Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
Error message
MDS Lookup
Reason Referral to Local Contact Agency (LCA) Not
Made (cont.)
Matrix review
5 matrix group(s) are already attached for review on this item.
Answer coverage
2 governed answer row(s) are attached for this item.
Answer Codes
Code 4
Discharge date 3 or fewer months away
if the resident has an expected discharge date of three (3) months or fewer, has an active discharge plan in progress, and the discharge pl...
Code 5
Discharge date more than 3 months away
if the resident has an expected discharge date of more than three (3) months and discharge plan is actively in progress.
What this item is
Made (cont.)
When to use it
Use this item when the facility is completing content tied to Section Q and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page Q-26
- CMS exact locator: Manual page Q-26
- This item has 2 governed answer row(s) attached.
Source awareness
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Source & Review
Manual
CMS MDS 3.0 RAI Manual v1.20.1
Status
Published
Effective start
2025-10-01
Item locator
Manual page Q-26
CMS exact locator
Manual page Q-26
Full CMS Text
Made (cont.) Code 4, Discharge date 3 or fewer months away: if the resident has an expected discharge date of three (3) months or fewer, has an active discharge plan in progress, and the discharge plan could not be improved upon with a referral to the LCA.
Code 5, Discharge date more than 3 months away: if the resident has an
expected discharge date of more than three (3) months and discharge plan is actively in progress.
Examples
1. Resident S has been in the nursing home for several months following an automobile
accident. They plan to return home after their therapy regime ends, which is expected in three to four weeks. In conjunction with Resident S’s Admission assessment, the facility team made a referral to the LCA but the agency is not currently working with the resident. The interdisciplinary team and the resident have developed a safe discharge plan for Resident S that could not be improved upon with a referral to the LCA.
Coding: Q0620 would be coded 4, Discharge date 3 or fewer months away.
Rationale: Resident S’s discharge is expected within three to four weeks, and their
discharge plan could not be improved upon with a referral to the LCA.
2. Resident J is unable to communicate verbally due to severe dementia. Their spouse met with
the care team, and the spouse and care team agree that long-term nursing home placement on the secure dementia unit is appropriate for Resident J. The spouse declined a referral to the LCA.
Coding: Q0620 would be coded 3, Referral not wanted.
Rationale: Resident J is unable to communicate verbally due to severe dementia. Their
spouse declined a referral to the LCA as they and the care team agree that long-term placement on the secure dementia unit is appropriate for Resident J. SECTION S IS RESERVED FOR ADDITIONAL STATE-DEFINED ITEMS. THERE IS NO SECTION S IN THE FEDERAL MDS VERSION 3.0 ITEM SET. YOUR STATE
MAY CHOOSE TO DESIGNATE A SECTION S.
Intent: The MDS does not constitute a comprehensive assessment. Rather, it is a preliminary assessment to identify potential resident problems, strengths, and preferences. Care Areas are triggered by MDS item responses that indicate the need for additional assessment based on problem identification, known as “triggered care areas,” which form a critical link between the MDS and decisions about care planning. There are 20 CAAs in Version 3.0 of the RAI, which includes the addition of “Pain” and “Return to the Community Referral.” These CAAs cover the majority of care areas known to be problematic for nursing home residents. The Care Area Assessment (CAA) process provides guidance on how to focus on key issues identified during a comprehensive MDS assessment and directs facility staff and health professionals to evaluate triggered care areas. The interdisciplinary team (IDT) then identifies relevant assessment information regarding the resident’s status. After obtaining input from the resident, the resident’s family, significant other, guardian, or legally authorized representative, the IDT decides whether or not to develop a care plan for triggered care areas. Chapter 4 of this manual provides detailed instructions on the CAA process and development of an individualized care plan. Whereas the MDS identifies actual or potential problem areas, the CAA process provides for further assessment of the triggered areas by guiding staff to look for causal or confounding factors, some of which may be reversible. It is important that the CAA documentation include the causal or unique risk factors for decline or lack of improvement. The plan of care then addresses these factors, with the goal of promoting the resident’s highest practicable level of functioning: (1) improvement where possible, or (2) maintenance and prevention of avoidable declines. Documentation should support your decision making regarding whether to proceed with a care plan for a triggered CAA and the type(s) of care plan interventions that are appropriate for a particular resident. Documentation may appear anywhere in the clinical record, e.g., progress notes, consults, flowsheets, etc.
Matrix Applicability
Nursing Home Subsets
NC - Comprehensive
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NQ - Quarterly
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
ND - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Swing Bed Subsets
SP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
SD - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
DC Planning / PASRR
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Discharge A=99, B=99, F=10, 11, G=1, 2, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
D/C Items (Only when A0310F = 10 or 11)
A0310G=1 PDC
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
A0310G=2 UPD
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4