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
Medicare Stay
Item Rationale
Matrix review
6 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 0
No
if the resident has not had a Medicare Part A covered stay since the most recent admission/entry or reentry. Skip to B0100, Comatose.
Code 1
Yes
if the resident has had a Medicare Part A covered stay since the most recent admission/entry or reentry. Continue to A2400B.
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section A and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page A-57
- CMS exact locator: Manual page A-57
- 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 A-57
CMS exact locator
Manual page A-57
Full CMS Text
Item Rationale
Identifies when a resident is receiving services under the scheduled PPS. Identifies when a resident’s Medicare Part A stay begins and ends.
Coding Instructions for A2400A, Has the
Resident Had a Medicare-covered Stay since the Most Recent Entry?
Code 0, no: if the resident has not had a Medicare
Part A covered stay since the most recent admission/entry or reentry. Skip to B0100, Comatose.
Code 1, yes: if the resident has had a Medicare Part
A covered stay since the most recent admission/entry or reentry. Continue to A2400B.
Coding Instructions for A2400B, Start of Most
Recent Medicare Stay Code the date of day 1 of this Medicare stay if A2400A is coded 1, yes.
Coding Instructions for A2400C, End Date of
Most Recent Medicare Stay Code the date of last day of this Medicare stay if A2400A is coded 1, yes.
DEFINITIONS
MOST RECENT MEDICARE STAY This is a Medicare Part A covered stay that has started on or after the most recent admission/entry or reentry to the nursing facility. MEDICARE-COVERED STAY Skilled Nursing Facility stays billable to Medicare Part A. Does not include stays billable to Medicare Advantage HMO plans. CURRENT MEDICARE STAY NEW ADMISSION: Day 1 of Medicare Part A stay. READMISSION: Day 1 of Medicare Part A coverage after readmission following a discharge. If the Medicare Part A stay is ongoing, there will be no end date to report. Enter dashes to indicate that the stay is ongoing. The end of Medicare date is coded as follows, whichever occurs first: — Date SNF benefit exhausts (i.e., the 100th day of the benefit); or — Date of last day covered as recorded on the effective date from the Notice of Medicare Non-Coverage (NOMNC); or — The last paid day of Medicare A when payer source changes to another payer (regardless if the resident was moved to another bed or not); or — Date the resident was discharged from the facility (see Item A2000, Discharge Date).
Coding Tips and Special Populations
When a resident on Medicare Part A returns following a therapeutic leave of absence or a hospital observation stay of less than 24 hours (without hospital admission), this is a continuation of the Medicare Part A stay, not a new Medicare Part A stay. When a resident on Medicare Part A has an interrupted stay (i.e., is discharged from SNF care and subsequently readmitted to the same SNF within the interruption window after the discharge), this is a continuation of the Medicare Part A stay, not a new Medicare Part A stay. The End Date of the Most Recent Medicare Stay (A2400C) may be earlier than the actual Discharge Date (A2000) from the facility. If this occurs, the Part A PPS Discharge assessment is required. If the resident subsequently physically leaves the facility, the OBRA Discharge assessment would be required. If the End Date of Most Recent Medicare Stay (A2400C) occurs on the day of or one day before the Discharge Date (A2000), the OBRA Discharge assessment and Part A PPS Discharge assessment are both required and must be combined. When the OBRA and Part A PPS Discharge assessments are combined, the ARD (A2300) must be equal to the Discharge Date (A2000). If the End Date of Most Recent Medicare Stay (A2400C) occurs on the same day that the resident dies, a Death in Facility Tracking Record is completed, with the Discharge Date (A2000) equal to the date the resident died. In this case, a Part A PPS Discharge assessment is not required. For a standalone Part A PPS Discharge assessment, the End Date of the Most Recent Medicare Stay (A2400C) must be equal to the ARD (Item A2300).
Examples
1. Resident G. began receiving services under Medicare Part A on October 14, 2021. Due to
their stable condition and ability to manage their medications and dressing changes, the facility determined that they no longer qualified for Part A SNF coverage and began planning their discharge. An Advanced Beneficiary Notice (ABN) and an NOMNC with the last day of coverage as November 23, 2021 were issued. Resident G. was discharged home from the facility on November 24, 2021. Code the following on their combined OBRA and Part A PPS Discharge assessment: A0310F = 10 A0310G = 1 A0310H = 1 A2000 = 11-24-2021 A2105 = 01 A2300 = 11-24-2021 A2400A = 1 A2400B = 10-14-2021 A2400C = 11-23-2021 Rationale: Because Resident G’s last day covered under Medicare was one day before their physical discharge from the facility, a combined OBRA and Part A PPS Discharge was completed.
2. Resident N began receiving services under Medicare Part A on December 11, 2021. They
were unexpectedly sent to the emergency department on December 19, 2021 at 8:30 p.m. and were not admitted to the hospital. They returned to the facility on December 20, 2021, at 11:00 a.m. Upon Resident N’s return, their physician’s orders included significant changes in their treatment regime. The facility staff determined that an Interim Payment Assessment (IPA) was indicated as the PDPM nursing component was impacted. They completed the IPA with an ARD of December 24, 2021. Code the following on the IPA: A2400A = 1 A2400B = 12-11-2021 A2400C = ---------- Rationale: Resident N was out of the facility at midnight but returned in less than 24 hours and was not admitted to the hospital, so was considered LOA. Therefore, no Discharge assessment was required. Their Medicare Part A Stay is considered ongoing; therefore, the date in A2400C is dashed.
3. Resident R. began receiving services under Medicare Part A on October 15, 2021. Due to
complications from their recent surgery, they were unexpectedly discharged to the hospital for emergency surgery on October 20, 2021, but are expected to return within 30 days. Code the following on their OBRA Discharge assessment: A0310F = 11 A0310G = 2 A0310H = 1 A2000 = 10-20-2021 A2105 = 03 A2300 = 10-20-2021 A2400A = 1 A2400B = 10-15-2021 A2400C = 10-20-2021 Rationale: Resident R’s physical discharge to the hospital was unplanned, yet it is anticipated that they will return to the facility within 30 days. Therefore, only an OBRA Discharge was required. Even though only an OBRA Discharge was required, when the Date of the End of the Medicare Stay is on the day of or one day before the Date of Discharge, MDS specifications require that A0310H be coded as 1.
4. Resident K began receiving services under Medicare Part A on October 4, 2021. They
were discharged from Medicare Part A services on December 17, 2021. They and their family had already decided that Resident K would remain in the facility for long-term care services, and they were moved into a private room (which was dually certified) on December 18, 2021. Code the following on their Part A PPS Discharge assessment: A0310F = 99 A0310G = ^ A0310H = 1 A2000 = ^ A2105 = ^ A2300 = 12-17-2021 A2400A = 1 A2400B = 10-04-2021 A2400C = 12-17-2021 Rationale: Because Resident K’s Medicare Part A stay ended, and they remained in the facility for long-term care services, a standalone Part A PPS Discharge was required.
5. Resident W began receiving services under Medicare Part A on November 15, 2021.
Their Medicare Part A stay ended on November 25, 2021, and they were unexpectedly discharged to the hospital on November 26, 2021. However, they are expected to return to the facility within 30 days. Code the following on their OBRA Discharge assessment: A0310F = 11 A0310G = 2 A0310H = 1 A2000 = 11-26-2021 A2105 = 03 A2300 = 11-26-2021 A2400A = 1 A2400B = 11-15-2021 A2400C = 11-25-2021 Rationale: Resident W’s Medicare stay ended the day before discharge and they are expected to return to the facility within 30 days. Because their discharge to the hospital was unplanned, only an OBRA Discharge assessment was required. Even though only an OBRA Discharge was required, when the Date of the End of the Medicare Stay is on the day of or one day before the Date of Discharge, MDS specifications require that A0310H be coded as 1. Medicare Stay End Date Algorithm A2400C Is the resident's Medicare stay ongoing? Enter dashes Yes Did the resident's SNF benefit exhaust? Enter the date of the last covered day, i.e., the 100th day Yes Was a generic notice issued to the resident? Enter the effective date on the Generic Notice for last covered day* Yes Did the resident's payer source change from Part A to another payer? Enter the date of the last paid day of Medicare A Yes Enter the date resident was discharged from facility *if resident leaves facility prior to last covered day as recorded on the generic notice, enter date resident left facility. Intent: The intent of items in this section is to document whether the resident is comatose, the resident’s ability to hear (with assistive hearing devices, if they are used), understand, and communicate with others, and the resident’s ability to see objects nearby in their environment.
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
NPE - PPS DC
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
NHQI Quality Measures
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Administrative (Tech Need / Edits / Processing)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP Quality Measures (Includes risk adjustment)
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
Shared NH/SB Subsets
IPA - Interim Payment
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NT / ST - Tracking
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
Item Subset Required Use ISC Skip Patterns
QRP PPS DC (A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4