Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.3 - Reimbursement for Skilled Nursing and Intermediate Care Services › Rule 37.40.320 - MINIMUM DATA SET SUBMISSION, TREATMENT OF DELAYS IN SUBMISSION, INCOMPLETE ASSESSMENTS, AND CASE MIX INDEX CALCULATION

Current through Register Vol. 13, July 5, 2024
(1)
				Nursing facilities shall submit all minimum data set assessments and tracking
				documents to the Centers for Medicare and Medicaid Services (CMS) database as
				required by federal participation requirements, laws, and
				regulations.
(2) Submitted
				assessment data shall conform to federal data specifications and meet minimum
				editing and validation requirements.
(3) Retention of assessments on the database
				will follow the records retention policy of the Department of Public Health and
				Human Services. Back up tapes of each rate setting period will be maintained
				for a period of five years.
(4)
				Assessments not containing sufficient in-range data to perform a resource
				utilization group-III (RUG-III) algorithm will not be included in the case mix
				calculation during the transition period.
(5) All current assessments in the database
				older than six months will be excluded from the case mix index
				calculation.
(6) For purposes of
				calculating rates, the department will use the RUG-III, 34 category, index
				maximizer model, version 5.12. The department may update the classification
				methodology to reflect advances in resident assessment or classification
				subject to federal requirements.
(7) For purposes of calculating rates, case
				mix weights will be developed for each of the 34 RUG-III groupings. The
				department will compute a Montana specific Medicaid case mix utilizing average
				nursing times from the 1995 and the 1997 CMS case mix time study. The average
				minutes per day per resident will be adjusted by Montana specific salary ratios
				determined by utilizing the licensed to non-licensed ratio spreadsheet
				information.
(8) For purposes of
				calculating rates, the department shall assign each resident a RUG-III group
				calculated on the most current non-delinquent assessment available on the first
				day of the second month of each quarter as amended during the correction
				period. The RUG-III group will be translated to the appropriate case mix index
				or weight. From the individual case mix weights for the applicable quarter, the
				department shall determine a simple facility average case mix index, carried to
				four decimal places, based on all resident case mix indices. For each quarter,
				the department shall calculate a Medicaid average case mix index, carried to
				four decimal places, based on all residents for whom Medicaid is reported as
				the per diem payor source any time during the 30 days prior to their current
				assessment.
(9) Facilities will be
				required to comply with the data submission requirements specified in this rule
				and ARM 37.40.321. The department will
				utilize Medicaid case mix data in the computation of rates for the period July
				1, 2001 through June 30, 2002 and for rate years thereafter.
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA;