BA211	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
BA212	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
BA213	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
BA214	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
BA215	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA216	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BA217	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
BA220	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day. "
BA221	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
BA224	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
BA225	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
BA226	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BA230	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day. "
BA231	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
BA234	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
BA235	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA236	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BA240	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day. "
BA241	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
BA244	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
BA245	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA246	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
BA250	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day. "
BA251	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
BA254	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
BA255	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BA256	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BA260	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
BA28A	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 120-day assessment "
BA28B	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 150-day assessment "
BA28C	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 180-day assessment "
BA28D	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 210-day assessment "
BA28E	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 240-day assessment "
BA28F	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 270-day assessment "
BA28G	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 300-day assessment "
BA28H	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 330-day assessment "
BA28I	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE 360-day assessment "
BA28X	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 0-1/TRICARE Post 360-day assessments with 30-day interval "
BB101	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
BB104	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
BB105	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB106	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BB110	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return. "
BB111	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
BB112	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
BB113	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
BB114	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
BB115	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB116	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BB117	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
BB120	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day. "
BB121	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
BB124	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
BB125	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
BB126	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BB130	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day. "
BB131	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
BB134	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
BB135	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB136	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BB140	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day. "
BB141	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
BB144	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
BB145	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB146	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
BB150	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day. "
BB151	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
BB154	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
BB155	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB156	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BB160	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
BB18A	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 120-day assessment "
BB18B	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 150-day assessment "
BB18C	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 180-day assessment "
BB18D	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 210-day assessment "
BB18E	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 240-day assessment "
BB18F	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 270-day assessment "
BB18G	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 300-day assessment "
BB18H	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 330-day assessment "
BB18I	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 360-day assessment "
BB18X	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
BB201	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
BB204	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
BB205	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB206	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BB210	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return. "
BB211	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
BB212	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
BB213	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
BB214	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
BB215	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB216	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BB217	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
BB220	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day. "
BB221	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
BB224	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
BB225	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
BB226	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BB230	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day. "
BB231	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
BB234	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
BB235	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB236	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
BB240	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day. "
BB241	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
BB244	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
BB245	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB246	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
BB250	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day. "
BB251	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
BB254	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
BB255	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
BB256	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
BB260	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
BB28A	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 120-day assessment "
BB28B	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 150-day assessment "
BB28C	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 180-day assessment "
BB28D	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 210-day assessment "
BB28E	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 240-day assessment "
BB28F	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 270-day assessment "
BB28G	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 300-day assessment "
BB28H	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 330-day assessment "
BB28I	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE 360-day assessment "
BB28X	10/01/10		SNF	"Behavioral Symptoms and Cognitive Performance , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
CA101	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/Stand-alone OBRA SCSA OR SCPA OR CCA."
CA104	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CA105	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA106	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CA110	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return. "
CA111	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CA112	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CA113	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CA114	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CA115	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA116	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CA117	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CA120	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day. "
CA121	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CA124	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CA125	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CA126	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CA130	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day. "
CA131	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CA134	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CA135	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA136	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CA140	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day. "
CA141	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CA144	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CA145	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA146	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CA150	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day. "
CA151	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CA154	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CA155	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA156	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CA160	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CA18A	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 120-day assessment "
CA18B	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 150-day assessment "
CA18C	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 180-day assessment "
CA18D	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 210-day assessment "
CA18E	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 240-day assessment "
CA18F	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 270-day assessment "
CA18G	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 300-day assessment "
CA18H	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 330-day assessment "
CA18I	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 360-day assessment "
CA18X	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE Post 360-day assessments with 30-day interval "
CA201	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/Stand-alone OBRA SCSA OR SCPA OR CCA."
CA204	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CA205	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA206	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CA210	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return. "
CA211	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CA212	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CA213	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CA214	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CA215	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA216	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CA217	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CA220	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day. "
CA221	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CA224	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CA225	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CA226	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CA230	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day. "
CA231	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CA234	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CA235	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA236	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CA240	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day. "
CA241	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CA244	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CA245	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA246	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CA250	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day. "
CA251	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CA254	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CA255	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CA256	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CA260	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CA28A	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 120-day assessment "
CA28B	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 150-day assessment "
CA28C	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 180-day assessment "
CA28D	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 210-day assessment "
CA28E	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 240-day assessment "
CA28F	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 270-day assessment "
CA28G	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 300-day assessment "
CA28H	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 330-day assessment "
CA28I	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE 360-day assessment "
CA28X	10/01/10		SNF	"Clinically Complex , ADL Index 0-1/TRICARE Post 360-day assessments with 30-day interval "
CB101	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
CB104	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CB105	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB106	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CB110	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return. "
CB111	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CB112	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CB113	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CB114	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CB115	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB116	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CB117	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CB120	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day. "
CB121	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CB124	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CB125	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CB126	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CB130	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day. "
CB131	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CB134	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CB135	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB136	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CB140	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day. "
CB141	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CB144	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CB145	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB146	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CB150	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day. "
CB151	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CB154	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CB155	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB156	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CB160	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CB18A	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 120-day assessment "
CB18B	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 150-day assessment "
CB18C	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 180-day assessment "
CB18D	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 210-day assessment "
CB18E	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 240-day assessment "
CB18F	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 270-day assessment "
CB18G	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 300-day assessment "
CB18H	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 330-day assessment "
CB18I	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 360-day assessment "
CB18X	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
CB201	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
CB204	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CB205	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB206	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CB210	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return. "
CB211	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CB212	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CB213	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CB214	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CB215	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB216	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CB217	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CB220	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day. "
CB221	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CB224	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CB225	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CB226	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CB230	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day. "
CB231	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CB234	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CB235	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB236	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CB240	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day. "
CB241	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CB244	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CB245	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB246	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CB250	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day. "
CB251	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CB254	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CB255	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CB256	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CB260	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CB28A	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 120-day assessment "
CB28B	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 150-day assessment "
CB28C	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 180-day assessment "
CB28D	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 210-day assessment "
CB28E	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 240-day assessment "
CB28F	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 270-day assessment "
CB28G	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 300-day assessment "
CB28H	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 330-day assessment "
CB28I	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE 360-day assessment "
CB28X	10/01/10		SNF	"Clinically Complex , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
CC101	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
CC104	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CC105	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC106	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CC110	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return. "
CC111	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CC112	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CC113	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CC114	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CC115	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC116	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CC117	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CC120	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day. "
CC121	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CC124	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CC125	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CC126	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CC130	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day. "
CC131	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CC134	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CC135	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC136	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CC140	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day. "
CC141	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CC144	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CC145	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC146	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CC150	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day. "
CC151	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CC154	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CC155	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC156	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CC160	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CC18A	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 120-day assessment "
CC18B	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 150-day assessment "
CC18C	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 180-day assessment "
CC18D	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 210-day assessment "
CC18E	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 240-day assessment "
CC18F	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 270-day assessment "
CC18G	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 300-day assessment "
CC18H	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 330-day assessment "
CC18I	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 360-day assessment "
CC18X	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
CC201	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
CC204	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CC205	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC206	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CC210	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return. "
CC211	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CC212	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CC213	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CC214	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CC215	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC216	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CC217	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CC220	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day. "
CC221	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CC224	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CC225	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CC226	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CC230	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day. "
CC231	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CC234	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CC235	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC236	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CC240	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day. "
CC241	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CC244	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CC245	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC246	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CC250	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day. "
CC251	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CC254	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CC255	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CC256	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CC260	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CC28A	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 120-day assessment "
CC28B	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 150-day assessment "
CC28C	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 180-day assessment "
CC28D	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 210-day assessment "
CC28E	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 240-day assessment "
CC28F	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 270-day assessment "
CC28G	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 300-day assessment "
CC28H	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 330-day assessment "
CC28I	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE 360-day assessment "
CC28X	10/01/10		SNF	"Clinically Complex , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
CD101	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
CD104	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CD105	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD106	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CD110	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return. "
CD111	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CD112	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CD113	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CD114	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CD115	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD116	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CD117	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CD120	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day. "
CD121	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CD124	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CD125	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CD126	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CD130	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day. "
CD131	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CD134	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CD135	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD136	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CD140	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day. "
CD141	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CD144	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CD145	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD146	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CD150	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day. "
CD151	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CD154	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CD155	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD156	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CD160	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CD18A	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 120-day assessment "
CD18B	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 150-day assessment "
CD18C	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 180-day assessment "
CD18D	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 210-day assessment "
CD18E	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 240-day assessment "
CD18F	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 270-day assessment "
CD18G	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 300-day assessment "
CD18H	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 330-day assessment "
CD18I	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 360-day assessment "
CD18X	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
CD201	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
CD204	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CD205	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD206	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CD210	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return. "
CD211	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CD212	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CD213	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CD214	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CD215	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD216	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CD217	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CD220	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day. "
CD221	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CD224	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CD225	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CD226	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CD230	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day. "
CD231	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CD234	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CD235	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD236	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CD240	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day. "
CD241	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CD244	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CD245	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD246	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CD250	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day. "
CD251	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CD254	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CD255	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CD256	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CD260	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CD28A	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 120-day assessment "
CD28B	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 150-day assessment "
CD28C	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 180-day assessment "
CD28D	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 210-day assessment "
CD28E	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 240-day assessment "
CD28F	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 270-day assessment "
CD28G	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 300-day assessment "
CD28H	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 330-day assessment "
CD28I	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE 360-day assessment "
CD28X	10/01/10		SNF	"Clinically Complex , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
CE101	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
CE104	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CE105	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE106	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CE110	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return. "
CE111	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CE112	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CE113	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CE114	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CE115	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE116	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CE117	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CE120	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day. "
CE121	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CE124	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CE125	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CE126	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CE130	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day. "
CE131	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CE134	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CE135	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE136	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CE140	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day. "
CE141	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CE144	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CE145	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE146	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CE150	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day. "
CE151	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CE154	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CE155	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE156	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CE160	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CE18A	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 120-day assessment "
CE18B	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 150-day assessment "
CE18C	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 180-day assessment "
CE18D	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 210-day assessment "
CE18E	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 240-day assessment "
CE18F	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 270-day assessment "
CE18G	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 300-day assessment "
CE18H	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 330-day assessment "
CE18I	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 360-day assessment "
CE18X	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
CE201	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
CE204	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
CE205	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE206	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CE210	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return. "
CE211	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
CE212	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
CE213	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
CE214	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
CE215	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE216	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CE217	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
CE220	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day. "
CE221	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
CE224	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
CE225	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
CE226	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CE230	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day. "
CE231	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
CE234	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
CE235	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE236	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
CE240	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day. "
CE241	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
CE244	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
CE245	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE246	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
CE250	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day. "
CE251	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
CE254	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
CE255	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
CE256	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
CE260	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
CE28A	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 120-day assessment "
CE28B	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 150-day assessment "
CE28C	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 180-day assessment "
CE28D	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 210-day assessment "
CE28E	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 240-day assessment "
CE28F	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 270-day assessment "
CE28G	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 300-day assessment "
CE28H	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 330-day assessment "
CE28I	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE 360-day assessment "
CE28X	10/01/10		SNF	"Clinically Complex , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
ES101	10/01/10		SNF	"Extensive Services , ADL Index 2-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
ES104	10/01/10		SNF	"Extensive Services , ADL Index 2-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
ES105	10/01/10		SNF	"Extensive Services , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES106	10/01/10		SNF	"Extensive Services , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES110	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return. "
ES111	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
ES112	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
ES113	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
ES114	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
ES115	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES116	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
ES117	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
ES120	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day. "
ES121	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
ES124	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
ES125	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
ES126	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES130	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day. "
ES131	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
ES134	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
ES135	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES136	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
ES140	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day. "
ES141	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
ES144	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
ES145	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES146	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
ES150	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day. "
ES151	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
ES154	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
ES155	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES156	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES160	10/01/10		SNF	"Extensive Services , ADL Index 2-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
ES18A	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 120-day assessment "
ES18B	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 150-day assessment "
ES18C	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 180-day assessment "
ES18D	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 210-day assessment "
ES18E	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 240-day assessment "
ES18F	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 270-day assessment "
ES18G	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 300-day assessment "
ES18H	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 330-day assessment "
ES18I	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 360-day assessment "
ES18X	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE Post 360-day assessments with 30-day interval "
ES201	10/01/10		SNF	"Extensive Services , ADL Index 2-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
ES204	10/01/10		SNF	"Extensive Services , ADL Index 2-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
ES205	10/01/10		SNF	"Extensive Services , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES206	10/01/10		SNF	"Extensive Services , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES210	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return. "
ES211	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
ES212	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
ES213	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
ES214	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
ES215	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES216	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
ES217	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
ES220	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day. "
ES221	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
ES224	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
ES225	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
ES226	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES230	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day. "
ES231	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
ES234	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
ES235	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES236	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
ES240	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day. "
ES241	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
ES244	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
ES245	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES246	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
ES250	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day. "
ES251	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
ES254	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
ES255	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES256	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES260	10/01/10		SNF	"Extensive Services , ADL Index 2-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
ES28A	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 120-day assessment "
ES28B	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 150-day assessment "
ES28C	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 180-day assessment "
ES28D	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 210-day assessment "
ES28E	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 240-day assessment "
ES28F	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 270-day assessment "
ES28G	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 300-day assessment "
ES28H	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 330-day assessment "
ES28I	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 360-day assessment "
ES28X	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE Post 360-day assessments with 30-day interval "
ES301	10/01/10		SNF	"Extensive Services , ADL Index 2-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
ES304	10/01/10		SNF	"Extensive Services , ADL Index 2-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
ES305	10/01/10		SNF	"Extensive Services , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES306	10/01/10		SNF	"Extensive Services , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES310	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return. "
ES311	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
ES312	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
ES313	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
ES314	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
ES315	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES316	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
ES317	10/01/10		SNF	"Extensive Services , ADL Index 2-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
ES320	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day. "
ES321	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
ES324	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
ES325	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
ES326	10/01/10		SNF	"Extensive Services , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES330	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day. "
ES331	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
ES334	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
ES335	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES336	10/01/10		SNF	"Extensive Services , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
ES340	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day. "
ES341	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
ES344	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
ES345	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES346	10/01/10		SNF	"Extensive Services , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
ES350	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day. "
ES351	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
ES354	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
ES355	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
ES356	10/01/10		SNF	"Extensive Services , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
ES360	10/01/10		SNF	"Extensive Services , ADL Index 2-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
ES38A	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 120-day assessment "
ES38B	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 150-day assessment "
ES38C	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 180-day assessment "
ES38D	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 210-day assessment "
ES38E	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 240-day assessment "
ES38F	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 270-day assessment "
ES38G	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 300-day assessment "
ES38H	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 330-day assessment "
ES38I	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE 360-day assessment "
ES38X	10/01/10		SNF	"Extensive Services , ADL Index 2-16/TRICARE Post 360-day assessments with 30-day interval "
HB101	10/01/10		SNF	"Special Care High , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
HB104	10/01/10		SNF	"Special Care High , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HB105	10/01/10		SNF	"Special Care High , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB106	10/01/10		SNF	"Special Care High , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HB110	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return. "
HB111	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HB112	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HB113	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HB114	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HB115	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB116	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HB117	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HB120	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day. "
HB121	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HB124	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HB125	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HB126	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HB130	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day. "
HB131	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HB134	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HB135	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB136	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HB140	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day. "
HB141	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HB144	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HB145	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB146	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HB150	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day. "
HB151	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HB154	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HB155	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB156	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HB160	10/01/10		SNF	"Special Care High , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HB18A	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 120-day assessment "
HB18B	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 150-day assessment "
HB18C	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 180-day assessment "
HB18D	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 210-day assessment "
HB18E	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 240-day assessment "
HB18F	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 270-day assessment "
HB18G	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 300-day assessment "
HB18H	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 330-day assessment "
HB18I	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 360-day assessment "
HB18X	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
HB201	10/01/10		SNF	"Special Care High , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
HB204	10/01/10		SNF	"Special Care High , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HB205	10/01/10		SNF	"Special Care High , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB206	10/01/10		SNF	"Special Care High , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HB210	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return. "
HB211	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HB212	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HB213	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HB214	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HB215	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB216	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HB217	10/01/10		SNF	"Special Care High , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HB220	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day. "
HB221	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HB224	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HB225	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HB226	10/01/10		SNF	"Special Care High , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HB230	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day. "
HB231	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HB234	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HB235	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB236	10/01/10		SNF	"Special Care High , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HB240	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day. "
HB241	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HB244	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HB245	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB246	10/01/10		SNF	"Special Care High , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HB250	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day. "
HB251	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HB254	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HB255	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HB256	10/01/10		SNF	"Special Care High , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HB260	10/01/10		SNF	"Special Care High , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HB28A	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 120-day assessment "
HB28B	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 150-day assessment "
HB28C	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 180-day assessment "
HB28D	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 210-day assessment "
HB28E	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 240-day assessment "
HB28F	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 270-day assessment "
HB28G	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 300-day assessment "
HB28H	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 330-day assessment "
HB28I	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE 360-day assessment "
HB28X	10/01/10		SNF	"Special Care High , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
HC101	10/01/10		SNF	"Special Care High , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
HC104	10/01/10		SNF	"Special Care High , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HC105	10/01/10		SNF	"Special Care High , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC106	10/01/10		SNF	"Special Care High , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HC110	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return. "
HC111	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HC112	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HC113	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HC114	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HC115	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC116	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HC117	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HC120	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day. "
HC121	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HC124	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HC125	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HC126	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HC130	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day. "
HC131	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HC134	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HC135	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC136	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HC140	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day. "
HC141	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HC144	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HC145	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC146	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HC150	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day. "
HC151	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HC154	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HC155	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC156	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HC160	10/01/10		SNF	"Special Care High , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HC18A	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 120-day assessment "
HC18B	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 150-day assessment "
HC18C	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 180-day assessment "
HC18D	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 210-day assessment "
HC18E	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 240-day assessment "
HC18F	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 270-day assessment "
HC18G	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 300-day assessment "
HC18H	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 330-day assessment "
HC18I	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 360-day assessment "
HC18X	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
HC201	10/01/10		SNF	"Special Care High , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
HC204	10/01/10		SNF	"Special Care High , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HC205	10/01/10		SNF	"Special Care High , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC206	10/01/10		SNF	"Special Care High , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HC210	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return. "
HC211	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HC212	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HC213	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HC214	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HC215	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC216	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HC217	10/01/10		SNF	"Special Care High , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HC220	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day. "
HC221	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HC224	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HC225	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HC226	10/01/10		SNF	"Special Care High , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HC230	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day. "
HC231	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HC234	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HC235	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC236	10/01/10		SNF	"Special Care High , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HC240	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day. "
HC241	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HC244	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HC245	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC246	10/01/10		SNF	"Special Care High , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HC250	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day. "
HC251	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HC254	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HC255	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HC256	10/01/10		SNF	"Special Care High , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HC260	10/01/10		SNF	"Special Care High , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HC28A	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 120-day assessment "
HC28B	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 150-day assessment "
HC28C	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 180-day assessment "
HC28D	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 210-day assessment "
HC28E	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 240-day assessment "
HC28F	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 270-day assessment "
HC28G	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 300-day assessment "
HC28H	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 330-day assessment "
HC28I	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE 360-day assessment "
HC28X	10/01/10		SNF	"Special Care High , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
HD101	10/01/10		SNF	"Special Care High , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
HD104	10/01/10		SNF	"Special Care High , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HD105	10/01/10		SNF	"Special Care High , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD106	10/01/10		SNF	"Special Care High , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HD110	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return. "
HD111	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HD112	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HD113	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HD114	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HD115	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD116	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HD117	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HD120	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day. "
HD121	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HD124	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HD125	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HD126	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HD130	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day. "
HD131	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HD134	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HD135	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD136	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HD140	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day. "
HD141	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HD144	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HD145	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD146	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HD150	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day. "
HD151	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HD154	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HD155	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD156	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HD160	10/01/10		SNF	"Special Care High , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HD18A	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 120-day assessment "
HD18B	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 150-day assessment "
HD18C	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 180-day assessment "
HD18D	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 210-day assessment "
HD18E	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 240-day assessment "
HD18F	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 270-day assessment "
HD18G	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 300-day assessment "
HD18H	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 330-day assessment "
HD18I	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 360-day assessment "
HD18X	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
HD201	10/01/10		SNF	"Special Care High , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
HD204	10/01/10		SNF	"Special Care High , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HD205	10/01/10		SNF	"Special Care High , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD206	10/01/10		SNF	"Special Care High , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HD210	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return. "
HD211	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HD212	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HD213	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HD214	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HD215	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD216	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HD217	10/01/10		SNF	"Special Care High , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HD220	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day. "
HD221	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HD224	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HD225	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HD226	10/01/10		SNF	"Special Care High , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HD230	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day. "
HD231	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HD234	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HD235	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD236	10/01/10		SNF	"Special Care High , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HD240	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day. "
HD241	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HD244	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HD245	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD246	10/01/10		SNF	"Special Care High , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HD250	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day. "
HD251	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HD254	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HD255	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HD256	10/01/10		SNF	"Special Care High , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HD260	10/01/10		SNF	"Special Care High , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HD28A	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 120-day assessment "
HD28B	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 150-day assessment "
HD28C	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 180-day assessment "
HD28D	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 210-day assessment "
HD28E	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 240-day assessment "
HD28F	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 270-day assessment "
HD28G	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 300-day assessment "
HD28H	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 330-day assessment "
HD28I	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE 360-day assessment "
HD28X	10/01/10		SNF	"Special Care High , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
HE101	10/01/10		SNF	"Special Care High , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
HE104	10/01/10		SNF	"Special Care High , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HE105	10/01/10		SNF	"Special Care High , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE106	10/01/10		SNF	"Special Care High , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HE110	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return. "
HE111	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HE112	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HE113	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HE114	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HE115	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE116	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HE117	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HE120	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day. "
HE121	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HE124	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HE125	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HE126	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HE130	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day. "
HE131	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HE134	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HE135	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE136	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HE140	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day. "
HE141	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HE144	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HE145	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE146	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HE150	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day. "
HE151	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HE154	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HE155	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE156	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HE160	10/01/10		SNF	"Special Care High , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HE18A	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 120-day assessment "
HE18B	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 150-day assessment "
HE18C	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 180-day assessment "
HE18D	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 210-day assessment "
HE18E	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 240-day assessment "
HE18F	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 270-day assessment "
HE18G	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 300-day assessment "
HE18H	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 330-day assessment "
HE18I	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 360-day assessment "
HE18X	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
HE201	10/01/10		SNF	"Special Care High , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
HE204	10/01/10		SNF	"Special Care High , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
HE205	10/01/10		SNF	"Special Care High , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE206	10/01/10		SNF	"Special Care High , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HE210	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return. "
HE211	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
HE212	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
HE213	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
HE214	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
HE215	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE216	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HE217	10/01/10		SNF	"Special Care High , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
HE220	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day. "
HE221	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
HE224	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
HE225	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
HE226	10/01/10		SNF	"Special Care High , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HE230	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day. "
HE231	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
HE234	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
HE235	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE236	10/01/10		SNF	"Special Care High , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
HE240	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day. "
HE241	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
HE244	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
HE245	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE246	10/01/10		SNF	"Special Care High , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
HE250	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day. "
HE251	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
HE254	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
HE255	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
HE256	10/01/10		SNF	"Special Care High , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
HE260	10/01/10		SNF	"Special Care High , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
HE28A	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 120-day assessment "
HE28B	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 150-day assessment "
HE28C	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 180-day assessment "
HE28D	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 210-day assessment "
HE28E	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 240-day assessment "
HE28F	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 270-day assessment "
HE28G	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 300-day assessment "
HE28H	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 330-day assessment "
HE28I	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE 360-day assessment "
HE28X	10/01/10		SNF	"Special Care High , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
LB101	10/01/10		SNF	"Special Care Low , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
LB104	10/01/10		SNF	"Special Care Low , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LB105	10/01/10		SNF	"Special Care Low , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB106	10/01/10		SNF	"Special Care Low , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LB110	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return. "
LB111	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LB112	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LB113	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LB114	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LB115	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB116	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LB117	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LB120	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day. "
LB121	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LB124	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LB125	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LB126	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LB130	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day. "
LB131	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LB134	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LB135	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB136	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LB140	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day. "
LB141	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LB144	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LB145	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB146	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LB150	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day. "
LB151	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LB154	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LB155	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB156	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LB160	10/01/10		SNF	"Special Care Low , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LB18A	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 120-day assessment "
LB18B	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 150-day assessment "
LB18C	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 180-day assessment "
LB18D	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 210-day assessment "
LB18E	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 240-day assessment "
LB18F	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 270-day assessment "
LB18G	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 300-day assessment "
LB18H	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 330-day assessment "
LB18I	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 360-day assessment "
LB18X	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
LB201	10/01/10		SNF	"Special Care Low , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
LB204	10/01/10		SNF	"Special Care Low , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LB205	10/01/10		SNF	"Special Care Low , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB206	10/01/10		SNF	"Special Care Low , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LB210	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return. "
LB211	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LB212	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LB213	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LB214	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LB215	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB216	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LB217	10/01/10		SNF	"Special Care Low , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LB220	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day. "
LB221	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LB224	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LB225	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LB226	10/01/10		SNF	"Special Care Low , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LB230	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day. "
LB231	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LB234	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LB235	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB236	10/01/10		SNF	"Special Care Low , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LB240	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day. "
LB241	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LB244	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LB245	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB246	10/01/10		SNF	"Special Care Low , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LB250	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day. "
LB251	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LB254	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LB255	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LB256	10/01/10		SNF	"Special Care Low , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LB260	10/01/10		SNF	"Special Care Low , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LB28A	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 120-day assessment "
LB28B	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 150-day assessment "
LB28C	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 180-day assessment "
LB28D	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 210-day assessment "
LB28E	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 240-day assessment "
LB28F	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 270-day assessment "
LB28G	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 300-day assessment "
LB28H	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 330-day assessment "
LB28I	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE 360-day assessment "
LB28X	10/01/10		SNF	"Special Care Low , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
LC101	10/01/10		SNF	"Special Care Low , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
LC104	10/01/10		SNF	"Special Care Low , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LC105	10/01/10		SNF	"Special Care Low , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC106	10/01/10		SNF	"Special Care Low , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LC110	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return. "
LC111	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LC112	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LC113	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LC114	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LC115	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC116	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LC117	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LC120	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day. "
LC121	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LC124	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LC125	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LC126	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LC130	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day. "
LC131	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LC134	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LC135	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC136	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LC140	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day. "
LC141	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LC144	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LC145	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC146	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LC150	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day. "
LC151	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LC154	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LC155	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC156	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LC160	10/01/10		SNF	"Special Care Low , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LC18A	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 120-day assessment "
LC18B	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 150-day assessment "
LC18C	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 180-day assessment "
LC18D	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 210-day assessment "
LC18E	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 240-day assessment "
LC18F	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 270-day assessment "
LC18G	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 300-day assessment "
LC18H	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 330-day assessment "
LC18I	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 360-day assessment "
LC18X	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
LC201	10/01/10		SNF	"Special Care Low , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
LC204	10/01/10		SNF	"Special Care Low , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LC205	10/01/10		SNF	"Special Care Low , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC206	10/01/10		SNF	"Special Care Low , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LC210	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return. "
LC211	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LC212	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LC213	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LC214	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LC215	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC216	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LC217	10/01/10		SNF	"Special Care Low , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LC220	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day. "
LC221	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LC224	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LC225	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LC226	10/01/10		SNF	"Special Care Low , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LC230	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day. "
LC231	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LC234	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LC235	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC236	10/01/10		SNF	"Special Care Low , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LC240	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day. "
LC241	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LC244	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LC245	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC246	10/01/10		SNF	"Special Care Low , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LC250	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day. "
LC251	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LC254	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LC255	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LC256	10/01/10		SNF	"Special Care Low , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LC260	10/01/10		SNF	"Special Care Low , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LC28A	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 120-day assessment "
LC28B	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 150-day assessment "
LC28C	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 180-day assessment "
LC28D	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 210-day assessment "
LC28E	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 240-day assessment "
LC28F	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 270-day assessment "
LC28G	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 300-day assessment "
LC28H	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 330-day assessment "
LC28I	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE 360-day assessment "
LC28X	10/01/10		SNF	"Special Care Low , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
LD101	10/01/10		SNF	"Special Care Low , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
LD104	10/01/10		SNF	"Special Care Low , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LD105	10/01/10		SNF	"Special Care Low , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD106	10/01/10		SNF	"Special Care Low , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LD110	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return. "
LD111	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LD112	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LD113	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LD114	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LD115	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD116	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LD117	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LD120	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day. "
LD121	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LD124	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LD125	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LD126	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LD130	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day. "
LD131	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LD134	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LD135	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD136	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LD140	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day. "
LD141	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LD144	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LD145	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD146	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LD150	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day. "
LD151	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LD154	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LD155	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD156	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LD160	10/01/10		SNF	"Special Care Low , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LD18A	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 120-day assessment "
LD18B	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 150-day assessment "
LD18C	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 180-day assessment "
LD18D	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 210-day assessment "
LD18E	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 240-day assessment "
LD18F	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 270-day assessment "
LD18G	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 300-day assessment "
LD18H	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 330-day assessment "
LD18I	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 360-day assessment "
LD18X	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
LD201	10/01/10		SNF	"Special Care Low , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
LD204	10/01/10		SNF	"Special Care Low , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LD205	10/01/10		SNF	"Special Care Low , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD206	10/01/10		SNF	"Special Care Low , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LD210	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return. "
LD211	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LD212	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LD213	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LD214	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LD215	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD216	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LD217	10/01/10		SNF	"Special Care Low , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LD220	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day. "
LD221	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LD224	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LD225	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LD226	10/01/10		SNF	"Special Care Low , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LD230	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day. "
LD231	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LD234	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LD235	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD236	10/01/10		SNF	"Special Care Low , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LD240	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day. "
LD241	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LD244	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LD245	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD246	10/01/10		SNF	"Special Care Low , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LD250	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day. "
LD251	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LD254	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LD255	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LD256	10/01/10		SNF	"Special Care Low , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LD260	10/01/10		SNF	"Special Care Low , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LD28A	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 120-day assessment "
LD28B	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 150-day assessment "
LD28C	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 180-day assessment "
LD28D	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 210-day assessment "
LD28E	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 240-day assessment "
LD28F	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 270-day assessment "
LD28G	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 300-day assessment "
LD28H	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 330-day assessment "
LD28I	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE 360-day assessment "
LD28X	10/01/10		SNF	"Special Care Low , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
LE101	10/01/10		SNF	"Special Care Low , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
LE104	10/01/10		SNF	"Special Care Low , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LE105	10/01/10		SNF	"Special Care Low , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE106	10/01/10		SNF	"Special Care Low , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LE110	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return. "
LE111	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LE112	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LE113	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LE114	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LE115	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE116	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LE117	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LE120	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day. "
LE121	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LE124	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LE125	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LE126	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LE130	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day. "
LE131	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LE134	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LE135	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE136	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LE140	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day. "
LE141	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LE144	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LE145	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE146	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LE150	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day. "
LE151	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LE154	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LE155	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE156	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LE160	10/01/10		SNF	"Special Care Low , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LE18A	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 120-day assessment "
LE18B	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 150-day assessment "
LE18C	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 180-day assessment "
LE18D	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 210-day assessment "
LE18E	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 240-day assessment "
LE18F	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 270-day assessment "
LE18G	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 300-day assessment "
LE18H	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 330-day assessment "
LE18I	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 360-day assessment "
LE18X	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
LE201	10/01/10		SNF	"Special Care Low , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
LE204	10/01/10		SNF	"Special Care Low , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
LE205	10/01/10		SNF	"Special Care Low , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE206	10/01/10		SNF	"Special Care Low , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LE210	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return. "
LE211	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
LE212	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
LE213	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
LE214	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
LE215	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE216	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LE217	10/01/10		SNF	"Special Care Low , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
LE220	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day. "
LE221	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
LE224	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
LE225	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
LE226	10/01/10		SNF	"Special Care Low , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LE230	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day. "
LE231	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
LE234	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
LE235	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE236	10/01/10		SNF	"Special Care Low , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
LE240	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day. "
LE241	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
LE244	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
LE245	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE246	10/01/10		SNF	"Special Care Low , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
LE250	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day. "
LE251	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
LE254	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
LE255	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
LE256	10/01/10		SNF	"Special Care Low , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
LE260	10/01/10		SNF	"Special Care Low , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
LE28A	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 120-day assessment "
LE28B	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 150-day assessment "
LE28C	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 180-day assessment "
LE28D	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 210-day assessment "
LE28E	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 240-day assessment "
LE28F	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 270-day assessment "
LE28G	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 300-day assessment "
LE28H	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 330-day assessment "
LE28I	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE 360-day assessment "
LE28X	10/01/10		SNF	"Special Care Low , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
PA101	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/Stand-alone OBRA SCSA OR SCPA OR CCA."
PA104	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PA105	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA106	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PA110	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return. "
PA111	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PA112	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PA113	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PA114	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PA115	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA116	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PA117	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PA120	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day. "
PA121	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PA124	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PA125	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PA126	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PA130	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day. "
PA131	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PA134	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PA135	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA136	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PA140	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day. "
PA141	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PA144	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PA145	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA146	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PA150	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day. "
PA151	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PA154	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PA155	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA156	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PA160	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PA18A	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 120-day assessment "
PA18B	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 150-day assessment "
PA18C	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 180-day assessment "
PA18D	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 210-day assessment "
PA18E	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 240-day assessment "
PA18F	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 270-day assessment "
PA18G	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 300-day assessment "
PA18H	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 330-day assessment "
PA18I	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 360-day assessment "
PA18X	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE Post 360-day assessments with 30-day interval "
PA201	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/Stand-alone OBRA SCSA OR SCPA OR CCA."
PA204	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PA205	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA206	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PA210	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return. "
PA211	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PA212	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PA213	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PA214	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PA215	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA216	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PA217	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PA220	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day. "
PA221	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PA224	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PA225	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PA226	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PA230	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day. "
PA231	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PA234	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PA235	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA236	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PA240	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day. "
PA241	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PA244	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PA245	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA246	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PA250	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day. "
PA251	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PA254	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PA255	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PA256	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PA260	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PA28A	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 120-day assessment "
PA28B	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 150-day assessment "
PA28C	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 180-day assessment "
PA28D	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 210-day assessment "
PA28E	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 240-day assessment "
PA28F	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 270-day assessment "
PA28G	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 300-day assessment "
PA28H	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 330-day assessment "
PA28I	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE 360-day assessment "
PA28X	10/01/10		SNF	"Reduced Physical Function , ADL Index 0-1/TRICARE Post 360-day assessments with 30-day interval "
PB101	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
PB104	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PB105	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB106	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PB110	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return. "
PB111	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PB112	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PB113	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PB114	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PB115	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB116	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PB117	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PB120	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day. "
PB121	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PB124	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PB125	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PB126	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PB130	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day. "
PB131	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PB134	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PB135	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB136	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PB140	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day. "
PB141	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PB144	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PB145	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB146	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PB150	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day. "
PB151	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PB154	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PB155	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB156	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PB160	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PB18A	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 120-day assessment "
PB18B	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 150-day assessment "
PB18C	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 180-day assessment "
PB18D	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 210-day assessment "
PB18E	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 240-day assessment "
PB18F	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 270-day assessment "
PB18G	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 300-day assessment "
PB18H	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 330-day assessment "
PB18I	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 360-day assessment "
PB18X	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
PB201	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
PB204	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PB205	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB206	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PB210	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return. "
PB211	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PB212	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PB213	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PB214	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PB215	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB216	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PB217	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PB220	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day. "
PB221	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PB224	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PB225	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PB226	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PB230	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day. "
PB231	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PB234	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PB235	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB236	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PB240	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day. "
PB241	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PB244	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PB245	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB246	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PB250	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day. "
PB251	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PB254	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PB255	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PB256	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PB260	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PB28A	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 120-day assessment "
PB28B	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 150-day assessment "
PB28C	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 180-day assessment "
PB28D	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 210-day assessment "
PB28E	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 240-day assessment "
PB28F	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 270-day assessment "
PB28G	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 300-day assessment "
PB28H	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 330-day assessment "
PB28I	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE 360-day assessment "
PB28X	10/01/10		SNF	"Reduced Physical Function , ADL Index 2-5/TRICARE Post 360-day assessments with 30-day interval "
PC101	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
PC104	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PC105	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC106	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PC110	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return. "
PC111	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PC112	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PC113	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PC114	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PC115	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC116	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PC117	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PC120	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day. "
PC121	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PC124	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PC125	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PC126	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PC130	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day. "
PC131	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PC134	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PC135	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC136	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PC140	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day. "
PC141	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PC144	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PC145	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC146	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PC150	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day. "
PC151	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PC154	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PC155	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC156	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PC160	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PC18A	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 120-day assessment "
PC18B	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 150-day assessment "
PC18C	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 180-day assessment "
PC18D	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 210-day assessment "
PC18E	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 240-day assessment "
PC18F	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 270-day assessment "
PC18G	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 300-day assessment "
PC18H	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 330-day assessment "
PC18I	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 360-day assessment "
PC18X	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
PC201	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
PC204	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PC205	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC206	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PC210	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return. "
PC211	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PC212	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PC213	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PC214	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PC215	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC216	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PC217	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PC220	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day. "
PC221	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PC224	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PC225	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PC226	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PC230	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day. "
PC231	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PC234	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PC235	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC236	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PC240	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day. "
PC241	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PC244	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PC245	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC246	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PC250	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day. "
PC251	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PC254	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PC255	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PC256	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PC260	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PC28A	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 120-day assessment "
PC28B	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 150-day assessment "
PC28C	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 180-day assessment "
PC28D	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 210-day assessment "
PC28E	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 240-day assessment "
PC28F	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 270-day assessment "
PC28G	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 300-day assessment "
PC28H	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 330-day assessment "
PC28I	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE 360-day assessment "
PC28X	10/01/10		SNF	"Reduced Physical Function , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
PD101	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
PD104	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PD105	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD106	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PD110	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return. "
PD111	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PD112	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PD113	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PD114	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PD115	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD116	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PD117	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PD120	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day. "
PD121	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PD124	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PD125	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PD126	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PD130	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day. "
PD131	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PD134	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PD135	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD136	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PD140	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day. "
PD141	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PD144	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PD145	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD146	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PD150	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day. "
PD151	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PD154	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PD155	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD156	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PD160	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PD18A	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 120-day assessment "
PD18B	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 150-day assessment "
PD18C	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 180-day assessment "
PD18D	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 210-day assessment "
PD18E	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 240-day assessment "
PD18F	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 270-day assessment "
PD18G	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 300-day assessment "
PD18H	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 330-day assessment "
PD18I	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 360-day assessment "
PD18X	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
PD201	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/Stand-alone OBRA SCSA OR SCPA OR CCA."
PD204	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PD205	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD206	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PD210	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return. "
PD211	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PD212	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PD213	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PD214	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PD215	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD216	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PD217	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PD220	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day. "
PD221	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PD224	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PD225	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PD226	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PD230	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day. "
PD231	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PD234	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PD235	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD236	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PD240	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day. "
PD241	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PD244	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PD245	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD246	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PD250	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day. "
PD251	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PD254	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PD255	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PD256	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PD260	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PD28A	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 120-day assessment "
PD28B	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 150-day assessment "
PD28C	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 180-day assessment "
PD28D	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 210-day assessment "
PD28E	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 240-day assessment "
PD28F	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 270-day assessment "
PD28G	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 300-day assessment "
PD28H	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 330-day assessment "
PD28I	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE 360-day assessment "
PD28X	10/01/10		SNF	"Reduced Physical Function , ADL Index 11-14/TRICARE Post 360-day assessments with 30-day interval "
PE101	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
PE104	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PE105	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE106	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PE110	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return. "
PE111	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PE112	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PE113	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PE114	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PE115	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE116	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PE117	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PE120	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day. "
PE121	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PE124	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PE125	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PE126	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PE130	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day. "
PE131	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PE134	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PE135	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE136	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PE140	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day. "
PE141	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PE144	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PE145	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE146	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PE150	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day. "
PE151	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PE154	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PE155	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE156	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PE160	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PE18A	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 120-day assessment "
PE18B	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 150-day assessment "
PE18C	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 180-day assessment "
PE18D	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 210-day assessment "
PE18E	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 240-day assessment "
PE18F	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 270-day assessment "
PE18G	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 300-day assessment "
PE18H	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 330-day assessment "
PE18I	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 360-day assessment "
PE18X	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
PE201	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
PE204	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/EOT OMRA OR EOT OMRA AND SCSA OR EOT OMRA AND SCPA OR EOT OMRA AND CCA."
PE205	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE206	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PE210	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return. "
PE211	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
PE212	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
PE213	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
PE214	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
PE215	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE216	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PE217	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
PE220	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day. "
PE221	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
PE224	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
PE225	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
PE226	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PE230	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day. "
PE231	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
PE234	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
PE235	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE236	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
PE240	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day. "
PE241	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
PE244	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
PE245	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE246	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
PE250	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day. "
PE251	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
PE254	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
PE255	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
PE256	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
PE260	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following: SNF notified untimely of MSP denial, or 
SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
PE28A	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 120-day assessment "
PE28B	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 150-day assessment "
PE28C	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 180-day assessment "
PE28D	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 210-day assessment "
PE28E	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 240-day assessment "
PE28F	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 270-day assessment "
PE28G	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 300-day assessment "
PE28H	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 330-day assessment "
PE28I	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE 360-day assessment "
PE28X	10/01/10		SNF	"Reduced Physical Function , ADL Index 15-16/TRICARE Post 360-day assessments with 30-day interval "
RHA01	10/01/10		SNF	"High Rehab , ADL Index 0-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
RHA02	10/01/10		SNF	"High Rehab , ADL Index 0-5/Stand-alone SOT OMRA (not Medicare short stay)."
RHA03	10/01/10		SNF	"High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RHA05	10/01/10		SNF	"High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHA06	10/01/10		SNF	"High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHA07	10/01/10		SNF	"High Rehab , ADL Index 0-5/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RHA10	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return. "
RHA11	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RHA12	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RHA13	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RHA14	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RHA15	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHA16	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHA17	10/01/10		SNF	"High Rehab , ADL Index 0-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RHA20	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day. "
RHA21	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RHA22	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay)."
RHA23	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHA24	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RHA25	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RHA26	10/01/10		SNF	"High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHA30	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day. "
RHA31	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RHA32	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay)."
RHA33	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHA34	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RHA35	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHA36	10/01/10		SNF	"High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHA40	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day. "
RHA41	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RHA42	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay)."
RHA43	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHA44	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RHA45	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHA46	10/01/10		SNF	"High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RHA50	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day. "
RHA51	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RHA52	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay)."
RHA53	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHA54	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RHA55	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHA56	10/01/10		SNF	"High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHA60	10/01/10		SNF	"High Rehab , ADL Index 0-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RHA8A	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 120-day assessment "
RHA8B	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 150-day assessment "
RHA8C	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 180-day assessment "
RHA8D	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 210-day assessment "
RHA8E	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 240-day assessment "
RHA8F	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 270-day assessment "
RHA8G	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 300-day assessment "
RHA8H	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 330-day assessment "
RHA8I	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE 360-day assessment "
RHA8X	10/01/10		SNF	"High Rehab , ADL Index 0-5/TRICARE Post 360-day assessments with 30-day interval "
RHB01	10/01/10		SNF	"High Rehab , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RHB02	10/01/10		SNF	"High Rehab , ADL Index 6-10/Stand-alone SOT OMRA (not Medicare short stay)."
RHB03	10/01/10		SNF	"High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RHB05	10/01/10		SNF	"High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHB06	10/01/10		SNF	"High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHB07	10/01/10		SNF	"High Rehab , ADL Index 6-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RHB10	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return. "
RHB11	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RHB12	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RHB13	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RHB14	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RHB15	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHB16	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHB17	10/01/10		SNF	"High Rehab , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RHB20	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day. "
RHB21	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RHB22	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay)."
RHB23	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHB24	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RHB25	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RHB26	10/01/10		SNF	"High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHB30	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day. "
RHB31	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RHB32	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay)."
RHB33	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHB34	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RHB35	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHB36	10/01/10		SNF	"High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHB40	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day. "
RHB41	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RHB42	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay)."
RHB43	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHB44	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RHB45	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHB46	10/01/10		SNF	"High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RHB50	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day. "
RHB51	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RHB52	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay)."
RHB53	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHB54	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RHB55	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHB56	10/01/10		SNF	"High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHB60	10/01/10		SNF	"High Rehab , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RHB8A	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 120-day assessment "
RHB8B	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 150-day assessment "
RHB8C	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 180-day assessment "
RHB8D	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 210-day assessment "
RHB8E	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 240-day assessment "
RHB8F	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 270-day assessment "
RHB8G	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 300-day assessment "
RHB8H	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 330-day assessment "
RHB8I	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE 360-day assessment "
RHB8X	10/01/10		SNF	"High Rehab , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
RHC01	10/01/10		SNF	"High Rehab , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RHC02	10/01/10		SNF	"High Rehab , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RHC03	10/01/10		SNF	"High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RHC05	10/01/10		SNF	"High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHC06	10/01/10		SNF	"High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHC07	10/01/10		SNF	"High Rehab , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RHC10	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return. "
RHC11	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RHC12	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RHC13	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RHC14	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RHC15	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHC16	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHC17	10/01/10		SNF	"High Rehab , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RHC20	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day. "
RHC21	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RHC22	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RHC23	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHC24	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RHC25	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RHC26	10/01/10		SNF	"High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHC30	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day. "
RHC31	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RHC32	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RHC33	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHC34	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RHC35	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHC36	10/01/10		SNF	"High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHC40	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day. "
RHC41	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RHC42	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RHC43	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHC44	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RHC45	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHC46	10/01/10		SNF	"High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RHC50	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day. "
RHC51	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RHC52	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RHC53	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHC54	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RHC55	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHC56	10/01/10		SNF	"High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHC60	10/01/10		SNF	"High Rehab , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RHC8A	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 120-day assessment "
RHC8B	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 150-day assessment "
RHC8C	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 180-day assessment "
RHC8D	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 210-day assessment "
RHC8E	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 240-day assessment "
RHC8F	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 270-day assessment "
RHC8G	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 300-day assessment "
RHC8H	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 330-day assessment "
RHC8I	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE 360-day assessment "
RHC8X	10/01/10		SNF	"High Rehab , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RHL01	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RHL02	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/Stand-alone SOT OMRA (not Medicare short stay)."
RHL03	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RHL05	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHL06	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHL07	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RHL10	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return. "
RHL11	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RHL12	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RHL13	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RHL14	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RHL15	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHL16	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHL17	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RHL20	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day. "
RHL21	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RHL22	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay)."
RHL23	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHL24	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RHL25	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RHL26	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHL30	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day. "
RHL31	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RHL32	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay)."
RHL33	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHL34	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RHL35	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHL36	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHL40	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day. "
RHL41	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RHL42	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay)."
RHL43	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHL44	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RHL45	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHL46	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RHL50	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day. "
RHL51	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RHL52	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay)."
RHL53	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHL54	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RHL55	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHL56	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHL60	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RHL8A	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 120-day assessment "
RHL8B	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 150-day assessment "
RHL8C	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 180-day assessment "
RHL8D	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 210-day assessment "
RHL8E	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 240-day assessment "
RHL8F	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 270-day assessment "
RHL8G	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 300-day assessment "
RHL8H	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 330-day assessment "
RHL8I	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE 360-day assessment "
RHL8X	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 2-10/TRICARE Post 360-day assessments with 30-day interval "
RHX01	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RHX02	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RHX03	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RHX05	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHX06	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHX07	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RHX10	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return. "
RHX11	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RHX12	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RHX13	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RHX14	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RHX15	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHX16	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHX17	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RHX20	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day. "
RHX21	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RHX22	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RHX23	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHX24	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RHX25	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RHX26	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHX30	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day. "
RHX31	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RHX32	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RHX33	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHX34	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RHX35	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHX36	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RHX40	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day. "
RHX41	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RHX42	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RHX43	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RHX44	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RHX45	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHX46	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RHX50	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day. "
RHX51	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RHX52	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RHX53	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RHX54	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RHX55	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RHX56	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RHX60	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RHX8A	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 120-day assessment "
RHX8B	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 150-day assessment "
RHX8C	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 180-day assessment "
RHX8D	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 210-day assessment "
RHX8E	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 240-day assessment "
RHX8F	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 270-day assessment "
RHX8G	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 300-day assessment "
RHX8H	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 330-day assessment "
RHX8I	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE 360-day assessment "
RHX8X	10/01/10		SNF	"High Rehab plus Extensive , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RLA01	10/01/10		SNF	"Low Rehab, ADL Index 0-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RLA02	10/01/10		SNF	"Low Rehab, ADL Index 0-10/Stand-alone SOT OMRA (not Medicare short stay)."
RLA03	10/01/10		SNF	"Low Rehab, ADL Index 0-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RLA05	10/01/10		SNF	"Low Rehab, ADL Index 0-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLA06	10/01/10		SNF	"Low Rehab, ADL Index 0-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLA07	10/01/10		SNF	"Low Rehab, ADL Index 0-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RLA10	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return. "
RLA11	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RLA12	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RLA13	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RLA14	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RLA15	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLA16	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RLA17	10/01/10		SNF	"Low Rehab, ADL Index 0-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RLA20	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day. "
RLA21	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RLA22	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day AND SOT OMRA (not Medicare short stay)."
RLA23	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RLA24	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RLA25	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RLA26	10/01/10		SNF	"Low Rehab, ADL Index 0-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLA30	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day. "
RLA31	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RLA32	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day AND SOT OMRA (not Medicare short stay)."
RLA33	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RLA34	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RLA35	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLA36	10/01/10		SNF	"Low Rehab, ADL Index 0-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RLA40	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day. "
RLA41	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RLA42	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day AND SOT OMRA (not Medicare short stay)."
RLA43	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RLA44	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RLA45	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLA46	10/01/10		SNF	"Low Rehab, ADL Index 0-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RLA50	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day. "
RLA51	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RLA52	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day AND SOT OMRA (not Medicare short stay)."
RLA53	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RLA54	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RLA55	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLA56	10/01/10		SNF	"Low Rehab, ADL Index 0-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLA60	10/01/10		SNF	"Low Rehab, ADL Index 0-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RLA8A	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 120-day assessment "
RLA8B	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 150-day assessment "
RLA8C	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 180-day assessment "
RLA8D	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 210-day assessment "
RLA8E	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 240-day assessment "
RLA8F	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 270-day assessment "
RLA8G	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 300-day assessment "
RLA8H	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 330-day assessment "
RLA8I	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE 360-day assessment "
RLA8X	10/01/10		SNF	"Low Rehab, ADL Index 0-10/TRICARE Post 360-day assessments with 30-day interval "
RLB01	10/01/10		SNF	"Low Rehab, ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RLB02	10/01/10		SNF	"Low Rehab, ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RLB03	10/01/10		SNF	"Low Rehab, ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RLB05	10/01/10		SNF	"Low Rehab, ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLB06	10/01/10		SNF	"Low Rehab, ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLB07	10/01/10		SNF	"Low Rehab, ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RLB10	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return. "
RLB11	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RLB12	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RLB13	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RLB14	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RLB15	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLB16	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RLB17	10/01/10		SNF	"Low Rehab, ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RLB20	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day. "
RLB21	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RLB22	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RLB23	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RLB24	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RLB25	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RLB26	10/01/10		SNF	"Low Rehab, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLB30	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day. "
RLB31	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RLB32	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RLB33	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RLB34	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RLB35	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLB36	10/01/10		SNF	"Low Rehab, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RLB40	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day. "
RLB41	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RLB42	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RLB43	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RLB44	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RLB45	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLB46	10/01/10		SNF	"Low Rehab, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RLB50	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day. "
RLB51	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RLB52	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RLB53	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RLB54	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RLB55	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLB56	10/01/10		SNF	"Low Rehab, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLB60	10/01/10		SNF	"Low Rehab, ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RLB8A	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 120-day assessment "
RLB8B	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 150-day assessment "
RLB8C	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 180-day assessment "
RLB8D	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 210-day assessment "
RLB8E	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 240-day assessment "
RLB8F	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 270-day assessment "
RLB8G	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 300-day assessment "
RLB8H	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 330-day assessment "
RLB8I	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE 360-day assessment "
RLB8X	10/01/10		SNF	"Low Rehab, ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RLX01	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RLX02	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/Stand-alone SOT OMRA (not Medicare short stay)."
RLX03	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RLX05	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLX06	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLX07	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RLX10	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return. "
RLX11	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RLX12	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RLX13	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RLX14	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RLX15	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLX16	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RLX17	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RLX20	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day. "
RLX21	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RLX22	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay)."
RLX23	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RLX24	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RLX25	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RLX26	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLX30	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day. "
RLX31	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RLX32	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay)."
RLX33	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RLX34	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RLX35	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLX36	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RLX40	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day. "
RLX41	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RLX42	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay)."
RLX43	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RLX44	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RLX45	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLX46	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RLX50	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day. "
RLX51	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RLX52	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay)."
RLX53	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RLX54	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RLX55	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RLX56	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RLX60	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RLX8A	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 120-day assessment "
RLX8B	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 150-day assessment "
RLX8C	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 180-day assessment "
RLX8D	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 210-day assessment "
RLX8E	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 240-day assessment "
RLX8F	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 270-day assessment "
RLX8G	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 300-day assessment "
RLX8H	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 330-day assessment "
RLX8I	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE 360-day assessment "
RLX8X	10/01/10		SNF	"Low Rehab plus Extensive , ADL Index 2-16/TRICARE Post 360-day assessments with 30-day interval "
RMA01	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
RMA02	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/Stand-alone SOT OMRA (not Medicare short stay)."
RMA03	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RMA05	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMA06	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMA07	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RMA10	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return. "
RMA11	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RMA12	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RMA13	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RMA14	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RMA15	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMA16	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMA17	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RMA20	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day. "
RMA21	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RMA22	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay)."
RMA23	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMA24	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RMA25	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RMA26	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMA30	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day. "
RMA31	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RMA32	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay)."
RMA33	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMA34	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RMA35	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMA36	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMA40	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day. "
RMA41	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RMA42	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay)."
RMA43	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMA44	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RMA45	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMA46	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RMA50	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day. "
RMA51	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RMA52	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay)."
RMA53	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMA54	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RMA55	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMA56	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMA60	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RMA8A	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 120-day assessment "
RMA8B	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 150-day assessment "
RMA8C	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 180-day assessment "
RMA8D	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 210-day assessment "
RMA8E	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 240-day assessment "
RMA8F	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 270-day assessment "
RMA8G	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 300-day assessment "
RMA8H	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 330-day assessment "
RMA8I	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE 360-day assessment "
RMA8X	10/01/10		SNF	"Medium Rehab , ADL Index 0-5/TRICARE Post 360-day assessments with 30-day interval "
RMB01	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RMB02	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/Stand-alone SOT OMRA (not Medicare short stay)."
RMB03	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RMB05	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMB06	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMB07	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RMB10	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return. "
RMB11	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RMB12	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RMB13	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RMB14	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RMB15	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMB16	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMB17	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RMB20	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day. "
RMB21	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RMB22	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay)."
RMB23	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMB24	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RMB25	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RMB26	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMB30	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day. "
RMB31	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RMB32	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay)."
RMB33	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMB34	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RMB35	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMB36	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMB40	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day. "
RMB41	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RMB42	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay)."
RMB43	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMB44	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RMB45	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMB46	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RMB50	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day. "
RMB51	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RMB52	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay)."
RMB53	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMB54	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RMB55	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMB56	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMB60	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RMB8A	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 120-day assessment "
RMB8B	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 150-day assessment "
RMB8C	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 180-day assessment "
RMB8D	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 210-day assessment "
RMB8E	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 240-day assessment "
RMB8F	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 270-day assessment "
RMB8G	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 300-day assessment "
RMB8H	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 330-day assessment "
RMB8I	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE 360-day assessment "
RMB8X	10/01/10		SNF	"Medium Rehab , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
RMC01	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RMC02	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RMC03	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RMC05	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMC06	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMC07	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RMC10	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return. "
RMC11	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RMC12	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RMC13	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RMC14	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RMC15	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMC16	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMC17	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RMC20	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day. "
RMC21	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RMC22	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RMC23	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMC24	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RMC25	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RMC26	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMC30	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day. "
RMC31	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RMC32	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RMC33	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMC34	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RMC35	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMC36	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMC40	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day. "
RMC41	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RMC42	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RMC43	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMC44	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RMC45	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMC46	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RMC50	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day. "
RMC51	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RMC52	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RMC53	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMC54	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RMC55	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMC56	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMC60	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RMC8A	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 120-day assessment "
RMC8B	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 150-day assessment "
RMC8C	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 180-day assessment "
RMC8D	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 210-day assessment "
RMC8E	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 240-day assessment "
RMC8F	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 270-day assessment "
RMC8G	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 300-day assessment "
RMC8H	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 330-day assessment "
RMC8I	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE 360-day assessment "
RMC8X	10/01/10		SNF	"Medium Rehab , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RML01	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RML02	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/Stand-alone SOT OMRA (not Medicare short stay)."
RML03	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RML05	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RML06	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RML07	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RML10	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return. "
RML11	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RML12	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RML13	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RML14	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RML15	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RML16	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RML17	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RML20	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day. "
RML21	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RML22	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay)."
RML23	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RML24	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RML25	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RML26	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RML30	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day. "
RML31	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RML32	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay)."
RML33	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RML34	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RML35	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RML36	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RML40	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day. "
RML41	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RML42	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay)."
RML43	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RML44	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RML45	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RML46	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RML50	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day. "
RML51	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RML52	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay)."
RML53	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RML54	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RML55	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RML56	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RML60	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RML8A	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 120-day assessment "
RML8B	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 150-day assessment "
RML8C	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 180-day assessment "
RML8D	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 210-day assessment "
RML8E	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 240-day assessment "
RML8F	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 270-day assessment "
RML8G	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 300-day assessment "
RML8H	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 330-day assessment "
RML8I	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE 360-day assessment "
RML8X	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 2-10/TRICARE Post 360-day assessments with 30-day interval "
RMX01	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RMX02	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RMX03	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RMX05	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMX06	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMX07	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RMX10	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return. "
RMX11	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RMX12	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RMX13	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RMX14	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RMX15	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMX16	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMX17	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RMX20	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day. "
RMX21	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RMX22	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RMX23	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMX24	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RMX25	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RMX26	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMX30	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day. "
RMX31	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RMX32	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RMX33	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMX34	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RMX35	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMX36	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RMX40	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day. "
RMX41	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RMX42	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RMX43	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RMX44	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RMX45	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMX46	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RMX50	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day. "
RMX51	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RMX52	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RMX53	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RMX54	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RMX55	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RMX56	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RMX60	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RMX8A	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 120-day assessment "
RMX8B	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 150-day assessment "
RMX8C	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 180-day assessment "
RMX8D	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 210-day assessment "
RMX8E	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 240-day assessment "
RMX8F	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 270-day assessment "
RMX8G	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 300-day assessment "
RMX8H	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 330-day assessment "
RMX8I	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE 360-day assessment "
RMX8X	10/01/10		SNF	"Medium Rehab plus Extensive, ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RUA01	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
RUA02	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/Stand-alone SOT OMRA (not Medicare short stay)."
RUA03	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RUA05	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUA06	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUA07	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RUA10	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return. "
RUA11	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RUA12	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RUA13	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RUA14	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RUA15	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUA16	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUA17	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RUA20	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day. "
RUA21	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RUA22	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay)."
RUA23	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUA24	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RUA25	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RUA26	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUA30	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day. "
RUA31	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RUA32	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay)."
RUA33	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUA34	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RUA35	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUA36	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUA40	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day. "
RUA41	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RUA42	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay)."
RUA43	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUA44	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RUA45	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUA46	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RUA50	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day. "
RUA51	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RUA52	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay)."
RUA53	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUA54	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RUA55	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUA56	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUA60	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RUA8A	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 120-day assessment "
RUA8B	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 150-day assessment "
RUA8C	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 180-day assessment "
RUA8D	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 210-day assessment "
RUA8E	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 240-day assessment "
RUA8F	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 270-day assessment "
RUA8G	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 300-day assessment "
RUA8H	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 330-day assessment "
RUA8I	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE 360-day assessment "
RUA8X	10/01/10		SNF	"Ultra High Rehab , ADL Index 0-5/TRICARE Post 360-day assessments with 30-day interval "
RUB01	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RUB02	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/Stand-alone SOT OMRA (not Medicare short stay)."
RUB03	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RUB05	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUB06	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUB07	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RUB10	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return. "
RUB11	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RUB12	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RUB13	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RUB14	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RUB15	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUB16	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUB17	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RUB20	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day. "
RUB21	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RUB22	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay)."
RUB23	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUB24	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RUB25	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RUB26	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUB30	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day. "
RUB31	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RUB32	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay)."
RUB33	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUB34	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RUB35	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUB36	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUB40	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day. "
RUB41	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RUB42	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay)."
RUB43	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUB44	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RUB45	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUB46	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RUB50	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day. "
RUB51	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RUB52	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay)."
RUB53	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUB54	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RUB55	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUB56	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUB60	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RUB8A	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 120-day assessment "
RUB8B	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 150-day assessment "
RUB8C	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 180-day assessment "
RUB8D	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 210-day assessment "
RUB8E	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 240-day assessment "
RUB8F	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 270-day assessment "
RUB8G	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 300-day assessment "
RUB8H	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 330-day assessment "
RUB8I	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE 360-day assessment "
RUB8X	10/01/10		SNF	"Ultra High Rehab , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
RUC01	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RUC02	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RUC03	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RUC05	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUC06	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUC07	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RUC10	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return. "
RUC11	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RUC12	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RUC13	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RUC14	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RUC15	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUC16	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUC17	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RUC20	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day. "
RUC21	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RUC22	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RUC23	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUC24	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RUC25	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RUC26	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUC30	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day. "
RUC31	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RUC32	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RUC33	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUC34	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RUC35	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUC36	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUC40	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day. "
RUC41	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RUC42	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RUC43	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUC44	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RUC45	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUC46	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RUC50	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day. "
RUC51	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RUC52	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RUC53	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUC54	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RUC55	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUC56	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUC60	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RUC8A	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 120-day assessment "
RUC8B	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 150-day assessment "
RUC8C	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 180-day assessment "
RUC8D	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 210-day assessment "
RUC8E	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 240-day assessment "
RUC8F	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 270-day assessment "
RUC8G	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 300-day assessment "
RUC8H	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 330-day assessment "
RUC8I	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE 360-day assessment "
RUC8X	10/01/10		SNF	"Ultra High Rehab , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RUL01	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RUL02	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/Stand-alone SOT OMRA (not Medicare short stay)."
RUL03	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RUL05	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUL06	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUL07	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RUL10	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return. "
RUL11	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RUL12	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RUL13	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RUL14	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RUL15	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUL16	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUL17	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RUL20	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day. "
RUL21	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RUL22	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay)."
RUL23	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUL24	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RUL25	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RUL26	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUL30	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day. "
RUL31	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RUL32	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay)."
RUL33	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUL34	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RUL35	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUL36	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUL40	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day. "
RUL41	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RUL42	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay)."
RUL43	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUL44	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RUL45	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUL46	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RUL50	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day. "
RUL51	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RUL52	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay)."
RUL53	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUL54	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RUL55	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUL56	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUL60	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RUL8A	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 120-day assessment "
RUL8B	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 150-day assessment "
RUL8C	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 180-day assessment "
RUL8D	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 210-day assessment "
RUL8E	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 240-day assessment "
RUL8F	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 270-day assessment "
RUL8G	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 300-day assessment "
RUL8H	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 330-day assessment "
RUL8I	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE 360-day assessment "
RUL8X	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 2-10/TRICARE Post 360-day assessments with 30-day interval "
RUX01	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RUX02	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RUX03	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RUX05	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUX06	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUX07	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RUX10	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return. "
RUX11	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RUX12	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RUX13	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RUX14	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RUX15	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUX16	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUX17	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RUX20	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day. "
RUX21	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RUX22	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RUX23	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUX24	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RUX25	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RUX26	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUX30	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day. "
RUX31	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RUX32	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RUX33	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUX34	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RUX35	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUX36	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RUX40	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day. "
RUX41	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RUX42	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RUX43	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RUX44	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RUX45	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUX46	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RUX50	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day. "
RUX51	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RUX52	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RUX53	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RUX54	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RUX55	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RUX56	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RUX60	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RUX8A	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 120-day assessment "
RUX8B	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 150-day assessment "
RUX8C	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 180-day assessment "
RUX8D	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 210-day assessment "
RUX8E	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 240-day assessment "
RUX8F	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 270-day assessment "
RUX8G	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 300-day assessment "
RUX8H	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 330-day assessment "
RUX8I	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE 360-day assessment "
RUX8X	10/01/10		SNF	"Ultra High Rehab plus Extensive , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RVA01	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/Stand-alone OBRA SCSA OR SCPA OR CCA."
RVA02	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/Stand-alone SOT OMRA (not Medicare short stay)."
RVA03	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RVA05	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVA06	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVA07	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RVA10	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return. "
RVA11	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RVA12	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RVA13	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RVA14	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RVA15	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVA16	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVA17	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RVA20	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day. "
RVA21	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RVA22	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay)."
RVA23	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVA24	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RVA25	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RVA26	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVA30	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day. "
RVA31	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RVA32	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay)."
RVA33	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVA34	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RVA35	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVA36	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVA40	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day. "
RVA41	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RVA42	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay)."
RVA43	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVA44	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RVA45	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVA46	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RVA50	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day. "
RVA51	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RVA52	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay)."
RVA53	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVA54	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RVA55	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVA56	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVA60	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RVA8A	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 120-day assessment "
RVA8B	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 150-day assessment "
RVA8C	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 180-day assessment "
RVA8D	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 210-day assessment "
RVA8E	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 240-day assessment "
RVA8F	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 270-day assessment "
RVA8G	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 300-day assessment "
RVA8H	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 330-day assessment "
RVA8I	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE 360-day assessment "
RVA8X	10/01/10		SNF	"Very High Rehab , ADL Index 0-5/TRICARE Post 360-day assessments with 30-day interval "
RVB01	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RVB02	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/Stand-alone SOT OMRA (not Medicare short stay)."
RVB03	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RVB05	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVB06	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVB07	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RVB10	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return. "
RVB11	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RVB12	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RVB13	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RVB14	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RVB15	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVB16	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVB17	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RVB20	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day. "
RVB21	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RVB22	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay)."
RVB23	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVB24	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RVB25	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RVB26	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVB30	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day. "
RVB31	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RVB32	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay)."
RVB33	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVB34	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RVB35	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVB36	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVB40	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day. "
RVB41	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RVB42	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay)."
RVB43	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVB44	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RVB45	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVB46	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RVB50	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day. "
RVB51	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RVB52	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay)."
RVB53	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVB54	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RVB55	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVB56	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVB60	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RVB8A	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 120-day assessment "
RVB8B	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 150-day assessment "
RVB8C	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 180-day assessment "
RVB8D	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 210-day assessment "
RVB8E	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 240-day assessment "
RVB8F	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 270-day assessment "
RVB8G	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 300-day assessment "
RVB8H	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 330-day assessment "
RVB8I	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE 360-day assessment "
RVB8X	10/01/10		SNF	"Very High Rehab , ADL Index 6-10/TRICARE Post 360-day assessments with 30-day interval "
RVC01	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RVC02	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RVC03	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RVC05	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVC06	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVC07	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RVC10	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return. "
RVC11	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RVC12	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RVC13	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RVC14	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RVC15	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVC16	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVC17	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RVC20	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day. "
RVC21	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RVC22	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RVC23	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVC24	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RVC25	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RVC26	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVC30	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day. "
RVC31	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RVC32	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RVC33	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVC34	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RVC35	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVC36	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVC40	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day. "
RVC41	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RVC42	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RVC43	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVC44	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RVC45	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVC46	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RVC50	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day. "
RVC51	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RVC52	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RVC53	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVC54	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RVC55	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVC56	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVC60	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RVC8A	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 120-day assessment "
RVC8B	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 150-day assessment "
RVC8C	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 180-day assessment "
RVC8D	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 210-day assessment "
RVC8E	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 240-day assessment "
RVC8F	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 270-day assessment "
RVC8G	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 300-day assessment "
RVC8H	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 330-day assessment "
RVC8I	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE 360-day assessment "
RVC8X	10/01/10		SNF	"Very High Rehab , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
RVL01	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/Stand-alone OBRA SCSA OR SCPA OR CCA."
RVL02	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/Stand-alone SOT OMRA (not Medicare short stay)."
RVL03	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RVL05	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVL06	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVL07	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RVL10	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return. "
RVL11	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RVL12	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RVL13	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RVL14	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RVL15	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVL16	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVL17	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RVL20	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day. "
RVL21	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RVL22	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay)."
RVL23	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVL24	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RVL25	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RVL26	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVL30	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day. "
RVL31	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RVL32	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay)."
RVL33	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVL34	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RVL35	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVL36	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVL40	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day. "
RVL41	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RVL42	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay)."
RVL43	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVL44	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RVL45	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVL46	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RVL50	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day. "
RVL51	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RVL52	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay)."
RVL53	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVL54	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RVL55	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVL56	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVL60	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RVL8A	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 120-day assessment "
RVL8B	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 150-day assessment "
RVL8C	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 180-day assessment "
RVL8D	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 210-day assessment "
RVL8E	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 240-day assessment "
RVL8F	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 270-day assessment "
RVL8G	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 300-day assessment "
RVL8H	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 330-day assessment "
RVL8I	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE 360-day assessment "
RVL8X	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 2-10/TRICARE Post 360-day assessments with 30-day interval "
RVX01	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/Stand-alone OBRA SCSA OR SCPA OR CCA."
RVX02	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/Stand-alone SOT OMRA (not Medicare short stay)."
RVX03	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND SCSA OR SOT OMRA (not Medicare short stay) AND SCPA OR SOT OMRA (not Medicare short stay) and CCA."
RVX05	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVX06	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVX07	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/Medicare short stay assessment AND SCSA OR Medicare short stay assessment AND SCPA OR Medicare short stay assessment AND CCA. "
RVX10	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return. "
RVX11	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SCSA OR 5-day or readmission return AND SCPA OR 5-day or readmission return AND CCA."
RVX12	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay)."
RVX13	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND CCA."
RVX14	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND EOT OMRA OR 5-day or readmission return AND EOT OMRA AND SCSA OR 5-day or readmission return AND EOT OMRA AND SCPA OR 5-day or readmission return AND EOT OMRA AND CCA."
RVX15	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVX16	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 5-day or readmission return AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVX17	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/5-day or readmission return AND Medicare short stay assessment AND SCSA OR 5-day or readmission return AND Medicare short stay assessment AND SCPA OR 5-day or readmission return AND Medicare short stay assessment AND CCA. "
RVX20	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day. "
RVX21	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day AND SCSA OR 14-day AND SCPA OR 14-day AND CCA."
RVX22	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay)."
RVX23	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVX24	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day AND EOT OMRA OR 14-day AND EOT OMRA AND SCSA OR14-day AND EOT OMRA AND SCPA OR 14-day AND EOT OMRA AND CCA."
RVX25	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) and EOT OMRA."
RVX26	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 14-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVX30	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day. "
RVX31	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day AND SCSA OR 30-day AND SCPA OR 30-day AND CCA."
RVX32	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay)."
RVX33	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVX34	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day AND EOT OMRA OR 30-day AND EOT OMRA AND SCSA OR 30-day AND EOT OMRA AND SCPA OR 30-day AND EOT OMRA AND CCA. "
RVX35	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVX36	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 30-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA. "
RVX40	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day. "
RVX41	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day AND SCSA OR 60-day AND SPCA OR 60-day AND CCA. "
RVX42	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay)."
RVX43	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) AND CCA."
RVX44	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day AND EOT OMRA OR 60-day AND EOT OMRA AND SCSA OR 60-day AND EOT OMRA AND SCPA OR 60-day AND EOT OMRA AND CCA. "
RVX45	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVX46	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 60-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 60-day AND SOT OMRA (not Medicare short stay) and EOT OMRA AND CCA."
RVX50	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day. "
RVX51	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day AND SCSA OR 90-day AND SCPA OR 90-day AND CCA."
RVX52	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay)."
RVX53	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND CCA. "
RVX54	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day AND EOT OMRA OR 90-day AND EOT OMRA AND SCSA OR 90-day AND EOT OMRA AND SCPA OR 90-day AND EOT OMRA AND CCA. "
RVX55	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA."
RVX56	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCSA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND SCPA OR 90-day AND SOT OMRA (not Medicare short stay) AND EOT OMRA AND CCA."
RVX60	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/OBRA assessment used for PPS (Not combined with any PPS assessment) when Part A eligibility unknown at time of assessment due to one of the following:  SNF notified untimely of MSP denial, or 
 SNF notified untimely of revocation of payment ban, or beneficiary requested demand bill, or SNF notified untimely of beneficiarys disenrollment from MA plan.
"
RVX8A	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 120-day assessment "
RVX8B	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 150-day assessment "
RVX8C	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 180-day assessment "
RVX8D	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 210-day assessment "
RVX8E	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 240-day assessment "
RVX8F	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 270-day assessment "
RVX8G	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 300-day assessment "
RVX8H	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 330-day assessment "
RVX8I	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE 360-day assessment "
RVX8X	10/01/10		SNF	"Very High Rehab plus Extensive , ADL Index 11-16/TRICARE Post 360-day assessments with 30-day interval "
