Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 45 - RATES FOR NURSING FACILITY SERVICES
Section 471-45-016 - CLASSIFICATION OF RESIDENTS AND CORRESPONDING WEIGHTS

016.01 RESIDENT LEVEL OF CARE. The Department will use a federally approved patient driven payment-model grouper to assign a level of care using the information from the minimum data set. Each level of care will be assigned the federally recommended weight. When no minimum data set assessment is available, the resident will be assigned to a default level of care, Level 280.

016.02 WEIGHTING OF RESIDENT DAYS USING RESIDENT LEVEL OF CARE AND WEIGHTS. Each facility resident is assigned to a level of care. Each resident's level of care is appropriately updated from each assessment to the next admission assessment, a significant change assessment, the quarterly review, the annual assessment, etc., and is effective for payment purposes on the first day of the month of the applicable assessment if it is received by the tenth day of the month of the applicable assessment. A change in resident level of care which results from an audit of assessments is retroactive to the effective date of the assessment which is audited. For purposes of the Medicaid case mix system, the Department does not change an assessment record. A record modification may replace an existing record in the Centers for Medicare & Medicaid Services minimum data set data base, but the Department will not replace the existing record in the Medicaid case mix system. The record modification will be processed by the Department as an original record. This means that the Department will process the record in the usual manner if the record is not already in the case mix system. The Department will reject the record as a duplicate if the record has already been accepted into the case mix system. The Department will inactivate a discharge or re-entry tracking record but not an assessment. For each reporting period, the total resident days, per the minimum data set system, at each care level are multiplied by the corresponding weight. The resulting products are summed to determine the total weighted resident days per the minimum data set system. This total is then divided by the minimum data set total resident days per the minimum data set system. This total is then divided by the minimum data set total resident days and multiplied by total resident days per the facility's Medicaid cost report to determine the total number of weighted resident days for the facility, which is the divisor for the direct nursing component.

016.03 RESIDENT LEVEL OF CARE WEIGHTS. The following weighting factors must be assigned to each resident level of care, based on the Centers for Medicare and Medicaid Services Patient Driven Payment Model Nursing classifications:

016.04 VERIFICATION. Resident assessment information is audited as a procedure in the Department of Health and Human Services Division of Public Health, Survey and Certification process.