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The Centers for Medicare & Medicaid Services (CMS) assessments have long been the standards for determining the quality of care, patient needs, and the financial dynamics of care facilities. It then follows that, as these assessments evolve, so must the strategies and approaches of those who work in long-term care. This is particularly the case with Section GG

Starting October 1, 2023, the CMS will shift its primary focus from Section G to Section GG. This transition underscores the agency’s commitment to staying updated with the changing needs of the healthcare sector. 

What does this shift mean for long-term care facilities across the nation? As part of this transition, Section G will be completely removed from the CMS framework, reflecting the agency’s intent to streamline its processes and prioritize areas that have a more direct impact on patient care and provider operations.

Also, while previously centered around therapy, Section GG will now be centered on the role of the Certified Nursing Assistant (CNA). This is a testament to the vital role CNAs play in the healthcare ecosystem today. Moreover, it’s worth noting that Section GG will now also count towards financial considerations, emphasizing the economic importance of CNAs in the healthcare system.

GG Scoring Explained

Understanding Section GG scoring can help ensure that long-term care professionals adapt their facility operations accordingly. However, before we dive into the scoring, it is worth mentioning the six elements of Section GG. These are: 

A long-term care administrator reading documentation on CMS' Section GG
Understanding Section GG scoring can help ensure that long-term care professionals adapt their facility operations accordingly.
  1. Independent: This signifies that the patient can perform activities without any assistance; they are self-reliant and do not require any external help.
  2. Setup/Cleanup Assistance: Here, the patient can perform the activity, but they need someone to prepare or clean up after the task is completed.
  3. Supervision/Touching Assistance: This indicates that while the patient can carry out the activity, they need supervision or minor physical assistance to ensure safety.
  4. Partial/Moderate Assistance: These patients require more hands-on help. They can do a part of the activity—but not the entirety of it—on their own.
  5. Substantial/Maximal Assistance: Patients falling under this element need significant assistance. They might be able to initiate the activity but require substantial help to complete it.
  6. Dependent: This is the highest level of assistance. Here, the patient is entirely reliant on someone else to perform the activity for them.

Having understood the different elements of Section GG, we can now look into how Section GG scoring works. Under Section GG, every post-acute setting now incorporates specific process measures to gauge the organization’s efficiency in collecting these items. 

One of the standout measures is the Functional Assessment and Care Plan. This measure provides insights into the percentage of patients whose admission and discharge functional assessments were completed within the initial three days of their stay. Additionally, it checks if there’s a care plan in place that addresses function.

But that’s not all. The CMS has also greenlit four additional outcome measures, specifically for the Inpatient Rehab Facility (IRF) and Skilled Nursing Facility (SNF) settings. These are:

  • Change in Self-Care Score
  • Change in Mobility Score
  • Discharge Self-Care Score
  • Discharge Mobility Score

Accuracy in Section GG scoring is not just a recommendation; it’s a necessity. Therapists and nurses need to be well-versed in the definitions of each Section GG item and the associated rating system. Any lapses in accurate scoring can have negative repercussions, potentially diminishing outcomes and impacting future payments.

Contact us here if you’d like to explore a comprehensive software designed to ensure accurate Section GG scoring and enhance outcomes in long-term care.

Section GG Codes: A Quick Look

One of the standout features of Section GG codes and coding is their ability to assess a person’s functioning before the onset of their current illness or injury. However, Section GG coding isn’t a one-size-fits-all system. Instead, it employs a nuanced 6-level rating scale, which is coded by qualified clinicians. 

A nurse using the new Section GG scoring in a patient's record
One of the advantages of Section GG codes and coding is that they help assess a person’s functioning before the onset of their current illness or injury.

This 6-level rating scale is meticulously designed to capture the varying degrees of a patient’s functionality. From complete independence to partial/moderate assistance to total dependence, each level on the scale paints a vivid picture of the resident’s current state. A higher score on the scale indicates a resident’s enhanced functionality and mobility. The closer a resident’s score is to the maximum on the scale, the more independent and mobile they are. 

At the forefront of ensuring precision in Section GG coding are Nurse Assessment Coordinators (NACs). These professionals shoulder the responsibility of guiding the interdisciplinary team, ensuring that the MDS section GG, which pertains to Functional Abilities and Goals, is coded with utmost accuracy.

Two items under Section GG scoring, namely GG0130 (Self-Care) and GG0170 (Mobility), demand particular attention. They play a decisive role in determining reimbursement rates under the Patient-Driven Payment Model (PDPM). And they are integral to the Skilled Nursing Facility Quality Reporting Program (SNF QRP). They not only contribute to the publicly reported quality measures but also dictate the data submission mandates that providers must adhere to. These items can impact both the quality of care and the financial health of long-term care facilities. 

To help with all this, the CMS offers long-term care staff the RAI User’s Manual—a comprehensive guide that offers insights into the coding process for Section GG.

What Section GG Means for Your Organization

Section GG is not just another bureaucratic checkbox. It’s a set of standardized patient assessment elements that were introduced by the Improving Post-Acute Care Transformation (IMPACT) Act of 2014. Designed for all post-acute care settings, these elements are meticulously crafted to measure functional changes in self-care and mobility. 

Residents at a facility where staff now fully understand how to use Section GG codes.
Section GG emerged as a solution by presenting a universal language that encapsulates functional ability.

Before the advent of Section GG, healthcare settings had unique data collection methods. Each came with its own set of definitions and rating scales. Naturally, this created confusion whenever a resident was transferred from one care setting to another, each setting interpreting the resident’s functional ability differently. 

Section GG emerged as a solution by presenting a universal language that encapsulates functional ability. The goal is to streamline communication across settings, decrease variability, standardize care, and lay the groundwork for a comprehensive comparison of patient types, outcomes, and costs.

The shift to Section GG is a call to action, a reminder of the ever-evolving nature of healthcare and the continuous need for adaptability, learning, and progress. As your long-term care facility and others embark on this journey, you must approach the transition with a spirit of collaboration, openness, and a commitment to excellence.

For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast.