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Functional Abilities and Goals (Section GG) Interim Payment Assessment

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SKU: 1897P-19

ALL residents receiving Part A skilled care on October 1, 2019 MUST have an IPA completed with an Assessment Reference Date (ARD) between 10/1 and 10/7/2019 in order for the facility to receive PPS reimbursement.  The IPA will be used after that week, following a 5-day PPS assessment, to report a change in the resident's PDPM classification.  Payment/reimbursement changes for the resident's care on the ARD date of the IPA and continues for the remainder of the skilled stay until and unless there is another IPA completed.



This worksheet is designed to record observation of the resident’s specific functional status for self-care and mobility during the 2 days prior as well as the Assessment Reference Date (ARD) of an Interim Payment Assessment (IPA).  The observational data is then encoded on Section GG of the MDS 3.0. 

ŸSteps for assessment and codes are clearly identified on the front of the worksheet
ŸDefinitions of Self-Care and Mobility feature graphical illustrations for ease of clinical identification
ŸSection GG Algorithm chart provided for accurate coding on the MDS 3.0

Download a sample today!

•  Size:  11” x 17” folding to 8-1/2” x 11” finished size

•  Format: 4-page booklet

•  Hole Punching:  5-hole top and side

•  Ink Color:  Black

•  Paper:  White

•  Packaging:  100/pack 

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