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Licensing and Certification
State House Station #11
41 Anthony Avenue
Augusta Maine 04333
Telephone:
1-800-791-4080 or
(207)287-9300
TDD Number:
Maine relay 711
Section E: Behavior
Section E Intent:
The items in this section identify behavioral symptoms in the last seven days that may cause distress to the resident, or may be distressing or disruptive to facility residents, staff members or the care environment. These behaviors may place the resident at risk for injury, isolation, and inactivity and may also indicate unrecognized needs, preferences or illness. Behaviors include those that are potentially harmful to the resident himself or herself. The emphasis is identifying behaviors, which does not necessarily imply a medical diagnosis. Identification of the frequency and the impact of behavioral symptoms on the resident and on others is critical to distinguish behaviors that constitute problems from those that are not problematic. Once the frequency and impact of behavioral symptoms are accurately determined, follow-up evaluation and care plan interventions can be developed to improve the symptoms or reduce their impact.
This section focuses on the resident's actions, not the intent of his or her behavior. Because of their interactions with residents, staff may have become used to the behavior and may underreport or minimize the resident’s behavior by presuming intent (e.g., “Mr. A. doesn’t really mean to hurt anyone. He’s just frightened.”). Resident intent should not be taken into account when coding for items in this section. (CMS’s Resident Assessment Instrument (RAI) Manual, Chapter.
Select the topic to view or close the training information.
RAI Manual for MDS 3.0
The RAI Manual is CMS’s official guide to MDS 3.0. This manual contains six chapters plus appendices. Chapter 3 includes step-by-step instructions for completing each section of the MDS 3.0. Since Chapter 3 Section E: Behavior. The RAI Manual could take between 3 to 10 minutes to download.
Directions: When you follow the link below, you will open the
MDS 3.0 RAI Manual page on the
U.S. Department of Health and Human Service, Centers for Medicare and Medicaid Services (CMS) site. Once you are on this page, scroll to the download section. Select
MDS 3.0
RAI Manual.
MDS 3.0 Forms (Resident Assessment & Care Screening All Item Listing)
Directions: When you follow the link below, you will open the MDS 3.0 Technical Information page on the
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) site. Once you are on this page, scroll to the download section. Sometimes you may find two releases of the Item Subsets in the download section; you will need to pay attention to the dates to get the right one to meet your needs. Select
MDS 3.0 Item Subsets to download the files.
MDS 3.0 Coding Training Section
Instructor Guides
This link will take you to PDF files of PowerPoint Slides with Instructor Notes used in CMS Training of Trainers. You can go through this training material at your own pace. You may find it helpful to have a copy of the MDS 3.0 forms when you review this information. Please refer to the RAI Manual and CMS Transmittals of Changes.
Presentation Slides
This link will take you to the CMS PowerPoint Slides developed for Training of Trainers for Section E. This PowerPoint includes only the slides; it does not include trainer notes or audio of the training.
Supplemental Training Handouts
There are no supplemental training handouts or interview aids for Section E.
Training Vidoes
If you would like to see a one hour and thirty-seven minute video of the actual CMS Training of Trainers session on Section E: Behavior presented by Ann Spenard (held in August 2010) view this YouTube video.
For more training videos, this link will take you to a list of MDS 3.0 videos on YouTube; it is filtered by date. Beginning at the top, you can view the most videos that have been uploaded on the subject of MDS 3.0. Please note that several of the videos have been uploaded by CMSHHSGOV. While there are many videos on this YouTube channel, the videos posted by CMS would be most recommended by the State of Maine as this is the primary source of guidance on the MDS 3.0 from CMS.
Some things, such as interview techniques have not changed since the implementation of MDS 3.0 in 2011, other sections may not have current information.
CAAs and CATs
Certain responses to questions in the MDS 3.0 will point to conditions, symptoms and other areas of concern that need further assessment in order to help the facility develop a comprehensive individualized care plan. These responses will “trigger” (Care Area Trigger, CAT) the need to complete a Care Area Assessment ( CAA). Chapter 4 of the RAI Manual covers the Care Area Assessment (CAA) Process and Care Planning.
Directions: When you follow the link below, you will open the MDS 3.0 RAI Manual page located on the
U.S. Department of Health and Human Service, Centers for Medicaid and Medicare Services (CMS) site. Once you are on this page, scroll to the download section. Select
MDS 3.0
RAI Manual. See Chapter 4 in the
MDS 3.0
RAI Manual.
Link to CAAs and CATs material
Responses to the following Items in Section E: Behavior may trigger the facility to conduct a Care Area Assessment.
- E0200A (CAA2 – Cognitive Loss/Dementia, & CAA7 – Psychosocial Well-Being)
- E0200B (CAA2 – Cognitive Loss/Dementia, & CAA7 – Psychosocial Well-Being)
- E0200C (CAA2 – Cognitive Loss/Dementia)
- E0300 (CAA 9 – Behavioral Symptoms)
- E0800 (CAA2 – Cognitive Loss/Dementia, & CAA9 Behavioral Symptoms)
- E0900 (CAA2 – Cognitive Loss/Dementia, & CAA9 Behavioral Symptoms & CAA11 – Falls)
- E1100 (CAA9 – Behavioral Symptoms)
Additional, compound responses to the following sections of the MDS 3.0 can trigger a Care Area Assessment directly related to Section E: Behavior.
- I4800 (CAA7 – Psychosocial Well-Being)
- I4200 (CAA7 – Psychosocial Well-Being)
Case Mix
Long Term Care facilities receive reimbursement through two government programs: Medicare and MaineCare. Both programs reimburse Long Term Care facilities based on measures of the intensity of care and services required for each resident. Case Mix refers to the aggregate level of services and care needed by all the residents of a Long Term Care facility.
Medicare reimbursement is based on a category-based classification system called Resource Utilization Group IV (RUG-IV). Certain responses on the MDS 3.0 determine assignment of a resident to a RUG-IV group. Medicare reimbursement guidelines are the same all across the country.
Medicaid reimbursement rules and guidelines differ from state to state. Currently Maine's Medicaid program (called MaineCare) uses a Case Mix system that differs from the Medicare system.
CMS does not require the completion of C0600 and C0700. However, the State of Maine does require these items to be completed in order to calculate Case Mix payment.
Some questions in Section E: Behavior effect Case Mix for RUG-IV (Medicare) and RUG-III (MaineCare). Select the link below for a copy of the MDS 3.0 Item Subset that identifies relevant questions.
Link to MDS 3.0 Item Subset (10/01/2018)
