MD-Calvert Manor Healthcare Center

I understand the proposal to state that an EOT OMRA will be required if the patient goes 3 consecutive days without therapy services. Lets say the patient receives therapy Monday through Friday. No therapy is delivered on Saturday or Sunday. On Monday the patient is cranky and refuses therapy. We now have three days with no therapy service. On Tuesday the patient participates and all is well. The problem is, there was no other medical skilled service being provided during the 3 days with no therapy. Instead of an EOT OMRA and an EOT-R OMRA being completed, we would have to discharge the patient and re-admit them on Tuesday. We have this same issue under the current regualtions and it will continue under the proposed rule. My problem with this is that we have no way of generating an ABN and complying with the 48 hour notice currently required when the patient refuses therapy on Monday. Could further clarification and guidance be provided on how this issue should be handled with regards to providing the ABN timely?