Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1187 - NURSING FACILITY SERVICES › Subchapter D - DATA REQUIREMENTS FOR NURSING FACILITY APPLICANTS AND RESIDENTS › Section 1187.33 - Resident data and picture date reporting requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Resident data and picture date
				  requirements
. A nursing facility shall meet the following resident
				  data and picture date reporting requirements:
(1) The nursing facility shall submit the
				  resident assessment data necessary for the CMI report to the Department as
				  specified in the
Resident Data Reporting Manual
.
(2) The nursing facility shall ensure that
				  the Federally approved PA specific MDS data for each resident accurately
				  describes the resident's condition, as documented in the resident's clinical
				  records maintained by the nursing facility.
(i) The nursing facility's clinical records
				  shall be current, accurate and in sufficient detail to support the reported
				  resident data.
(ii) The Federally
				  approved PA specific MDS shall be coordinated and certified by the nursing
				  facility's RNAC.
(iii) The records
				  listed in this section are subject to periodic verification and
				  audit.
(3) The nursing
				  facility shall maintain the records pertaining to each Federally-approved PA
				  Specific MDS record and tracking form submitted to the Department for at least
				  4 years from the date of submission.
(4) The nursing facility shall ensure that
				  resident assessments accurately reflect the residents' conditions on the
				  assessment date.
(5) The nursing
				  facility shall correct and verify that the information in the quarterly CMI
				  report is accurate for the picture date and in accordance with paragraph (6)
				  and shall sign and submit the CMI report to the Department postmarked no later
				  than 5 business days after the 15th day of the third month of the
				  quarter.
(6) The CMI report must
				  include resident assessment data for every MA and every non-MA resident
				  included in the census of the nursing facility on the picture date.
(i) A resident shall be included in the
				  census of the nursing facility on the picture date if all of the following
				  apply:
(A) The resident was admitted to the
				  nursing facility prior to or on the picture date.
(B) The resident was not discharged with
				  return not anticipated prior to or on the picture date.
(C) Any resident assessment is available for
				  the resident from which data may be obtained to calculate the resident's
				  CMI.
(ii) A resident who,
				  on the picture date, is temporarily discharged from the nursing facility with a
				  return anticipated shall be included in the census of the nursing facility on
				  the picture date as a non-MA resident.
(iii) A resident who, on the picture date, is
				  on therapeutic leave shall be included in the census of the nursing facility on
				  the picture date as an MA resident if the conditions of §
												1187.104(2) 
				  (relating to limitations on payment for reserved beds) are met on the picture
				  date. If the conditions of §
												1187.104(2) are
				  not met, the resident shall be included in the census of the nursing facility
				  as a non-MA resident.