South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:45 - Nursing facility level of care and claims
Chapter 67:45:03 - Case mix validation process
Section 67:45:03:04 - Review to validate resident classifications

At least every fifteen months, a nurse consultant shall conduct a facility review to validate resident assessments and classifications. The nurse consultant shall notify the nursing facility of a pending review at least forty-eight hours before the review is conducted. The review may encompass any resident of the nursing facility, regardless of payment source, whose assessment was completed in the last forty-five to ninety days.

Validation of resident assessments and classifications is accomplished by reviewing the resident's clinical record, interviewing staff from the nursing facility, and comparing the nurse consultant's findings with the resident assessment completed by the facility. If a resident to be reviewed no longer lives in the facility or is temporarily absent, the nurse consultant may review another resident of the same classification. The nurse consultant may conduct the review onsite at the facility and may observe or interview the resident.

If the nurse consultant finds an error or- inconsistency on the resident assessment being reviewed, the nurse consultant may review that resident's assessments completed during the prior- twelve months.

If the nurse consultant identifies errors or irregularities in any one classification, the nurse consultant may expand the review to include resident assessments completed for residents of the same classification. This expanded review may include residents who have since died or been discharged from the facility.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2).