§ 1187.33. Resident data and picture date reporting requirements.
(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.
(b) Failure to comply with the submission of resident assessment data.
(1) If a valid assessment is not received within the acceptable time frame for an individual resident, the resident will be assigned the lowest individual RUG-III CMI value for the computation of the facility MA CMI and the highest RUG-III CMI value for the computation of the total facility CMI.
(2) If an error on a classifiable data element on a resident assessment is not corrected by the nursing facility within the specified time frame, the assumed answer for purposes of CMI computations will be ‘‘no/not present.’’
(3) If a valid CMI report is not received in the time frame outlined in subsection (a)(5), the facility will be assigned the lowest individual RUG-III CMI value for the computation of the facility MA CMI and the highest RUG-III CMI value for the computation of the total facility CMI.
Authority The provisions of this § 1187.33 amended under sections 201(2), 206(2), 403(b) and 443.1(5) of the Public Welfare Code (62 P.S. § § 201(2), 206(2), 403(b) and 443.1(5)).
Source The provisions of this § 1187.33 amended June 23, 2006, effective July 1, 2006, with the exception of § 1187.33(a) effective October 1, 2006, 36 Pa.B. 3207; amended August 26, 2011, effective retroactive to July 1, 2010, 41 Pa.B. 4630. Immediately preceding text appears at serial pages (351452) and (354199).
Cross References This section cited in 55 Pa. Code § 1187.22 (relating to ongoing responsibilities of nursing facilities); 55 Pa. Code § 1187.32 (relating to continued need for nursing facility services requirements); 55 Pa. Code § 1187.91 (relating to database); 55 Pa. Code § 1187.92 (relating to resident classification system); 55 Pa. Code § 1187.97 (relating to rates for new nursing facilities, nursing facilities with a change of ownership, reorganized nursing facilities, and former prospective payment nursing facilities); 55 Pa. Code § 1187.104 (relating to limitations on payment for reserved beds); 55 Pa. Code § 1187.117 (relating to supplemental ventilator care and tracheostomy care payments); 55 Pa. Code § 1189.3 (relating to compliance with regulations governing noncounty nursing facilities); and 55 Pa. Code § 1189.105 (relating to incentive payments).
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