Current through Register Vol. 54, No. 12, March 23, 2024
(a)
Resident data and picture date
requirements. A nursing facility shall meet the following resident
data and picture date reporting requirements:
(1) The nursing facility shall submit the
resident assessment data necessary for the CMI report to the Department as
specified in the Resident Data Reporting Manual.
(2) The nursing facility shall ensure that
the Federally approved PA specific MDS data for each resident accurately
describes the resident's condition, as documented in the resident's clinical
records maintained by the nursing facility.
(i) The nursing facility's clinical records
shall be current, accurate and in sufficient detail to support the reported
resident data.
(ii) The Federally
approved PA specific MDS shall be coordinated and certified by the nursing
facility's RNAC.
(iii) The records
listed in this section are subject to periodic verification and
audit.
(3) The nursing
facility shall maintain the records pertaining to each Federally-approved PA
Specific MDS record and tracking form submitted to the Department for at least
4 years from the date of submission.
(4) The nursing facility shall ensure that
resident assessments accurately reflect the residents' conditions on the
assessment date.
(5) The nursing
facility shall correct and verify that the information in the quarterly CMI
report is accurate for the picture date and in accordance with paragraph (6)
and shall sign and submit the CMI report to the Department postmarked no later
than 5 business days after the 15th day of the third month of the
quarter.
(6) The CMI report must
include resident assessment data for every MA and every non-MA resident
included in the census of the nursing facility on the picture date.
(i) A resident shall be included in the
census of the nursing facility on the picture date if all of the following
apply:
(A) The resident was admitted to the
nursing facility prior to or on the picture date.
(B) The resident was not discharged with
return not anticipated prior to or on the picture date.
(C) Any resident assessment is available for
the resident from which data may be obtained to calculate the resident's
CMI.
(ii) A resident who,
on the picture date, is temporarily discharged from the nursing facility with a
return anticipated shall be included in the census of the nursing facility on
the picture date as a non-MA resident.
(iii) A resident who, on the picture date, is
on therapeutic leave shall be included in the census of the nursing facility on
the picture date as an MA resident if the conditions of §
1187.104(2)
(relating to limitations on payment for reserved beds) are met on the picture
date. If the conditions of §
1187.104(2) are
not met, the resident shall be included in the census of the nursing facility
as a non-MA resident.
(b)
Failure to comply with the
submission of resident assessment data.
(1) If a valid assessment is not received
within the acceptable time frame for an individual resident, the resident will
be assigned the lowest individual RUG-III CMI value for the computation of the
facility MA CMI and the highest RUG-III CMI value for the computation of the
total facility CMI.
(2) If an error
on a classifiable data element on a resident assessment is not corrected by the
nursing facility within the specified time frame, the assumed answer for
purposes of CMI computations will be "no/not present."
(3) If a valid CMI report is not received in
the time frame outlined in subsection (a)(5), the facility will be assigned the
lowest individual RUG-III CMI value for the computation of the facility MA CMI
and the highest RUG-III CMI value for the computation of the total facility
CMI.
The provisions of this §
1187.33 amended under sections
201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P.S.
§§
201(2),
206(2), 403(b) and
443.1(5)).
This section cited in 55 Pa. Code §
1187.22 (relating to ongoing
responsibilities of nursing facilities); 55 Pa. Code §
1187.32 (relating to continued
need for nursing facility services requirements); 55 Pa. Code §
1187.91 (relating to database); 55
Pa. Code §
1187.92 (relating to resident
classification system); 55 Pa. Code §
1187.97 (relating to rates for new
nursing facilities, nursing facilities with a change of ownership, reorganized
nursing facilities, and former prospective payment nursing facilities); 55 Pa.
Code §
1187.104 (relating to limitations
on payment for reserved beds); 55 Pa. Code §
1187.117 (relating to supplemental
ventilator care and tracheostomy care payments); 55 Pa. Code §
1189.3 (relating to compliance
with regulations governing noncounty nursing facilities); and 55 Pa. Code
§
1189.105 (relating to incentive
payments).
