Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-97 - Private Non-Medical Institution Services › Appendix 144-101-III-97-C - MEDICAL AND REMEDIAL SERVICE FACILITIES › Section 144-101-III-97-C-7000 - RESIDENT ASSESSMENTS

Current through 2024-29, July 17, 2024
7010
Purpose
						of Resident Assessments
The provider shall assess each resident, regardless of
						  payment source utilizing an assessment tool on which provider staff will base a
						  service plan designed to assist the resident to reach his/her highest
						  practicable level of physical, mental, and psychosocial functioning. The
						  MDS-RCA is the Department's approved resident assessment
						  instrument.
7020
Schedule of Resident Assessments
The provider must complete the MDS-RCA within 30 days
						  of admission and at least every 180 days thereafter during a resident's stay.
						  The provider will sequence the assessments from the date in Section S.2.B of
						  the MDS-RCA, Assessment Completion Date. The provider will complete subsequent
						  assessments within 180 days from the date in S.2.B. Providers must complete a
						  significant change MDS-RCA assessment within 14 calendar days after
						  determination is made of a significant change in resident status as defined in
						  the Training Manual for the MDS-RCA Tool. Providers must complete a Resident
						  Tracking Form within 7 days of the discharge, transfer, or death of a resident.
						  Providers must maintain all resident assessments completed within the previous
						  12 months in the resident's active record.
7030
Accuracy of Assessments
7030.1 Each assessment must be conducted or
						coordinated by staff trained in completion of the MDS-RCA.
7030.2 Certification: Each individual who
						completes a portion of the assessment must sign and date the form to certify
						the accuracy of that portion of the assessment.
7030.3 Documentation: Documentation is
						required to support the time periods and information coded on the
						MDS-RCA.
7030.4 Penalty for
						Falsification: The provider may be sanctioned whenever an individual willfully
						and knowingly certifies (or causes another individual to certify) a material
						and false statement in a resident assessment. This may be in addition to any
						other penalties provided by statute, including but not limited to,
						22 MRSA
						§15. The Department's R.N. assessors
						will review the accuracy of information reported on the MDS-RCA instruments. If
						the Department determines that there has been a knowing and willful
						certification of false statements, the Department may require (for a period
						specified by the Department) that the resident assessments under this Appendix
						be conducted and certified by individuals who are independent of the provider
						and who are approved by the Department.
7030.5 Review of Assessment Forms: The
						Department may review all forms, documentation and evidence used for completion
						of the MDS-RCA at any time. The Department will undertake quality review
						periodically to ensure that assessments are completed accurately, correctly,
						and on a timely basis.
7030.6
						Facilities shall submit completed assessments to include Admissions,
						Semi-Annuals, Annuals, Significant Change, other required assessments and MDS
						Tracking Forms within 30 days of completion to the Department or the
						Department's designated agent.
7030.7 Providers must submit all claims on
						electronic media to be specified by the Department. Failure to submit on
						electronic media on or after this date may result in the provider being paid
						the DCP adjusted by the default classification (not classified) weight of
						0.731.
7030.8 Providers must use
						the MDS-RCA Correction Form in order to request modification or inactivation of
						erroneous data previously submitted as part of the MDS record (assessment or
						tracking forms). The MDS-RCA Correction Form is for corrections of two types:
1) Modification, which should be requested
						when a valid MDS-RCA record (assessment or tracking form) is in the State
						MDS-RCA database, but the information in the record contains errors; or
2) Inactivation, which should be
						requested when an incorrect reason for assessment has been submitted under item
						"Reason for Assessment." Providers must then resubmit the record with the
						correct reason for assessment. An inactivation should also be used when an
						invalid record has been accepted into the State MDS-RCA database. A record may
						considered invalid for the following reasons:
1) the event did not occur;
2) the record submitted identifies the wrong
						resident;
3) the record
						submitted identifies the wrong reason for assessment; or
4) it was an inadvertent submission of a
						non-required record.