Current through Reg. 49, No. 38; September 20, 2024
A facility must conduct, initially and periodically, a
comprehensive, accurate, standardized, reproducible assessment of a resident's
functional capacity. The facility must electronically transmit to CMS
resident-entry-and-death-in-facility tracking records required by the RAI; and
OBRA assessments, including admission, annual, quarterly, significant change,
significant correction, and discharge assessments.
(1) Admission orders. At the time a resident
is admitted, the facility must have physician orders for the resident's
immediate care.
(2) Comprehensive
assessments.
(A) A facility must make a
comprehensive assessment of a resident's needs, strengths, goals, life history,
and preferences, using the current RAI process, including the MDS, Care Area
Assessment process, and the Utilization Guidelines specified by HHSC and
approved by CMS. The current RAI process is found in the MDS 3.0 manual posted
by CMS on
http://www.cms.gov.
(B) A facility must conduct an additional
assessment and document the summary information if the MDS indicates an
additional assessment on a care area is required.
(C) A facility must conduct a comprehensive
assessment of a resident as follows:
(i)
within 14 calendar days after admission, excluding readmissions in which there
is no significant change in the resident's physical or mental condition. For
purposes of this section, "readmission" means a return to the facility
following a temporary absence for hospitalization or for therapeutic
leave;
(ii) within 14 calendar days
after the facility determines, or should have determined, that there has been a
significant change in the resident's physical or mental condition. For purposes
of this section, a "significant change" means a major decline or improvement in
the resident's status that will not normally resolve itself without further
intervention by staff or by implementing standard disease-related clinical
interventions, that has an impact on more than one area of the resident's
health status, and requires interdisciplinary review or revision of the
comprehensive care plan, or both; and
(iii) not less often than once every 12
months.
(3)
Quarterly review assessment. A facility must assess a resident using the
quarterly review instrument specified by HHSC and approved by CMS not less
frequently than once every three months.
(4) Use. A facility must maintain all
resident assessments completed within the previous 15 months in the resident's
active record and use the results of the assessments to develop, review, and
revise the resident's comprehensive care plan as specified in § 554.802 of
this subchapter (relating to Comprehensive Person-Centered Care
Planning).
(5) PASRR. A
Medicaid-certified facility must:
(A)
coordinate assessments with the PASRR process in 42 CFR, Part 483, Subpart C to
the maximum extent practicable to avoid duplicative testing and effort,
including:
(i) incorporating the
recommendations from the PASRR level II determination and the PASRR evaluation
report into a resident's assessment, care planning, and transitions of care;
and
(ii) referring a level II
resident and a resident suspected of having mental illness, an intellectual
disability, or a developmental disability for level II resident review upon a
significant change in status assessment; and
(B) promptly report a significant change in
the mental or physical condition of a resident by submitting an MDS Significant
Change in Status Assessment Form in the LTC Online Portal, in accordance with
§ 554.2704(i)(12) of this chapter (Nursing Facility Responsibilities
Related to PASRR).
(6)
Automated data processing requirement.
(A) A
facility must complete an MDS for a resident. The facility must enter MDS data
into the facility's assessment software within 7 days after completing the MDS
and electronically transmit the MDS data to CMS within 14 days after completing
the MDS.
(B) A facility must
complete the Long Term Care Medicaid Information form on an OBRA assessment
that is submitted to the state Medicaid claims system for a Medicaid recipient
or Medicaid applicant according to HHSC instructions located on the Texas
Medicaid Healthcare Partnership Long Term Care Portal at
http://www.tmhp.com.
(C) Data format. The facility must transmit
MDS data to CMS in the format specified by CMS and HHSC.
(D) Information concerning a resident is
confidential and a facility must not release information concerning a resident
except as allowed by this chapter, including § 554.407 of this chapter
(relating to Privacy and Confidentiality) and § 554.1910(d) of this
chapter (relating to Clinical Records).
(7) Accuracy of assessments. The assessment
must accurately reflect the resident's status.
(8) Coordination. A registered nurse must
conduct or coordinate each assessment with the appropriate participation of
health professionals.
(9)
Certification.
(A) A registered nurse must
sign and certify that the assessment is completed.
(B) Each individual who completes a portion
of the assessment must sign and certify the accuracy of that portion of the
assessment.
(10) Penalty
for falsification under Medicare and Medicaid.
(A) An individual who willfully and
knowingly:
(i) certifies a material and false
statement in a resident assessment is subject to a civil money penalty of not
more than $1,000 for each assessment; or
(ii) causes another individual to certify a
material and false statement in a resident assessment is subject to a civil
money penalty of not more than $5,000 for each assessment.
(B) Clinical disagreement does not constitute
a material and false statement.
(11) Use of independent assessors in
Medicaid-certified facilities and dually certified facilities. If HHSC
determines, under a certification survey or otherwise, that there has been a
knowing and willful certification of false statements under paragraph (10) of
this section, HHSC may require (for a period specified by HHSC) individuals who
are independent of the facility and who are approved by HHSC to conduct and
certify the resident assessments under this section.
(12) Pediatric resident assessment.
(A) A facility must ensure that a pediatric
assessment:
(i) is performed by a licensed
health professional experienced in the care and assessment of
children;
(ii) includes parents or
guardians in the assessment process; and
(iii) includes a discussion with a parent or
guardian about the potential for community transition.
(B) The clinical record of a child must
include a record of immunizations, blood screening for lead, and developmental
assessment. The local school district's developmental assessment may be used if
available.
(C) A licensed health
professional must assess a child's functional status in relation to pediatric
developmental levels, rather than adult developmental levels.
(D) A facility must ensure pediatric
residents receive services in accordance with the guidelines established by the
Department of State Health Services' Texas Health Steps (THSteps). For
Medicaid-eligible pediatric residents between the ages of six months and six
years, blood screening for lead must be done in accordance with THSteps
guidelines.
