August 28, 2023 | Net Health

9 min read

Unlocking Section GG: Answers to the Burning Regulatory Questions

Unlocking Section GG

Is Section GG making your head hurt? Net Health Optima  is offering a regulatory remedy.

We’re answering the top thirteen questions about Section GG , so you can avoid frustration and wasted time searching for answers. Share this with you rehab therapy and occupational therapy clinicians in your Post Acute setting Care facility or home health agency for easy post-acute setting education! In the age of value based care, understanding changes from MDS, proper scoring section gg (or proper scoring section g) are critical.

Q: Who is responsible for completing MDS Section GG? 

A: The Impact Act mandated that the Centers for Medicare & Medicaid Services (CMS) establish a Quality Reporting System (QRP) around section GG, impacting rehab therapy and occupational therapy, wherein each long term care or SNF must submit data on quality measures.

CMS created Section GG to capture the required quality measures for functional data reporting in post acute care settings.

Thus, the Skilled Nursing Facility (SNF) providing medicaid services is ultimately responsible for completing Section GG. This applies to home health agencies or any post acute settings offering rehab therapy services. However, due to the nature of the requirements around data collection, all core staff in post acute care and long term care settings (including therapy) working with patients will be affected.

This applies to physical therapists and occupational therapy services at inpatient rehabilitation and skilled nursing facilities and post acute care settings.

Q: What patients should Section GG be completed on? 

A: Section GG must be completed on Medicare part A PPS patients in inpatient rehabilitation facilities and SNF or post acute care settings.

Q: Should Section GG only be completed once? 

A: No. Section GG must be completed on the Evaluation, as well as the planned Discharge. This applies to physical therapists and occupational therapists alike.

Q: In what context should Section GG MDS be completed? (Many patients perform better in a therapy setting than they do in a nursing unit.)

A: Per CMS, providers should refer to facility, Federal and State policies and procedures to determine which staff members may complete Section GG. Namely this will be of importance to your rehab therapy providers at post acute care and inpatient rehab facilities.

Since a functional assessment Section GG score is based on the usual performance of the patient, the data collection may be completed with input from nursing staff and/or physical or occupational therapy professionals; the assessment is based upon direct observation, patient self-report and direct care staff reports.

Your interdisciplinary team of physical and occupational therapy pros in inpatient rehabilitation facilities (physical therapy, occupational therapy) offering any level of assistance in post acute care and inpatient rehab facilities should do a standardized assessment.

Q: How does CMS define usual performance?

A: The draft RAI manual defines usual performance (also referred to as baseline performance) as the resident’s usual activity or performance for any of the self care or mobility activities, NOT the most independent or dependent performance. Another important facet of section GG that should be noted by physical therapists and occupational therapy providers.

Per CMS (during the SNF QRP training on June 21 – June 22, 2016), while the assessment period is the first and last three days of the SNF Medicare Part A PPS stay, reporting should reflect the patient’s admission status as close to day one as possible.

Q: When the patient is admitted to the SNF, do providers need to assess each self care and mobility Section GG item on every shift, across the first three days of the stay? 

A: No. During the SNF QRP training on June 21 – June 22, 2016, CMS training professionals confirmed that the data reporting expectation is the patient’s usual performance (i.e. admission status) and functional status as close to day one as possible. The data collection should provide a general picture of the patient’s baseline function before any improvement occurs.

Q: Who should determine the discharge goal? 

A: The QRP measure requires care plan data for each patient. This requirement is met by documenting at least one discharge goal item on Section GG for at least one self care or mobility item. The discharge goal does not have to be created by therapy (in some cases, that would not be appropriate) and should be based on results of the initial Section GG assessment and collaboration with the care plan team.

Q: Do I have to complete the CARE Item Set to comply with Section GG? 

A: No. Section GG is required by CMS but the CARE Item Set is not. Section GG does contain CARE items, which is why some therapy providers are choosing to require staff to complete the CARE Item Set as well.

Q: What are the differences between Section GG and the CARE Item Set? 

A: There are three main differences between Section GG and the CARE Item Set.

  • The definition of Dependent on the six-point scale: CMS added an additional caveat on Section GG that if assistance of more than one helper is required, then the task is scored as Dependent regardless of the percentage of assistance required.
  • Section GG has three numeric score options that can be used to classify the reasons for an activity not being attempted, whereas the CARE Item Set has four alpha scores.
  • Section GG includes a slightly different set of items than are used in the CARE Item Set.

Q: How do clinicians become CARE certified? 

A: Net Health Optima currently facilitates certification and CEU credits through its CARE Self Care and Mobility Item Sets curriculum, offered to physical and occupational therapists, as well as your interdisciplinary team. Contact Net Health to learn more about this curriculum and the assistance provided.

Q: What are the benefits of participating in CARE? 

A: Participating in CARE will allow you to contribute data to a national repository during a standardized assessment, giving you the opportunity to compare your organization to other providers. Plus, since clinician certification is required, you can trust the validity of the data.

Q: What should I expect from my vendor? 

A: Your vendor should ensure that the software enables you to implement Section GG requirements in the most efficient manner for your organization. This will vary depending on your unique needs, but at a minimum your vendor should:

  • Have facility-level configurability options regarding which patients your therapy staff will complete Section GG on, including:
  • All Medicare A PPS patients
  • Medicare A PPS therapy patients only
  • No patients
  • Allow for integrated CARE, Section GG MDS assessments and OBRA assessments
  • Create interoperability options that allow for read-only access of Section GG
  • Upon evaluation it make reporting available so you can understand what your data says about your performance and patient care

More on Section GG items

Understanding and leveraging Section GG scoring is pivotal for enhancing patient outcomes, streamlining therapy evaluation, recording accurate information in long term care hospitals and home health visits, and ensuring compliance for Medicare beneficiaries.

This universal language of GG terms not only bridges communication gaps among healthcare professionals but also sets a standard for measuring functional mobility and patient progress, including improved functional abilities.

As occupational therapists and other direct care staff in skilled nursing facilities navigate through the complexities of medical conditions and daily living tasks, incorporating Section GG scoring into therapy evaluations becomes instrumental in capturing the essence of a patient’s journey towards recovery.

Learn about Medicare’s 8 Minute Rule and How it Effects Your Rehab Therapy Operations

What is Functional Independence Measure (FIM)?

The Functional Independence Measure (FIM) assesses patient disability to inform practitioners how much assistance they’ll need to perform common daily tasks. The FIM is based on the International Classification of Impairment, Disabilities, and Handicaps (ICDH). Determining this will help gauge how much a helper assists or helper lifts off the patient’s plate, as well as how much assistance a patient may need in your facility. Medicare and medicaid services will thank you. Do not jump directly into strenuous activity prior to determining this. Also pay attention to verbal cues and any lower body impairment a patient may be displaying.

More on Section GG scoring, section GG items and section G.

Incorporating self care items into the assessment process through Section GG scoring is crucial for painting a comprehensive picture of a resident’s functional status. By systematically evaluating self care items, healthcare providers can pinpoint specific areas where residents might be struggling, whether it’s with basic hygiene, dressing, or eating.

These evaluations are integral to developing personalized care plans that address each resident’s unique needs. Moreover, section GG items provide emphasis on self care and mobility ensure that both physical and everyday practical abilities are taken into account, offering a holistic approach to improving the residents’ quality of life and encouraging staff routinely assess in ongoing evaluation.

The GG items, including those focused on mobility terms, play a pivotal role in assessing and documenting the residents’ functional status. By leveraging both self care items and mobility terms, therapists and care staff are equipped to make informed decisions regarding the most appropriate interventions. This dual focus ensures that all aspects of a resident’s ability to navigate their environment and perform daily tasks are considered.

Furthermore, tracking progress on GG items over time allows for adjustments to care plans, ensuring they remain aligned with the residents’ evolving needs. The inclusion of these GG items in routine evaluations underscores the importance of a comprehensive approach to assessing and improving the residents’ functional status, ultimately enhancing their overall well-being and independence.

GG items and Medicare Beneficiaries

For Medicare beneficiaries, the accurate application of Section GG scoring ensures that their functional mobility, oral hygiene, functional cognition, mobility items, environmental limitations and other safety concerns are assessed with the utmost precision within GG items. This assessment is crucial as it directly influences the care plan, including the tailored activities and interventions aimed at improving their quality of life.

The role of the occupational therapist, in this context of GG items, extends beyond traditional therapy; they become advocates for the patient, utilizing GG terms to accurately reflect the patient’s capabilities and areas needing improvement. This detailed assessment aids in monitoring progress and ability for self care, particularly in the realms of functional mobility and cognition, essential components for achieving independence despite a potentially limiting medical condition.

Functional Cognition

Functional cognition, a term frequently intertwined with Section GG scoring, deserves special attention. It represents the cognitive processes necessary for planning, executing, and managing daily living tasks. For Medicare beneficiaries, demonstrating improvement in functional cognition can significantly impact their ability to perform daily activities independently, making your MDS assessment a factor in improved patient outcomes, despite any functional limitation a patient may have had.

Hence, incorporating GG terms related to functional cognition into evaluations provides a comprehensive view of the patient’s capabilities, fostering a targeted approach to enhance their daily living skills.


In conclusion, Section GG scoring serves as a keystone in the realm of post-acute care, especially for Medicare beneficiaries. It offers a universal language that encapsulates the core elements of functional mobility, self care progress, and functional cognition. Keeping an eye on self care items is crucial.

By diligently applying GG terms in MDS assessments, occupational therapists and direct care staff can offer more personalized, effective care plans that cater to the unique needs of each patient. This collaborative approach not only champions the well-being of Medicare beneficiaries but also propels the healthcare sector towards a more integrated, patient-centered model of care.

Share this post

Subscribe and See More