Ftag of the Week – F688 Increase/Prevent Decrease in ROM/Mobility (Pt. 2)

In Part 1 of our “Ftag of the Week” series on the CMSCG Blog, we reviewed the regulatory requirements for F688, key definitions, and the list of policies that providers need to have in place for compliance. Now we’ll review assessments, a key part of this regulation.


The regulation includes Interpretive Guidance for both range of motion and mobility. As part of the comprehensive assessment for either of these, resident-specific risks must be identified. These risks could include, but are not limited to:

  • Immobilization
  • Neurological conditions which cause functional limitations
  • Clinical conditions (i.e., surgical procedure including amputation or immobilized limb/digit due to fracture or other injury)
  • Any condition where movement may result in pain, spasm or loss of movement

Range of Motion Assessment

Per the Interpretive Guidance (IG) in Appendix PP of the State Operations Manual (SOM), the comprehensive assessment for range of motion should include, and measure (as appropriate):

  • Current extent of joint movement
  • Identification of limitations, if any
  • Identification of opportunities for improvement

The assessment should also address previous treatment/services for ROM, including:

  • If the resident maintained his/her ROM after treatment
  • If ROM declined
  • Why the treatment/services were discontinued

The assessment for a resident with limited ROM who is not receiving services must also address why he/she is not receiving treatment/services.

Mobility Assessment

The IG also indicates what should be included in the comprehensive assessment for mobility. The resident’s current mobility status, limitations and opportunities for improvement, if any, should be addressed and measured in the assessment. The assessment should also address:

  • Previous treatment and services provided for mobility
  • If the resident maintained his/her mobility
  • If there was a decline in the resident’s mobility
  • Why the treatment/services were discontinued

Like the ROM assessment, for a resident who has limited mobility but is not receiving treatment/services, the reason services are not being provided should be indicated.

Compliance Reminder

CMSCG President Linda Elizaitis, RN, BS, RAC-CT, CDS shared the following compliance reminder regarding assessments:

While you are thinking about assessments that must be done, I am hoping that you remind your staff of their responsibility to promptly report a decline in ROM and/or mobility, just as they should any improvement. Remember that you might have missed the boat if a decline in ROM or mobility is not identified until it is time to complete a routinely scheduled MDS assessment. Review the plan of care and determine if staff were carrying it out. Did no one see all of the charting omissions or refusals for ROM or ambulation? What would your staff say during a recertification survey interview about any identified decline?

In Part 3 of our Ftag of the Week series for F688, we’ll review care planning and offer some tips on issues that could result in a deficient practice being identified on survey.

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