Section GG is a standardized functional assessment tool mandated by the Centers for Medicare & Medicaid Services (CMS) to measure a patient’s independence in daily activities. This collection of data elements provides a common language for healthcare providers to describe a patient’s ability to perform specific tasks. It plays a foundational role in post-acute care settings, establishing a patient’s baseline performance upon admission and tracking their progress toward recovery. The assessment is designed to capture a patient’s “usual performance,” reflecting how they typically complete an activity rather than their best or worst attempt.
What Section GG Measures and Where It Applies
Its implementation was mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, with the goal of standardizing data collection to allow for meaningful comparisons of patient outcomes across different types of facilities. The assessment focuses on a patient’s actual performance of daily activities.
This standardized section is incorporated into the required assessment tools for various healthcare environments. By using a single set of measures across these settings, CMS aims to ensure seamless care transitions and consistent quality measurement.
- Skilled Nursing Facilities (SNFs) using the Minimum Data Set (MDS).
- Home Health Agencies using the Outcome and Assessment Information Set (OASIS).
- Inpatient Rehabilitation Facilities (IRFs) via the Patient Assessment Instrument (IRF-PAI).
- Long-Term Care Hospitals (LTCHs).
The assessment collects information on a patient’s functional status, including their ability to perform activities before their current illness or injury. It measures a patient’s need for assistance across two main categories: self-care and mobility. This data provides clinicians with a comprehensive picture of the patient’s functional baseline and helps inform the development of an effective care plan.
Decoding the Functional Assessment Scale
The core of Section GG lies in its 6-point scoring scale, which assesses the level of human assistance a patient requires to complete a given activity. The scale ranges from 06, indicating complete independence, down to 01, signifying total dependence. Higher scores consistently reflect greater functional ability and less reliance on a helper.
The two primary domains assessed are Self-Care and Mobility, each comprising multiple distinct activities.
Self-Care Activities
- Eating.
- Oral hygiene.
- Toileting hygiene.
- Upper body dressing.
- Lower body dressing.
Mobility Activities
- Rolling in bed.
- Moving from a lying to a sitting position.
- Transferring from a chair or toilet.
- Walking various distances.
The scoring definitions are highly specific, differentiating between levels of effort provided by the patient and the helper.
A score of 06, “Independent,” means the patient safely completes the activity alone without any assistance. A score of 05, “Setup or Cleanup Assistance,” is assigned when the helper only assists before or after the activity, such as setting up a meal tray.
A score of 04, “Supervision or Touching Assistance,” is given if the helper provides verbal cues, steadying, or light contact guard to ensure safety. For a score of 03, “Partial/Moderate Assistance,” the patient performs more than half the effort, while the helper provides the remaining support.
A score of 02, “Substantial/Maximal Assistance,” means the helper provides more than half the effort to complete the task. A score of 01, “Dependent,” is coded when the helper performs all the effort, or if two or more helpers are required to safely complete the activity. Codes also exist for activities not attempted due to medical conditions, environmental limitations, or patient refusal.
How the Scores Influence Care Planning and Facility Funding
The numerical results from Section GG are integrated into complex payment models that determine a facility’s reimbursement from Medicare. For Skilled Nursing Facilities, the scores are a major component of the Patient-Driven Payment Model (PDPM), affecting nursing, physical therapy, and occupational therapy. In home health, the scores contribute to the Patient-Driven Groupings Model (PDGM) classification.
The aggregated scores directly influence the level of resources and staffing allocated to the patient. Higher scores indicate a more independent patient, which impacts the facility’s classification and the daily reimbursement rate it receives. Accurate coding of Section GG is paramount for both appropriate patient care and facility solvency due to this financial link.
The scores are foundational to the patient’s rehabilitation and care planning. The admission score establishes the patient’s functional baseline, and discharge goals are set based on expected improvement. The difference between the admission and discharge scores serves as a measurable metric of the patient’s functional progress and the overall effectiveness of the care provided. This data is also used by CMS for quality reporting.
The Patient’s Experience During Assessment
The Section GG assessment is an interdisciplinary effort, typically conducted by nurses and therapists during the first three days of a patient’s admission. This short look-back period ensures that the assessment captures the patient’s functional status before the full effects of treatment begin. Qualified clinicians gather information through direct observation, reviewing medical records, and gathering input from the patient, family, and care staff.
Patients should understand that the score reflects their “usual performance,” meaning how they typically manage an activity more than half the time. Patients should accurately communicate their typical level of assistance, rather than trying to perform at their highest or lowest ability level during the assessment period. This focus ensures the score is an accurate representation of the patient’s needs for daily life and helps shape their individual care plan and rehabilitation goals.