Section 405 IAC 1-14.7-8 - Minimum data setAuthority: IC 12-15-1-10; IC 12-15-21-3
Affected: IC 4-21.5-3; IC 12-13-7-3; IC 12-15
Sec. 8.
(a) Nursing facilities are required to electronically transmit MDS resident assessments in a complete, accurate, and timely manner as prescribed in the MDS and Case Mix Index Supportive Documentation Manual. An extension of the electronic MDS assessment due date may be granted by the office to a new operation attempting to submit MDS assessments for the first time if the: (1) new operation is not currently enrolled or submitting MDS assessments under the Medicare program; and(2) provider is able to prove to the office circumstances preventing timely electronic transmission.(b) If the office determines a nursing facility has a delinquent MDS resident assessment, the assessment shall be assigned the delinquent classification as prescribed in the MDS and Case Mix Index Supportive Documentation Manual.(c) The office shall adjust or revise MDS data items that an MDS review determines are unsupported to reflect a resident's highest functioning level supported by the MDS and Case Mix Index Supportive Documentation Manual. Incorporation of adjustments or revisions may result in a reclassification of the resident under the resident classification system.(d) For rates effective prior to June 30, 2024, after an MDS review, the office shall recalculate the facility's CMI. If the recalculated CMI results in a change to the established Medicaid rate:(1) the rate is recalculated; and(2) any payment adjustment is made.(e) For rates effective beginning July 1, 2024, and after, the result of an MDS review shall be applied as prescribed in section 12 of this rule.(f) CMIs are determined as prescribed in the MDS and Case Mix Index Supportive Documentation Manual for each resident to calculate the facility average CMI for all residents, as well as the facility average CMI for Medicaid residents.(g) The office shall provide each nursing facility with the following:(1) A preliminary CMI report.(2) A final CMI report that shall be used to establish the facility average CMI, and the facility average CMI for Medicaid residents used in establishing the nursing facility's Medicaid rate.(h) To determine the normalized allowable direct care costs from each facility's cost report, the office shall determine each facility's CMI for all residents that corresponds to the cost reporting period under the MDS and Case Mix Index Supportive Documentation Manual.Office of the Secretary of Family and Social Services; 405 IAC 1-14.7-8; filed 8/20/2024, 9:11 a.m.: 20240918-IR-405240088FRA