Chapter 514 - Nursing Facility Services - DHHR - State of West ...

The nursing facilities must transmit all assessments that correspond with claims scheduled forpayment in that month at least 36 hours in advance of this extraction. If MDS transmissionsoccur on or after the MDS extraction date, the MDS assessment will not be included until thefollowing month’s extraction. Therefore, authorizations in the claims payment system will not beloaded manually if the transmissions occur on or after the extraction date.When the MDS extraction is completed, this is given to the fiscal agent for BMS in order tocreate authorizations for nursing facility placement. Nursing facility providers may review theirMDS authorization reports on the web portal to identify which MDS assessments were loadedfrom the extract received.Authorizations are created for a three-month period of time and are based upon the ARD (i.e., ifthe MDS assessment has an ARD of 06/30/11, the authorization in the claims processingsystem will be created for 06/01/11 - 08/31/11). If a resident has two MDS assessments withARD dates in the same month, the second assessment is to be used for billing, (i.e. assessmentwith ARD on 08/05/11 and a second assessment was completed with ARD 08/19/11, thesecond MDS submitted will be the assessment used by the facility for claim submission).Please take note that, if a member’s MDS assessment is missed or submitted late, the defaultrate must be billed.514.7.6 Care Area Assessments (CAAs)Per Federal regulations, each triggered Care Area Assessments (CAAs) must be addressedfurther to facilitate design of the care plan, but it may or may not represent a condition thatshould be addressed in the care plan. The CAAs and the process for their completion arepublished and periodically updated by CMS and may be found in the RAI Version 3.0 UserManual.514.7.7 Care Plan (CP)A comprehensive care plan must be developed by the interdisciplinary care plan team at thenursing facility for each resident that includes measurable objectives and time-tables to meet aresident’s medical, nursing, mental and psychosocial needs that are identified in thecomprehensive assessment as promulgated in 42 CFR 483.20(k).514.8 SERVICES UNDER ALL-INCLUSIVE RATEBMS will pay an all-inclusive per diem rate for nursing facility services. This rate representspayment for all medically necessary and medically appropriate services and items that arerequired to be provided by the nursing facility to achieve optimum quality care and quality of lifefor each resident.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 37January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.