Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities › Section 5160-3-43.1 - Nursing facilities (NFs): case mix assessment instrument - minimum data set version 3.0 (MDS 3.0)

Current through all regulations passed and filed through July 1, 2024
(A) As used in this rule:
(1) "Annual facility average case mix score"
			 is the score used to calculate the facility's cost per case-mix unit.
(2) "Assessment reference date (ARD)" is the
			 last day of the observation (or "look back") period that the MDS 3.0 assessment
			 covers for the resident.
(3) "Case mix report"
			 is a report generated by the Ohio department of medicaid
			 (ODM) and distributed to the provider on the status of all MDS 3.0
			 assessment data that pertains to the calculation of a quarterly, semiannual, or annual facility average case mix score.
(4)
			 "Comprehensive assessment" means an assessment that includes completion of
			  the appropriate MDS 3.0 assessment
			 type listed in paragraph (B)(2) of this rule .
(5) "Critical elements"
			 are data items from a resident's MDS 3.0 that ODM verifies prior to determining a
			 resident's resource utilization group (RUG )
			 classification.
(6)
			 "Critical errors" are errors in the MDS 3.0 critical elements that prevent
			 
									ODM
			 from determining the resident's RUG 
			 classification.
(7) "Default group" is
			  the case mix
			 group assigned to residents with MDS 3.0 records with inconsistent date fields,
			 missing, incomplete, out of range, or inaccurate
			 data, including inaccurate resident identifiers,
			 any of which precludes grouping the record into non-default RUG  groups .
(8) "Encoded," when
			 used with reference to a record, means that the record has been recorded in
			 electronic format. The record must be encoded in accordance with
			 
									MDS 3.0 data submission
			 specifications version 1.15.0.
(9) "Filing date" is
			 the deadline for submission of the NF's MDS 3.0 assessment data that will be
			 used to calculate the preliminary facility quarterly average case mix score.
			 The filing date is the fifteenth calendar day following the reporting period
			 end date (RPED).
(10)
									 "MDS 3.0 " is the uniform resident assessment
			 instrument specified for use in Ohio pursuant to
			 42 C.F.R.
			 483.20 (October 1, 2014) for implementing
			 standardized resident assessments and for facilitating care management in
			 nursing facilities. The MDS 3.0 provides the core data elements used to group
			 residents into case mix categories. It also includes Ohio-specific data
			 elements, designated as section S. A copy of the section S requirements is
			 available at
http://medicaid.ohio.gov/PROVIDERS/ProviderTypes/LongTermCareFacilities.aspx
.
(11)
			 "Medicare required assessment" means the MDS 3.0 that is required only for
			 facilities participating in the medicare prospective payment system
			 .
(12) "Other medicare
			 required assessment (OMRA)" is an unscheduled MDS 3.0prospective payment system (PPS)
									 assessment required to be completed
			 during a resident's medicare "Part A" SNF covered stay based on the start or
			 cessation of rehabilitation services.
(13) "PPS assessment"
			 is the 
									MDS
			 3.0 that skilled nursing facilities (SNFs) use to assess the clinical
			 condition for each medicare resident receiving "Part A" SNF level care for
			 reimbursement under the SNF PPS.
(14) "Quarterly
			 facility average total case mix score" is the facility average case mix score
			 based on both medicaid and non-medicaid resident data submitted for one
			 reporting quarter and calculated pursuant to paragraph (B)(1) of rule
			 5160-3- 43.3 of the Administrative Code.
(15)
			 "Quarterly facility average medicaid case mix score" is the facility average
			 case mix score based on only medicaid resident data submitted for one reporting
			 quarter and calculated pursuant to paragraph (B)(2) of rule
			 5160-3- 43.3 of the Administrative Code.
(16)
			 "Quarterly review assessment" means an assessment that is normally conducted no
			 less than once every three months using the MDS 3.0.
(17) "Record" means a
			 resident's encoded MDS 3.0 assessment as described in paragraphs (B)(1) to
			 (B)(4) of this rule.
(18) "Relative
			 resource weight" is the measure of the relative costliness of caring for
			 residents in one case mix group versus another, indicating the relative amount
			 and cost of staff time required on average for defined worker classifications
			 to care for residents in a single case mix group. The methodology for
			 calculating relative resource weights is described in paragraph
			 (E) of
			 rule 5160-3- 43.2 of the Administrative Code.
(19)
			 "Reporting period end date" (RPED) is the last day of each calendar
			 quarter.
(20) "Reporting
			 quarter" is the calendar quarter in which the MDS 3.0 is completed, as
			 indicated by the assessment reference date in MDS 3.0 section A, item A2300,
			 except as specified in paragraphs (C)(7) and (C)(8) of this rule.
(21)
			 "Resident Assessment Instrument (RAI)" is the 
									MDS 3.0
			 used by NFs in Ohio to comply with regulations in
									42 C.F.R.
			 483.20
									.
(22) "Resident case
			 mix score" is the relative resource weight for the RUG
			 group to which the resident is assigned
			 based on data elements from the resident's MDS 3.0 assessment.
(23)
			 "Resident identifier code" is an alternative resident identifier if the
			 resident does not have a social security number. The resident identifier code
			 shall be reported in MDS 3.0section S, item
			 S0150. The following method must be used to construct the identifier
			 code:
(a)
										
			 In the first three boxes, enter the first three letters of the resident's last
			 name.
(b)
										 In the next six boxes, enter the six digits of the
			 resident's date of birth.
(c)
										 Omit the century in the birth date.
(24) "RUG
			 " is the resource utilization
			 groups system of classifying
			 NF residents  described
			 in paragraph (B) of rule 5160-3- 43.2 of the Administrative Code. Resource
			 utilization groups are clusters of NF residents defined by resident characteristics that correlate with resource use.
(a)
										 For rates paid
			 for services provided before July 1, 2016, the RUG version used in Ohio is
			 version III (RUG III).
(b)
										 For rates paid for services provided July 1, 2016 and
			 thereafter, the RUG version used in Ohio shall be version IV (RUG
			 IV).
(25) "Semiannual
			 facility average medicaid case mix score" is the average of a facility's two
			 quarterly facility average medicaid case mix scores. It is used to establish
			 the direct care rate and is calculated pursuant to paragraph (E) of rule
			 5160-3- 43.3 of the Administrative Code.