Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 147 - REIMBURSEMENT FOR NURSING COSTS FOR GERIATRIC FACILITIES › Section 147.315 - Nursing Facility Resident Assessment Instrument

Current through Register Vol. 48, No. 28, July 12, 2024
a) A facility shall conduct and
			 electronically submit a Minimum Data Set (MDS) assessment that conforms with
			 the assessment schedule and guidance defined by Code of Federal Regulations,
			 Title 42, section 483.20, and in the RAI Manual, published by the United States
			 Department of Health and Human Services, Centers for Medicare and Medicaid
			 Services (federal CMS), and subsequent updates when issued by federal
			 CMS.
b) A facility shall complete
			 the MDS Comprehensive Item Set form that includes all items Section A-Z, for
			 each resident quarterly, regardless of the resident's payment source. The
			 Comprehensive Item Set refers to the MDS items that are active on a particular
			 assessment type or tracking form. While a Comprehensive Item Set is required
			 for all assessments including quarterlies, a comprehensive assessment is not
			 required on a quarterly basis. A comprehensive assessment is defined as both
			 the completion of a Comprehensive Item Set as well as completion of the Care
			 Area Assessment (CAA) process and care planning. When completing the
			 Comprehensive Item Set for the quarterly MDS, the CAA process is not required.
			 The federal regulatory requirements at
			 42 CFR
			 483.20(d) requires nursing
			 facilities to maintain all resident assessments completed within the previous
			 15 months in the resident's active clinical record.
c) A facility shall electronically transmit
			 to the federal CMS database the following MDS assessments in the timeframes
			 identified.
1) The Omnibus Budget
			 Reconciliation Act (OBRA) regulations require nursing facilities that are
			 Medicare or Medicaid certified to conduct initial and periodic assessments for
			 all their residents. The MDS 3.0 is part of that assessment process and is
			 required by federal CMS. The assessment that will be used for the purpose of
			 rate calculations shall be identified as an OBRA assessment on the MDS
			 following the guidance in the RAI Manual.
2) Admission, Annual, Significant Change in
			 Status, and Significant Correction to Prior Comprehensive Assessments shall be
			 completed and transmitted to the federal CMS database no later than 14 calendar
			 days after the care plan completion date. The quarterly assessment shall
			 identify the MDS was transmitted to the federal CMS database no later than 14
			 calendar days after the MDS completion date.
3) An MDS admission assessment and CAAs shall
			 be completed by the 14th calendar day from the
			 resident's admission date. This assessment shall include completion of the MDS
			 Comprehensive Item Set as well as completion of the CAA process and care
			 planning. Care plan completion date is 7 calendar days after the MDS/CAA
			 completion date. Transmission date is within 14 calendar days after the care
			 plan completion date.
4) An annual
			 assessment shall have an assessment reference date (ARD) within 366 calendar
			 days of the ARD identified on the last comprehensive assessment. This
			 assessment shall include completion of the MDS Comprehensive Item Set as well
			 as completion of the CAA process and care planning. The MDS/CAA completion date
			 is the ARD plus 14 calendar days. The care plan completion date is MDS/CAA
			 completion date plus 7 calendar days. Transmission date is care plan date plus
			 14 calendar days.
5) A significant
			 change assessment shall be completed within 14 calendar days after the
			 identification of a significant change. This assessment shall include
			 completion of the MDS Comprehensive Item Set as well as completion of the CAA
			 process and care planning. The MDS/CAA completion date is 14 calendar days
			 after the determination date plus 7 calendar days. Transmission date is care
			 plan date plus 14 calendar days.
6)
			 All quarterly assessments shall have an ARD within 92 calendar days after the
			 previous OBRA assessment. This assessment includes the completion of the MDS
			 Comprehensive Item Set, but does not include the completion of the CAA process
			 and care planning. MDS completion date is ARD plus 14 calendar days.
			 Transmission date is completion date plus 14 calendar days.
7) The significant correction to a prior
			 comprehensive assessment or significant correction to a prior quarterly
			 assessment shall be completed when the interdisciplinary team determines that a
			 resident's prior assessment contains a significant error that has not been
			 corrected by more recent assessments as required by the RAI Manual. Nursing
			 facilities shall document the initial identification of a significant error in
			 a prior assessment in the progress notes.