A0310B


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Property Specification
Data System MDS
Data Specs V3.02.0
Description Type of assessment: PPS
Group Asmt
Type Code
Length 2
Fixed Start-End 272-273
Version Notes

Item Subsets
Active NC,NQ,NP,ND,NT,NPE,IPA,SP,SD,ST
Inactive XX
State optional

Item Values
Value LOINC Text
01 5-day scheduled assessment
08 IPA - Interim Payment Assessment
99 None of the above

Item Edits
Edit ID Type Severity Edit Text
-3676 Format Fatal Values of Code and Checklist Items:
Only the coded values listed in the "Item Values" table of the Detailed Data Specifications Report may be submitted for this item.
-3796 Consistency Fatal The submission system will recalculate the ISC and compare the recalculated value with the value that is submitted in ITM_SBST_CD. If A0050 (formerly X0100)=[3] (the record is an inactivation), then the recalculated ISC value will be [XX]. If A0050=[1,2] (the record is a new record or a modification record), then the recalculated ISC value will be based upon the submitted RFA values. In either case, if the recalculated value does not match the value submitted in ITM_SBST_CD, a fatal error will result.
-3826 Consistency Fatal If B0100=[0,-] and A0310G=[2] and A0310A=[99] and A0310B=[99], then all active items from C0100 through C0600 must equal [^] and all active items from C0700 through C1000 must not equal [^].
-3837 Consistency Fatal If B0100=[0,-] and A0310G=[2] and A0310A=[99] and A0310B=[99], then all active items from J0200 through J0850 must equal [^].
-3699 Consistency Fatal If A0310B=[01], and O0400D1 and O0400D2 are active, and O0400D1 is not equal to [0000,-] and O0400D2 is not equal to [-], then the following rules apply:
a) O0400D1 must be greater than or equal to O0400D2*15.
b) If O0400D2>[0], then O0400D1 must be less than or equal to O0400D2*1440 (there are 1440 minutes in a day).
c) If O0400D2=[0], then O0400D1 must be less than or equal to [0098] (if there are 99 or more minutes across 7 days, then at least one of the days must have 15 minutes or more).
-3891 Consistency Warning ***THIS EDIT WAS DELETED IN V3.02.0***
-3897 Consistency Warning If A0310B=[01], then the following warning message will apply if a dash is submitted for this item:

Payment Reduction Warning: A dash (-) submitted in this quality measure assessment item may result in a payment reduction for your facility of two percentage points for the affected payment determination.
-3914 Consistency Fatal The Item Subset Code (ISC) is a two- or three-character code that indicates the type of record that is being submitted. The set of active items is controlled by the ISC. With the exceptions of the IPA and OSA ISCs, the characters of the ISC are defined as follows:

Character 1 indicates the type of provider and is based upon the value of A0200, as follows:
a) If A0200 is equal to [1] (nursing home record), then character 1 of the ISC is equal to [N].
b) If A0200 is equal to [2] (swing bed record), then character 1 of the ISC is equal to [S].

Characters 2 and 3 indicate the type of record and are based upon the values of the Reason For Assessment (RFA) items A0310A, A0310B, A0310F, and A0310H. The "Item Subset Code (ISC) Report" that accompanies the data specs lists all possible combinations of the RFA items and their associated ISCs. If the ISC that is listed in the report is equal to dashes, then the combination of RFA items is not allowed. If a record is submitted with one of these invalid RFA combinations, a fatal error will occur and it will be rejected.

The ISC_VAL table that is contained in the data specifications Access database is used to generate the ISC report and can be used by programmers as a lookup table. In addition, an appendix of the overview document that accompanies these data specifications contains source code for a Visual Basic function (GetISC_10012019()) that can be used to determine the ISC that is associated with any combination of the RFA items.

For a more complete explanation of the meaning and use of the ISC codes, please refer to the documentation that accompanies these data specifications.
-3915 Consistency Fatal a) If B0100=[0] and A0310G=[1,^], then if C0100 is active it must not equal [^].
b) If B0100=[-] and A0310G=[1,^], then if C0100 is active it must equal [-].
c) If B0100=[0] and A0310G=[2] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]), then if C0100 is active it must not equal [^].
d) If B0100=[-] and A0310G=[2] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]), then if C0100 is active it must equal [-].
-3916 Consistency Fatal a) If B0100=[0] and A0310G=[1,^], then if D0100 is active it must not equal [^].
b) If B0100=[-] and A0310G=[1,^], then if D0100 is active it must equal [-].
c) If B0100=[0] and A0310G=[2] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]), then if D0100 is active it must not equal [^].
d) If B0100=[-] and A0310G=[2] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]), then if D0100 is active it must equal [-].
-3917 Consistency Fatal If this is a PPS assessment (A0310B=[01,08]), then the Medicare number (A0600B) must be present (not [^]). Thus, the submission will be rejected if this is a PPS assessment and A0600B is equal to [^].
-3918 Consistency Fatal a) If B0100=[0] and A0310G=[1,^], then if J0200 is active it must not equal [^].
b) If B0100=[-] and A0310G=[1,^], then if J0200 is active it must equal [-].
c) If B0100=[0] and A0310G=[2] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]), then if J0200 is active it must not equal [^].
d) If B0100=[-] and A0310G=[2] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]), then if J0200 is active it must equal [-].
-3920 Consistency Fatal a) If A0200=[1] (this is a nursing home record) and A0310E is equal to
[1], then A0310A must equal [01,02,03,04,05,06] OR A0310B must equal [01] OR A0310F must equal [10,11].

b) If A0200=[2] (this is a swing bed record) and A0310E is equal to [1],
then A0310B must equal [01] OR A0310F must equal [10,11].
-3924 Consistency Fatal Date restrictions when combining SNF PPS Part A Discharge assessments with other assessment types:

(a) If A0200=[1] and (A0310A=[01,02,03,04,05,06] or A0310B=[01]) and A0310F=[99] and A0310H=[1], then if A2300 and A2400C are active, A2300 must be equal to A2400C.

(b) If A0200=[2] and A0310B=[01] and A0310F=[99] and A0310H=[1], then if A2300 and A2400C are active, A2300 must be equal to A2400C.

(c) If A0310F=[10,11] and A0310H=[1], then if A2000 and A2400C are active, ((A2400C = A2000) OR (A2000 - A2400C = 1)).
-3945 Consistency Fatal If A0310B=[01,08], then this ICD code must be one of the codes in the data spec dictionary table pdpm_icd_codes_FYxxxx (where FYxxxx is the fiscal year matching the target date of the assessment), in order to ensure that the PDPM grouper is able to generate a valid HIPPS code.
-3947 Consistency Fatal Prevent Interrupted Stay on SD ISC.

If A0200=[2] and A0310A=[99] and A0310B=[99] and A0310F=[10,11], then A0310G1 must not be equal to [1].
-3951 Consistency Fatal If A0310B=[08], then A0310F must equal [99].
-3953 Consistency Fatal If A0310B=[08], then A0310E must equal [0].
-3954 Consistency Fatal If A0310B=[08], then A0410 must equal [3].
-3966 Consistency Warning If A0310A=[01,02,03,04,05,06] and A0310B=[99] and the target date for the assessment is on or after October 1, 2020, then the iQIES value specified by the state for the date range where the target date of the assessment falls should match the submitted value for STATE_PDPM_OBRA_CD.
-3967 Consistency Warning If A0310B=[99] and STATE_PDPM_OBRA_CD is active and STATE_PDPM_OBRA_CD=[1] and I0020B cannot be found in either data spec dictionary table pdpm_icd_codes_FYxxxx or pdpm_icd_codes_2_FYxxxx (where FYxxxx is the fiscal year matching the target date of the assessment), then the PDPM cannot be determined for this assessment.

NOTE: The submission system will use the iQIES value for the state where the assessment was performed instead of STATE_PDPM_OBRA_CD to determine whether this warning is applicable.

This edit only applies to assessments with target date on or after October 1, 2020.
-3919 Skip pattern Fatal If A0310B=[01,08], then I0020 and I0020B must not equal [^].
-3925 Skip pattern Fatal a) If A0310B=[01], then if J2000 is active, it must not be equal to [^].

b) If A0310B=[99], then if J2000 is active, it must be equal to [^].
-3926 Skip pattern Fatal a) If A0310B=[01], then if N2001 is active, it must not be equal to [^].

b) If A0310B=[99], then if N2001 and N2003 are active, they must be equal to [^].
-3928 Skip pattern Fatal a) If A0310B=[01], then all active items from GG0100A through GG0100D must not be equal to [^].

b) If A0310B=[99], then all active items from GG0100A through GG0100D must be equal to [^].
-3929 Skip pattern Fatal a) If A0310B=[01], then all active items from GG0110A through GG0110Z must not be equal to [^].

b) If A0310B=[99], then all active items from GG0110A through GG0110Z must be equal to [^].
-3930 Skip pattern Fatal If B0100=[0,-] and A0310G=[2] and A0310A=[99] and A0310B=[99], then all active items from D0100 through D0600 must equal [^].
-3942 Skip pattern Fatal a) If A0310B=[01,08], then if J2100 is active, it must not be equal to [^].

b) If A0310B=[99], then

--b1) If STATE_PDPM_OBRA_CD is active and STATE_PDPM_OBRA_CD=[0], then if J2100 is active, it must be equal to [^].

--b2) If STATE_PDPM_OBRA_CD is active and STATE_PDPM_OBRA_CD=[1], then if J2100 is active, it must not be equal to [^].

--b3) If STATE_PDPM_OBRA_CD is not active, then if J2100 is active, it must be equal to [^].

NOTE: The submission system will use the iQIES value instead of STATE_PDPM_OBRA_CD in order to determine whether to enforce the b1 and b2 edits.
-3981 Skip pattern Fatal a) If A0050 (formerly X0100)=[2] and A0310B=[01,99], then the following items, when active, must not equal [^]: X0600A, X0600B, X0600F, X0600H.

b) If A0050 (formerly X0100)=[2] and A0310B=[08], then the following items, when active, must not equal [^]: X0600A, X0600B, X0600F.
-3985 Skip pattern Fatal A1250 skip pattern on SD ISC:

If A0200=[2] AND A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] then
the following subedits apply:

(a) If (A0310G=[1] AND A0310H=[1]) then the following items must not equal [^]: A1250A, A1250B, A1250C, A1250X, A1250Y.

(b) If (A0310G=[2] OR A0310H=[0]) then the following items must equal [^]: A1250A, A1250B, A1250C, A1250X, A1250Y.
-3986 Skip pattern Fatal A1250 skip pattern on NC and NQ ISCs:

If A0200=[1] AND A0310A=[01,02,03,04,05,06] AND A0310B=[01,99] AND A0310F=[10,11,99] then the following subedits apply:

(a) If A0310B=[01] OR (A0310G=[1] AND A0310H=[1]) then the following items must not equal [^]: A1250A, A1250B, A1250C, A1250X, A1250Y.

(b) If A0310B=[99] AND (A0310G=[2,^] OR A0310H=[0]) then the following items must equal [^]: A1250A, A1250B, A1250C, A1250X, A1250Y.
-3987 Skip pattern Fatal A1250 skip pattern on NPE, NP and SP ISCs:

If (A0310A=[99] AND A0310B=[99] AND A0310F=[99])
OR (A0310A=[99] AND A0310B=[01] AND A0310F=[10,11,99])
then the following items must not equal [^]: A1250A, A1250B, A1250C A1250X, A1250Y.
-3989 Skip pattern Fatal ***THIS EDIT WAS DELETED IN V3.02.0***
-3994 Skip pattern Fatal B1300 skip patterns:

NPE skip:
(a) If A0310A=[99] AND A0310B=[99] AND A0310F=[99], then if B1300 is active, it must not equal [^].

Otherwise:
(b) If B0100=[0] AND (A0310B=[01] OR (A0310G=[1] AND A0310H=[1])), then if B1300 is active, it must not equal [^].
(c) If B0100=[0] AND (A0310B=[99] AND (A0310G=[2,^] OR A0310H=[0])), then if B1300 is active, it must equal [^].
-4047 Skip pattern Fatal (a) If A0310A=[02,03,04,05,06,99] AND A0310B=[99], then the following items, when active, must be equal to [^]: GG0130A1, GG0130B1, GG0130C1, GG0130E1, GG0130F1, GG0130G1, GG0130H1, GG0130I1.

(b) If A0310A=[01] OR A0310B=[01], then the following items, when active, must not be equal to [^]: GG0130A1, GG0130B1, GG0130C1, GG0130E1, GG0130F1, GG0130G1, GG0130H1, GG0130I1.
-4048 Skip pattern Fatal ***THIS EDIT WAS DELETED IN V3.02.0***
-4049 Skip pattern Fatal (a) If A0310A=[02,03,04,05,06,99] AND A0310B=[99], then the following items, when active, must be equal to [^]: GG0170A1, GG0170B1, GG0170C1, GG0170D1, GG0170E1, GG0170F1, GG0170FF1, GG0170G1, GG0170I1, GG0170M1, GG0170P1, GG0170Q1.

(b) If A0310A=[01] OR A0310B=[01], then the following items, when active, must not be equal to [^]: GG0170A1, GG0170B1, GG0170C1, GG0170D1, GG0170E1, GG0170F1, GG0170FF1, GG0170G1, GG0170I1, GG0170M1, GG0170P1, GG0170Q1.
-4050 Skip pattern Fatal ***THIS EDIT WAS DELETED IN V3.02.0***
-4051 Skip pattern Fatal Skips for GG0130 items:

(a) IF A0200=[2] AND A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] AND (A0310G=[1,^] AND A0310H=[1] AND A2400C-A2400B>2 AND A2105=[01,02,03,05,06,07,08,09,10,11,12,13,99,^]), then the following items, when active, must not be equal to [^]: GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, GG0130H3, GG0130I3.
(b) IF A0200=[2] AND A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] AND (A0310G=[2] OR A0310H=[0] OR A2400C-A2400B<=2 OR A2105=[04]) then the following items, when active, must be equal to [^]: GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, GG0130H3, GG0130I3.
(c) If A0310A=[99] and A0310B=[99] AND A0310F=[99] AND A0310H=[1] AND A0310G=[1,^] AND A2400C-A2400B>2, then the following items, when active, must not be equal to [^]: GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, GG0130H3, GG0130I3.
(d) If A0310A=[99] and A0310B=[99] AND A0310F=[99] AND A0310H=[1] AND (A0310G=[2] OR A2400C-A2400B<=2) then the following items, when active, must be equal to [^]: GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, GG0130H3, GG0130I3.

Otherwise, if subedits a through d do not apply because the ISC is not SD or NPE, then the following edits apply:

(e) If A0310F=[01,12,99] AND A0310H=[0], then the following items, when active, must be equal to [^]: GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, GG0130H3, GG0130I3.
(f) If A0310F=[10,11] OR A0310H=[1], then the following items, when active, must not be equal to [^]: GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, GG0130H3, GG0130I3.
-4052 Skip pattern Fatal Skips for GG0170 items:

(a) IF A0200=[2] AND A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] AND (A0310G=[1,^] AND A0310H=[1] AND A2400C-A2400B>2 AND A2105=[01,02,03,05,06,07,08,09,10,11,12,13,99,^]), then the following items, when active, must not be equal to [^]: GG0170A3, GG0170B3, GG0170C3, GG0170D3, GG0170E3, GG0170F3, GG0170FF3, GG0170G3, GG0170I3, GG0170M3, GG0170P3, GG0170Q3.
(b) IF A0200=[2] AND A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] AND (A0310G=[2] OR A0310H=[0] OR A2400C-A2400B<=2 OR A2105=[04]) then the following items, when active, must be equal to [^]: GG0170A3, GG0170B3, GG0170C3, GG0170D3, GG0170E3, GG0170F3, GG0170FF3, GG0170G3, GG0170I3, GG0170M3, GG0170P3, GG0170Q3.
(c) If A0310A=[99] and A0310B=[99] AND A0310F=[99] AND A0310H=[1] AND A0310G=[1,^] AND A2400C-A2400B>2, then the following items, when active, must not be equal to [^]: GG0170A3, GG0170B3, GG0170C3, GG0170D3, GG0170E3, GG0170F3, GG0170FF3, GG0170G3, GG0170I3, GG0170M3, GG0170P3, GG0170Q3.
(d) If A0310A=[99] and A0310B=[99] AND A0310F=[99] AND A0310H=[1] AND (A0310G=[2] OR A2400C-A2400B<=2) then the following items, when active, must be equal to [^]: GG0170A3, GG0170B3, GG0170C3, GG0170D3, GG0170E3, GG0170F3, GG0170FF3, GG0170G3, GG0170I3, GG0170M3, GG0170P3, GG0170Q3.

Otherwise, if subedits a through d do not apply because the ISC is not SD or NPE, then the following edits apply:

(e) If A0310F=[01,12,99] AND A0310H=[0], then the following items, when active, must be equal to [^]: GG0170A3, GG0170B3, GG0170C3, GG0170D3, GG0170E3, GG0170F3, GG0170FF3, GG0170G3, GG0170I3, GG0170M3, GG0170P3, GG0170Q3.
(f) If A0310F=[10,11] OR A0310H=[1], then the following items, when active, must not be equal to [^]: GG0170A3, GG0170B3, GG0170C3, GG0170D3, GG0170E3, GG0170F3, GG0170FF3, GG0170G3, GG0170I3, GG0170M3, GG0170P3, GG0170Q3.
-4053 Skip pattern Fatal (a) If (A0310A=[02,03,04,05,06] AND A0310B=[01]) OR (A0310A=[01,99] AND A0310B=[01,99]), then the following items, when active, must be equal to [^]:
GG0130A5, GG0130B5, GG0130C5, GG0130E5, GG0130F5, GG0130G5, GG0130H5, GG0130I5.

(b) If (A0310A=[02,03,04,05,06] AND A0310B=[99]) OR A0310B=[08], then the following items, when active, must not be equal to [^]: GG0130A5, GG0130B5, GG0130C5, GG0130E5, GG0130F5, GG0130G5, GG0130H5, GG0130I5.
-4054 Skip pattern Fatal (a) If (A0310A=[02,03,04,05,06] AND A0310B=[01]) OR (A0310A=[01,99] AND A0310B=[01,99]), then the following items, when active, must be equal to [^]:
GG0170A5, GG0170B5, GG0170C5, GG0170D5, GG0170E5, GG0170F5, GG0170FF5, GG0170I5, GG0170Q5.

(b) If (A0310A=[02,03,04,05,06] AND A0310B=[99]) OR A0310B=[08], then the following items, when active, must not be equal to [^]: GG0170A5, GG0170B5, GG0170C5, GG0170D5, GG0170E5, GG0170F5, GG0170FF5, GG0170I5, GG0170Q5.
-4059 Skip pattern Fatal D0700 skip patterns:

(a) If A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] and A0310G=[1] and B0100=[0] then if D0700 is active, it must not equal [^].
(b) If A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] and A0310G=[2] then if D0700 is active, it must equal [^].
-4060 Skip pattern Fatal K0520 Column 1 skip patterns:

(a) If A0310B=[01], then the following items, if active, must not equal [^]: K0520A1, K0520B1, K0520C1, K0520D1 and K0520Z1.
(b) If A0310B=[99], then the following items, if active, must equal [^]: K0520A1, K0520B1, K0520C1, K0520D1 and K0520Z1.
-4062 Skip pattern Fatal O0110 Column 1 skip patterns:

(a) If A0310B=[01], then the following items, if active, must not equal [^]: O0110A1A, O0110B1A, O0110C1A, O0110D1A, O0110E1A, O0110F1A, O0110G1A, O0110H1A, O0110I1A, O0110J1A, O0110O1A, O0110Z1A.

(b) If A0310B=[99], then the following items, if active, must equal [^]:
O0110A1A, O0110B1A, O0110C1A, O0110D1A, O0110E1A, O0110F1A, O0110G1A, O0110H1A, O0110I1A, O0110J1A, O0110O1A, O0110Z1A.
-4064 Skip pattern Fatal A1250 skip pattern on ND ISC:

If A0200=[1] AND A0310A=[99] AND A0310B=[99] AND A0310F=[10,11] then the following subedits apply:

(a) If (A0310G=[1] AND A0310H=[1]) then the following items must not equal [^]: A1250A, A1250B, A1250C, A1250X, A1250Y.

(b) If (A0310G=[2] OR A0310H=[0]) then the following items must equal [^]: A1250A, A1250B, A1250C, A1250X, A1250Y.
-4067 Skip pattern Fatal O0400E2 on NQ and NP assessments:

If A0310A=[02,06] OR (A0200=[1] AND A0310A=[99] AND
A0310B=[01]), AND O0400E1 is not active, then O0400E2 must not equal [^].
-4066 Skip pattern Fatal O0400D2 on NQ, NP, SP, and IPA assessments:

If A0310A=[02,06] OR (A0310A=[99] AND A0310B=[01]) OR
A0310B=[08], AND O0400D1 is not active, then O0400D2 must not equal [^].
-4070 Skip pattern Fatal A2121, A2123 skip patterns:

(a) If A0310H=[1] and A2105=[01,99], then A2121, if active, must equal [^] and A2123, if active, must not equal [^].

(b) If A0310H=[1] and A2105=[02,03,04,05,06,07,08,09,10,11,12], then A2121, if active, must not equal [^] and A2123, if active, must equal [^].

(c) If A0310H=[0], then the following items, if active, must equal [^]: A2121, A2123.

(d) If A0310H=[1] and A2105=[^], then A2121, if active, must equal [^] and A2123, if active, must equal [^].
-4071 Skip pattern Fatal D0700 skip patterns:

(a) If A0310A=[99] AND A0310B=[99] AND A0310F=[99] AND B0100=[0] then if D0700 is active, it must not equal [^].
(b) If A0310A=[99] AND A0310B=[01] AND B0100=[0] then if D0700 is active, it must not equal [^].
(c) If A0310A=[01,02,03,04,05,06] AND A0310B=[01,99] AND B0100=[0] then if D0700 is active, it must not equal [^].

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Generated: 03/04/2024 10:13:44 PM