2008 .URSING &ACILITY&ORMS and Hospice Quick Reference Guide Term Care... · 8 Texas Medicaid & Healthcare Partnership—Nursing Facility/Hospice Quick Reference Guide-05/19/2008

2008 Nursing Facilities and Hospice

Quick Reference Guide

Copyright AcknowledgmentsUse of the American Medical Association’s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication with the following disclosure: “Current Procedural Terminology (CPT) is copyright 2007 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System/Department of Defense Regulation System (FARS/DFARS) restrictions apply to government use.”The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: “CDT 2007/2008 [including procedure codes, definitions (descriptions), and other data] is copyrighted by the American Dental Association. © 2006 American Dental Association. All Rights Reserved. Applicable Federal Acquisition Regulation System/Department of Defense Acquisition Regulation System (FARS/DFARS) restrictions apply.”

Texas Medicaid & Healthcare Partnership—Nursing Facility/Hospice Quick Reference Guide-05/19/2008 1

Helpful Telephone Numbers

Texas Medicaid & Healthcare Partnership (TMHP)

General Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-925-9126

Long Term Care (LTC) Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-727-5436 / 1-800-626-4117

General Inquiries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 1

Medical Necessity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 2

Technical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 3

Audio Message for Paper Submissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 4

Fair Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 5

LTC Department (fax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-514-4223

Medicaid Hotline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-252-8263

Department of Aging and Disability Services (DADS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-3011

Provider Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-2200

Nursing Facility and Hospice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 1

Using PCS Website Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 2

Deductions and Holds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 3

Third Party Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 4

Home Community Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 5

TX Home Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 5

Rehabilitative and Specialized Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 6

Criminal History Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-2363

Consumer Rights & Services Hotline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-458-9858

Complaint for LTC Facility/Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 2

Information About a Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 4

Provider Self-Reported Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 5

Survey Documents/DADS literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Press 6

Facility Licensure/Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-2630

Hospice Policy (Medicaid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-3519

Medication Aide Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-231-5800

Nurse Aide Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-452-3934

Nurse Aide Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-231-5800

Nursing Facility Administrator Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-231-5800

Nursing Facility Dental/Rehab Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-792-1109

Nursing Facility Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-3161

Nursing Facility/Hospice Contracting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-2080

Preadmission Screening and Resident Review (PASARR)–State Office . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-4345

Regulatory Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-438-2625

2 Texas Medicaid & Healthcare Partnership—Nursing Facility/Hospice Quick Reference Guide-05/19/2008

Health and Human Services (HHSC)

HHSC Ombudsman Office Medicaid Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-877-787-8999

Medicaid Fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-436-6184

HHSC Utilization Review Administrator Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-491-2065

HHSC Program Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-491-2065

Resource Utilization Groups (RUGs) Information

Nurse Specialist (Corrective Action & RUGs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-491-2074

Purpose Code U Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-491-2074

RUG Training Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-245-7118

RUG Training Online Course Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-512-245-7118

Vendor Drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-252-8263


Informational Websites

Texas Medicaid & Healthcare Partnership (TMHP): www.tmhp.com

CARE Form instructions: www .tmhp .com/ltc programs

HIPAA information: www .tmhp .com/hipaa

Long Term Care Division: www .tmhp .com/ltc programs

Nursing Facility Long Term Care Medicaid Information (LTCMI) and Pre-admission Screening and Resident Review (PASARR) information is also available on the TMHP website .

Texas Department of Aging and Disability Services (DADS): www.dads.state.tx.us

All DADS provider information can be found at www .dads .state .tx .us/providers/index .cfm . Please choose your particular provider type for available online resources:

Assisted Living: http://www .dads .state .tx .us/providers/alf/index .cfm

Handbooks: www .dads .state .tx .us/news_info/publications/handbooks/index .html#handbooks

Consumer Rights and Services (includes information about how to make a complaint): www .dads .state .tx .us/news_info/report_problems .html

Nursing Facility: www .dads .state .tx .us/providers/nf/index .cfm

PASARR: www .DADS .state .tx .us/providers/pasarr/index .html

Provider Claims Services: http://ausmis31 .dhs .state .tx .us/cmsmail

Provider Letters: http://www .dads .state .tx .us/providers/communications/letters .cfm See the page for your particular provider type at http://www .dads .state .tx .us/providers/index .cfm

Email TILE to RUG questions to: RUGS@dads .state .tx .us

Health and Human Services Commission (HHSC): www.hhsc.state.tx.us

HHSC Regions: www .hhsc .state .tx .us/about_hhsc/hhs_regions .html

Vendor Drug Program: www .hhsc .state .tx .us/hcf/vdp/vdpstart .html

Other

Centers for Medicare & Medicaid Services: www .cms .gov

Department of State Health Services: www .dshs .state .tx .us

Texas Administrative Code: www .sos .state .tx .us/tac/index .html

RUG Training: http://www .txstate .edu/continuinged/programs/RUG-Training .html


Texas Health and Human Services Commission Office of Inspector General–Utilization Review Unit

Regional Directory for RUG Questions

City - Region Address Mail Code Phone Fax

Abilene - 2 4601 S . First St ., Ste H

Abilene, TX 79605

001-6 1-325-795-5598 1-325-795-5604

Austin/Waco - 7 PO Box 977

Waco, TX 76703

942-1 1-254-750-9652 1-254-750-9698

Corpus Christi - 11 5155 Flynn Pkwy, Ste 211

Corpus Christi, TX 78411

073-4 1-361-878-3211 1-361-878-3298

Fort Worth - 3 1501 Circle Drive, Ste 155-B

Fort Worth, TX 76119

128-9 1-817-321-8116 1-817-321-8113

Houston - 6 PO Box 16017

Houston, TX 77222

179-1 1-713-735-8310 1-713-735-8905

San Antonio - 8 PO Box 23990

San Antonio, TX 78223

281-1 1-210-431-8759 1-210-431-2377

For RUG Questions, call: 1-512-491-2072, 1-512-491-4046, or 1-512-491-2025

For RUG Training Information, call: 1-512-491-4046, 1-512-491-2072, or 512-491-2025 or visit https://oig .hhsc .state .tx .us/Reports/Training .aspx .


Benefits of the LTC Online Portal

Web-based application .

24/7 system availability .

Application edits verify the validity of data that is entered on forms .

Errors must be corrected before submission .

Form status inquiry (FSI) provides a search tool for forms and assessments that have been submitted .

Current Activity provides a search tool for forms and assessments submitted in the last 14 calendar days .

Submit additional information through the LTC Online Portal .

TMHP provides LTC Online Portal, reference manual, and technical support by phone at 1-800-727-5436, Option 3 .

TMHP Website Security

There is no website security changes related to transition from TILEs to RUGs .

Effective September 1, 2008, Third Party Software Vendors will not be able to submit 3618, 3619, 3652, or LTCMI information on behalf of a provider .

Administrator account required:

Strongly recommended to have multiple Administrator Accounts

Provider can establish user accounts for each provider/contractor number .

Provides for secure access to web functions .

•

•

•

•

•

•

•

•

•

•

•

•

•

•


Creating Administrator Account on TMHP.com

• Select the Activate my Account link from the “I would like to…” section of the TMHP home page.


• Click the Create a provider/vendor administrator account to continue. o Long Term Care providers will need the following items to create their account:

Vendor Number. Contract Number.

Vendor Password.


• Select the Account Type that you wish to set up: - Long Term Care is used for submitting 3071 and 3074 forms, viewing R&S, and using

TexMedConnect. - NF/Waiver is used to submit forms 3618, 3619, LTCMI, PASARR, Medical Necessity and

Level of Care.

• Provide the requested information and proceed to complete the Account Activation process.


• Provide the requested information and proceed to complete the Account Activation process. • Check the box at the bottom of the screen to indicate agreement to the General Terms and

Conditions. • Click the Create Provider Administrator button to create your user ID.


• Access the My Account screen to administer your user account and to access any of the functions on the LTC Online Portal or TexMedConnect.


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ine

MN

an

d•

Est

abli

sh t

he

RU

G

Wh

en T

MH

P r

ecei

ves

a 36

18

Res

iden

t T

ran

sact

ion

Not

ice

the

LT

C O

nli

ne

Por

tal w

ill a

ttem

pt

to

retr

ieve

th

e co

veri

ng

MD

S A

sses

smen

t an

d a

ny

subs

equ

ent

asse

ssm

ents

for

the

resi

den

t fr

om

the

Fed

eral

CM

S D

atab

ase,

so

the

pro

vid

er c

an u

se t

he

exis

tin

g as

sess

men

t, r

ath

er t

han

su

bmit

tin

g an

off

-cyc

le M

DS

asse

ssm

ent.

F

or a

new

res

iden

t, t

he

pro

vid

er

wil

l nee

d t

o co

mp

lete

an

d s

ubm

it

an M

DS

adm

issi

on a

sses

smen

t.


Pag

e 3

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

pre

viou

sly

subm

itte

d t

o th

e F

eder

al C

MS

dat

abas

e.

oT

he

LT

C O

nli

ne

Por

tal w

ill m

ove

the

Ass

essm

ent

into

th

e M

edic

al N

eces

sity

W

orkf

low

pro

cess

. o

Subs

equ

ent

prog

ress

of t

he

Med

icai

d p

roce

ss

can

be

obta

ined

by

usi

ng

the

For

m S

tatu

s In

quir

y fu

nct

ion

of t

he

LT

C O

nli

ne

Por

tal.

If t

he

reci

pie

nt

has

not

bee

n p

revi

ousl

y ad

mit

ted

into

th

e N

urs

ing

Fac

ilit

y u

nd

er a

non

-Med

icai

d p

aym

ent

sou

rce

a C

omp

reh

ensi

ve A

sses

smen

t fo

r In

itia

l A

dm

issi

on is

req

uir

ed (

AA

8a

= 0

1).

oT

he

MD

S A

sses

smen

t w

ill b

e re

trie

ved

from

th

e F

eder

al C

MS

dat

abas

e an

d b

e m

ade

avai

labl

e on

th

e L

TC

On

lin

e P

orta

l in

th

e C

urr

ent

Act

ivit

y R

epor

t w

hen

th

e P

rovi

der

lo

gs in

to t

he

syst

em.

oT

he

Pro

vid

er w

ill t

hen

com

ple

te t

he

LT

C

Med

icai

d I

nfo

rmat

ion

form

for

the

resi

den

t as

soci

atin

g it

wit

h t

he

MD

S A

sses

smen

t as

p

revi

ousl

y su

bmit

ted

to

the

Fed

eral

CM

S d

atab

ase.

o

Th

e L

TC

On

lin

e P

orta

l wil

l mov

e th

e A

sses

smen

t in

to t

he

Med

ical

Nec

essi

ty

Wor

kflo

w p

roce

ss.

oSu

bseq

uen

t pr

ogre

ss o

f th

e M

edic

aid

pro

cess

ca

n b

e ob

tain

ed b

y u

sin

g th

e F

orm

Sta

tus

Inqu

iry

fun

ctio

n o

f th

e L

TC

On

lin

e P

orta

l.

2T

ran

sfer

from

an

oth

er N

F

Use

th

e P

urp

ose

Cod

e 2

wh

en a

re

sid

ent

is t

ran

sfer

rin

g fr

om a

not

her

fa

cili

ty if

th

e re

cip

ien

t d

oes

not

hav

e p

erm

anen

t M

N a

nd

th

e fo

rm is

Th

e N

urs

ing

Fac

ilit

y th

at t

he

reci

pie

nt

is t

ran

sfer

red

to

mu

st c

omp

lete

a n

ew A

dm

issi

on M

DS

asse

ssm

ent

in c

omp

lian

ce w

ith

th

e fe

der

al M

DS

subm

issi

on

sch

edu

le.

See

Ru

le 1

9.2

40

3 (e

) (4

).


Pag

e 4

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

subm

itte

d w

ith

in 2

0 d

ays.

2

Ad

mis

sion

into

Hos

pic

e

Th

is p

urp

ose

cod

e is

use

d w

hen

th

e ad

mis

sion

into

Hos

pic

e co

inci

des

wit

h

Ad

mis

sion

into

NF

Wh

en a

rec

ipie

nt

elec

ts H

osp

ice

serv

ices

in a

Nu

rsin

g F

acil

ity,

th

e H

osp

ice

pro

vid

er is

req

uir

ed t

o su

bmit

H

osp

ice

For

ms

3071

an

d 3

074

via

th

e L

TC

On

lin

e P

orta

l (u

sin

g th

e cu

rren

t m

ech

anis

m).

An

MD

S as

sess

men

t is

not

req

uir

ed t

o re

por

t H

osp

ice

elec

tion

un

less

a S

ign

ific

ant

Ch

ange

in S

tatu

s A

sses

smen

t (A

A8

a=0

3) is

req

uir

ed a

ccor

din

g to

th

e F

eder

al C

MS

rule

s as

soci

ated

wit

h a

sig

nif

ican

t ch

ange

at

the

tim

e of

Hos

pic

e E

lect

ion

.

Up

on s

ubs

equ

ent

subm

issi

on o

f th

e M

DS

Ass

essm

ent

for

the

Hos

pic

e re

cip

ien

t th

e fo

llow

ing

dat

a ar

e re

quir

ed: P1o

(o

not

zer

o) i

s ch

ecke

d

S1c

= S

ervi

ce G

rou

p 1

(N

F)

S1d

= H

osp

ice

Con

tra

ct N

um

ber

S4a

= R

N A

sses

smen

t C

oord

ina

tor

La

st

Na

me

S4b

= R

N A

sses

smen

t C

oord

ina

tor

Lic

ense

N

um

ber

Ru

le 3

71.2

14 (

f) (

2)

Ru

le 3

71.2

14 (

f) (

3)

3M

N R

evie

w

Th

e 36

52-A

form

wit

h a

Pu

rpos

e C

ode

3 is

su

bmit

ted

wit

hin

18

0 d

ays

of a

P

urp

ose

Cod

e 2

ind

icat

ing

a M

edic

al

Nec

essi

ty R

evie

w. P

erm

anen

t M

N is

gr

ante

d w

hen

pu

rpos

e co

de

3 be

com

es

effe

ctiv

e.

Th

e N

urs

ing

Fac

ilit

y is

req

uir

ed t

o su

bmit

an

MD

S Q

uar

terl

y A

sses

smen

t (A

A8

a =

05)

eve

ry 9

2 d

ays.

oT

he

Pro

vid

er w

ill s

ubm

it t

he

MD

S Q

uar

terl

y A

sses

smen

t to

th

e F

eder

al C

MS

dat

abas

e u

sin

g th

eir

nor

mal

pra

ctic

es fo

r th

eir

faci

lity

(e

.g. R

AV

EN

).

oT

he

MD

S A

sses

smen

t w

ill b

e re

trie

ved

from

th

e F

eder

al C

MS

dat

abas

e an

d b

e m

ade

avai

labl

e on

th

e L

TC

On

lin

e P

orta

l in

th

e C

urr

ent

Act

ivit

y R

epor

t w

hen

th

e P

rovi

der

Th

e fo

llow

ing

chan

ges

wil

l be

imp

lem

ente

d:

1.M

N w

ill b

e re

view

ed e

very

qu

arte

r ra

ther

th

an o

n a

6

mon

th b

asis

. See

Ru

le

19.2

413

(b)

. 2.

Per

man

ent

MN

is g

ran

ted

w

ith

at

leas

t 18

4 d

ays

of

app

rove

d M

N fo

r th

e re

cip

ien

t. T

he

Per

man

ent

MN

clo

ck w

ill b

e ke

pt

wit

h


Pag

e 5

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

logs

into

th

e sy

stem

. o

Th

e P

rovi

der

wil

l th

en c

omp

lete

th

e L

TC

M

edic

aid

In

form

atio

n fo

rm fo

r th

e re

sid

ent

asso

ciat

ing

it w

ith

th

e M

DS

Ass

essm

ent

as

pre

viou

sly

subm

itte

d t

o th

e F

eder

al C

MS

dat

abas

e.

oT

he

LT

C O

nli

ne

Por

tal w

ill m

ove

the

Ass

essm

ent

into

th

e M

edic

al N

eces

sity

W

orkf

low

pro

cess

. o

Subs

equ

ent

prog

ress

of t

he

Med

icai

d p

roce

ss

can

be

obta

ined

by

usi

ng

the

For

m S

tatu

s In

quir

y fu

nct

ion

of t

he

LT

C O

nli

ne

Por

tal.

the

reci

pie

nt

not

bas

ed o

n

the

Rea

son

for

Ass

essm

ent

cod

es.

See

Ru

le 1

9.2

40

3 (e

) (1

) an

d (

e) (

3).

4T

ILE

rev

iew

(ev

ery

6 m

onth

s)

Con

dit

ion

1:

oF

or H

osp

ice

reci

pie

nts

th

is r

evie

w

mu

st b

e co

mp

lete

d t

o al

low

a

det

erm

inat

ion

th

at a

rec

ipie

nt

nee

ds

con

tin

ued

hos

pic

e ca

re.

Com

ple

te o

nly

th

e fi

eld

s m

arke

d

wit

h a

n a

ster

isk

on F

orm

36

52.

Doe

s n

ot a

pp

ly t

o M

DS

Ass

essm

ents

in t

he

Nu

rsin

g F

acil

ity.

Th

e H

osp

ice

resi

den

t w

ill f

ollo

w t

he

MD

S A

sses

smen

t sc

hed

ule

an

d t

her

efor

e w

ill b

e as

sess

ed e

very

92

day

s.

4T

ILE

rev

iew

(ev

ery

6 m

onth

s)

Con

dit

ion

2:

oD

o n

ot s

ubm

it P

urp

ose

Cod

e 4

on

an

exi

stin

g T

ILE

211

for

non

-h

osp

ice

reci

pie

nts

in y

our

faci

lity

; p

aym

ent

wil

l con

tin

ue

Th

is fu

nct

ion

doe

s n

ot a

pp

ly t

o th

e M

DS

Ass

essm

ent

pro

cess

an

d w

ill n

o lo

nge

r be

su

pp

orte

d.

4T

ILE

rev

iew

(ev

ery

6 m

onth

s)

Con

dit

ion

3:

oT

ran

sfer

ad

mis

sion

from

an

oth

er

faci

lity

for

reci

pie

nt

wit

h

per

man

ent

MN

Th

is fu

nct

ion

doe

s n

ot a

pp

ly t

o th

e M

DS

Ass

essm

ent

pro

cess

an

d w

ill n

o lo

nge

r be

su

pp

orte

d.

Th

e n

ew

faci

lity

mu

st s

ubm

it t

he

MD

S A

sses

smen

ts a

ccor

din

g to

th

e F

eder

al C

MS

sch

edu

le.

Th

e re

sid

ent’

s P

erm

anen

t M

N s

tatu

s w

ill b

e va

lid

ated

d

uri

ng

the

subm

issi

on o

f th

eir

asse

ssm

ent

in t

he

new

fa

cili

ty.

RO

ff-c

ycle

ca

se-m

ix c

ha

ng

e i

n

Wh

en a

sig

nif

ican

t ch

ange

in c

ond

itio

n o

ccu

rs t

he

NF

R

UG

wil

l be

calc

ula

ted

up

on


Pag

e 6

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

con

dit

ion

th

at

cha

ng

es

TIL

E (

on

ce

ev

ery

6 m

on

ths)

. If

a r

ecip

ien

t's

med

ical

con

dit

ion

ch

ange

s to

th

e ex

ten

t th

at t

he

reci

pien

t m

ay q

ual

ify

for

a d

iffe

ren

t T

ILE

, th

e N

F p

rovi

der

can

ch

oose

to

com

ple

te a

new

ass

essm

ent.

O

nly

tw

o of

f-cy

cle

asse

ssm

ents

for

any

NF

rec

ipie

nt

are

per

mit

ted

per

cal

end

ar

year

, on

e fr

om J

anu

ary

thro

ugh

Ju

ne

and

on

e fr

om J

uly

th

rou

gh D

ecem

ber.

T

his

ass

essm

ent

sets

a n

ew s

ched

ule

for

subm

issi

on o

f for

ms

if p

erm

anen

t M

N

has

bee

n a

chie

ved

.

pro

vid

er w

ill s

ubm

it a

com

pre

hen

sive

ass

essm

ent

as

requ

ired

by

Fed

eral

CM

S (A

A8

a =

03)

:

oT

he

Pro

vid

er w

ill s

ubm

it t

he

MD

S Si

gnif

ican

t C

han

ge in

Sta

tus

Ass

essm

ent

(SC

SA)

to t

he

Fed

eral

CM

S d

atab

ase

usi

ng

thei

r n

orm

al

pra

ctic

es fo

r th

eir

faci

lity

(e.

g. R

AV

EN

).

oT

he

MD

S A

sses

smen

t w

ill b

e re

trie

ved

from

th

e F

eder

al C

MS

dat

abas

e an

d b

e m

ade

avai

labl

e on

th

e L

TC

On

lin

e P

orta

l in

th

e C

urr

ent

Act

ivit

y R

epor

t w

hen

th

e P

rovi

der

lo

gs in

to t

he

syst

em.

oT

he

Pro

vid

er w

ill t

hen

com

ple

te t

he

LT

C

Med

icai

d I

nfo

rmat

ion

form

for

the

resi

den

t as

soci

atin

g it

wit

h t

he

MD

S A

sses

smen

t as

p

revi

ousl

y su

bmit

ted

to

the

Fed

eral

CM

S d

atab

ase.

o

Th

e L

TC

On

lin

e P

orta

l wil

l mov

e th

e A

sses

smen

t in

to t

he

Med

ical

Nec

essi

ty

Wor

kflo

w p

roce

ss.

oSu

bseq

uen

t pr

ogre

ss o

f th

e M

edic

aid

pro

cess

ca

n b

e ob

tain

ed b

y u

sin

g th

e F

orm

Sta

tus

Inqu

iry

fun

ctio

n o

f th

e L

TC

On

lin

e P

orta

l.

subm

issi

on.

See

Ru

le 1

9.2

413

(h

).

RA

dm

it t

o h

osp

ice.

W

hen

an

NF

rec

ipie

nt

is a

dm

itte

d t

o or

d

isch

arge

d fr

om h

osp

ice,

th

is

rep

rese

nts

a s

ign

ific

ant

chan

ge in

th

e re

cip

ien

t's m

edic

al c

ond

itio

n. S

ubm

it a

P

urp

ose

Cod

e R

to

refl

ect

the

chan

ge in

th

e re

cip

ien

t's s

tatu

s, a

nd

th

e ad

mis

sion

to

or d

isch

arge

from

hos

pic

e.

Th

ese

Pu

rpos

e C

ode

Rs

are

not

in

clu

ded

in t

he

two

allo

wab

le o

ff-c

ycle

as

sess

men

ts.

If a

Sig

nif

ican

t C

han

ge in

Sta

tus

Ass

essm

ent

is

requ

ired

by

Fed

eral

CM

S ru

les

for

the

pers

on b

ein

g ad

mit

ted

into

Hos

pic

e:

oT

he

Pro

vid

er w

ill s

ubm

it M

DS

Sign

ific

ant

Ch

ange

in S

tatu

s A

sses

smen

t (S

CSA

) to

th

e F

eder

al C

MS

dat

abas

e u

sin

g th

eir

nor

mal

p

ract

ices

for

thei

r fa

cili

ty (

e.g.

RA

VE

N).

In

clu

din

g th

e fo

llow

ing

fiel

d in

Sec

tion

P:

P1a

o is

ch

ecke

d in

dic

atin

g H

osp

ice

Car

e.

oT

he

MD

S A

sses

smen

t w

ill b

e re

trie

ved

from

th

e F

eder

al C

MS

dat

abas

e an

d b

e m

ade

Th

e St

ate

wil

l no

lon

ger

requ

ire

a si

gnif

ican

t ch

ange

in c

ond

itio

n

asse

ssm

ent

for

adm

issi

on o

f a

reci

pie

nt

into

Hos

pic

e. T

his

is a

n

opti

onal

ass

essm

ent

only

wh

en it

ap

pli

es.

See

Ru

le 3

71.2

14 (

f) (

3).


Pag

e 7

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

avai

labl

e on

th

e L

TC

On

lin

e P

orta

l in

th

e C

urr

ent

Act

ivit

y R

epor

t w

hen

th

e P

rovi

der

lo

gs in

to t

he

syst

em.

oT

he

Pro

vid

er w

ill t

hen

com

ple

te t

he

LT

C

Med

icai

d I

nfo

rmat

ion

form

for

the

resi

den

t as

soci

atin

g it

wit

h t

he

MD

S A

sses

smen

t as

p

revi

ousl

y su

bmit

ted

to

the

Fed

eral

CM

S d

atab

ase.

An

d m

ust

incl

ud

e th

e fo

llow

ing

in

the

LT

C M

I H

osp

ice

fiel

ds:

o

S1c

= S

ervi

ce G

rou

p 1

(N

F)

o

S1d

= H

osp

ice

Con

tra

ct N

um

ber

o

S4a

= R

N A

sses

smen

t C

oord

ina

tor

La

st N

am

e o

S4b

= R

N A

sses

smen

t C

oord

ina

tor

Lic

ense

Nu

mbe

r o

Th

e L

TC

On

lin

e P

orta

l wil

l mov

e th

e A

sses

smen

t in

to t

he

Med

ical

Nec

essi

ty

Wor

kflo

w p

roce

ss.

oSu

bseq

uen

t pr

ogre

ss o

f th

e M

edic

aid

pro

cess

ca

n b

e ob

tain

ed b

y u

sin

g th

e F

orm

Sta

tus

Inqu

iry

fun

ctio

n o

f th

e L

TC

On

lin

e P

orta

l.

ER

etro

acti

ve M

N d

eter

min

atio

n;

Rec

over

lost

pay

men

t (f

or m

isse

d

asse

ssm

ent)

If t

he

Nu

rsin

g F

acil

ity

iden

tifi

es a

mis

sed

ass

essm

ent

outs

ide

the

quar

ter

in w

hic

h it

is d

ue

the

foll

owin

g p

roce

du

re is

to

be fo

llow

ed:

oT

he

Pro

vid

er w

ill s

ubm

it w

hat

ever

typ

e of

M

DS

Ass

essm

ent

was

mis

sed

to

the

Fed

eral

C

MS

dat

abas

e u

sin

g th

eir

nor

mal

pra

ctic

es

for

thei

r fa

cili

ty (

e.g.

RA

VE

N).

o

Th

e M

DS

Ass

essm

ent

wil

l be

retr

ieve

d fr

om

the

Fed

eral

CM

S d

atab

ase

and

be

mad

e av

aila

ble

on t

he

LT

C O

nli

ne

Por

tal i

n t

he

Cu

rren

t A

ctiv

ity

Rep

ort

wh

en t

he

Pro

vid

er

logs

into

th

e sy

stem

. o

Th

e P

rovi

der

wil

l th

en c

omp

lete

th

e L

TC

See

Ru

le 1

9.2

413

(g)

.


Pag

e 8

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

Med

icai

d I

nfo

rmat

ion

form

for

the

resi

den

t as

soci

atin

g it

wit

h t

he

MD

S A

sses

smen

t as

p

revi

ousl

y su

bmit

ted

to

the

Fed

eral

CM

S d

atab

ase.

An

d m

ust

incl

ud

e th

e fo

llow

ing

in

the

fiel

ds:

o

S1e(

Pu

rpos

e C

ode)

= E

o

S1f

= M

isse

d A

sses

smen

t St

art

Da

te

oS1

g =

Mis

sed

Ass

essm

ent

En

d D

ate

o

Th

e L

TC

On

lin

e P

orta

l wil

l mov

e th

e A

sses

smen

t in

to t

he

Med

ical

Nec

essi

ty

Wor

kflo

w p

roce

ss.

oSu

bseq

uen

t pr

ogre

ss o

f th

e M

edic

aid

pro

cess

ca

n b

e ob

tain

ed b

y u

sin

g th

e F

orm

Sta

tus

Inqu

iry

fun

ctio

n o

f th

e L

TC

On

lin

e P

orta

l.

Ple

ase

not

e th

at t

he

Def

ault

RU

G r

ate

rath

er t

han

th

e ac

tual

RU

G r

ate

wil

l be

assi

gned

to

the

per

iod

th

at

was

mis

sed

. F

Off

-cyc

le P

ASA

RR

du

e to

ch

ange

in

PA

SAR

R c

ond

itio

n.

oT

he

Pro

vid

er w

ill s

ubm

it t

he

MD

S Si

gnif

ican

t C

han

ge in

Sta

tus

Ass

essm

ent

(SC

SA)

to t

he

Fed

eral

CM

S d

atab

ase

usi

ng

thei

r n

orm

al

pra

ctic

es fo

r th

eir

faci

lity

(e.

g. R

AV

EN

).

oT

he

MD

S A

sses

smen

t w

ill b

e re

trie

ved

from

th

e F

eder

al C

MS

dat

abas

e an

d b

e m

ade

avai

labl

e on

th

e L

TC

On

lin

e P

orta

l in

th

e C

urr

ent

Act

ivit

y R

epor

t w

hen

th

e P

rovi

der

lo

gs in

to t

he

syst

em.

oT

he

Pro

vid

er w

ill t

hen

com

ple

te t

he

LT

C

Med

icai

d I

nfo

rmat

ion

form

for

the

resi

den

t as

soci

atin

g it

wit

h t

he

MD

S A

sses

smen

t as

p

revi

ousl

y su

bmit

ted

to

the

Fed

eral

CM

S d

atab

ase.

In

clu

din

g th

e fo

llow

ing

fiel

ds:

o

S1E

Pu

rpos

e C

ode

= F

o

Th

e L

TC

On

lin

e P

orta

l wil

l mov

e th

e A

sses

smen

t in

to t

he

Med

ical

Nec

essi

ty

Wor

kflo

w p

roce

ss.


Pag

e 9

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

oSu

bseq

uen

t pr

ogre

ss o

f th

e M

edic

aid

pro

cess

ca

n b

e ob

tain

ed b

y u

sin

g th

e F

orm

Sta

tus

Inqu

iry

fun

ctio

n o

f th

e L

TC

On

lin

e P

orta

l.

UC

ase-

mix

ass

essm

ent

corr

ecti

on o

f T

ILE

fiel

ds.

Ru

les: •

Cor

rect

ion

to

TIL

E fi

eld

s 30

, 31

and

50

th

rou

gh 9

9

•C

omp

lete

d b

y n

urs

ing

faci

lity

st

aff w

ith

rev

iew

by

HH

SC/U

R.

•D

oes

not

get

su

bmit

ted

to

TM

HP

.•

Mu

st b

e su

bmit

ted

wit

hin

60

d

ays

of a

sses

smen

t in

err

or

Th

e F

eder

al C

MS

pro

vid

es fo

r tw

o m

eth

ods

of

Cor

rect

ion

:1)

Mod

ific

atio

n/I

nac

tiva

tion

of a

n e

xist

ing

asse

ssm

ent

(aff

ects

an

exi

stin

g M

DS

asse

ssm

ent)

. 2)

Sig

nif

ican

t C

orre

ctio

n (

Qu

arte

rly

or F

ull

)

AA

8a=

04

OR

AA

8a=

10

(n

ew a

sses

smen

t, r

eset

s as

sess

men

t cy

cle)

.

o T

he

Pro

vid

er w

ill s

ubm

it t

he

app

rop

riat

e fo

rm a

ccor

din

g to

th

e F

eder

al C

MS

subm

issi

on r

ule

s u

sin

g th

eir

nor

mal

pra

ctic

es

for

thei

r fa

cili

ty (

e.g.

RA

VE

N).

o

Th

e M

DS

Ass

essm

ent

or

Mod

ific

atio

n/I

nac

tiva

tion

wil

l be

retr

ieve

d

from

th

e F

eder

al C

MS

dat

abas

e an

d b

e m

ade

avai

labl

e on

th

e L

TC

On

lin

e P

orta

l in

th

e C

urr

ent

Act

ivit

y R

epor

t w

hen

th

e P

rovi

der

lo

gs in

to t

he

syst

em.

oIf

th

e C

orre

ctio

n is

on

e of

th

e Si

gnif

ican

t C

orre

ctio

n A

sses

smen

ts t

he

Pro

vid

er w

ill

then

com

ple

te t

he

LT

C M

edic

aid

In

form

atio

n

form

for

the

resi

den

t as

soci

atin

g it

wit

h t

he

MD

S A

sses

smen

t as

pre

viou

sly

subm

itte

d t

o th

e F

eder

al C

MS

dat

abas

e.

oIf

it is

a M

odif

icat

ion

to

an e

xist

ing

MD

S A

sses

smen

t fo

r M

edic

aid

, th

e in

accu

rate

re

cord

is m

oved

into

th

e h

isto

ry fi

le in

th

e F

eder

al M

DS

Dat

abas

e an

d r

epla

ced

wit

h t

he

corr

ecte

d r

ecor

d in

th

e ac

tive

dat

abas

e.

TM

HP

wil

l rep

lace

th

e or

igin

al fo

rm w

ith

th

e "m

odif

icat

ion

" fo

rm o

n t

he

LT

C O

nli

ne

Por

tal

and

th

e fo

rm s

tatu

s w

ill b

e ch

ange

d t

o a

See

Ru

le 1

9.2

413

(h

).


Pag

e 10

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

Pu

rpo

se

Co

de

Cu

rre

nt

Pro

cess

F

utu

re P

roce

ss

Co

mm

en

ts

corr

ecte

d s

tatu

s. T

he

LT

C O

nli

ne

Por

tal w

ill

mov

e th

e as

sess

men

t in

to t

he

Med

ical

N

eces

sity

Wor

kflo

w p

roce

ss.

oIf

it is

an

In

acti

vati

on t

he

MD

S A

sses

smen

t w

ill b

e lo

cate

d o

n t

he

LT

C O

nli

ne

Por

tal a

nd

m

oved

to

an “

inac

tive

” st

atu

s.

oW

hen

an

MD

S as

sess

men

t in

acti

vati

on is

ac

cep

ted

into

th

e T

MH

P L

TC

On

lin

e P

orta

l an

d m

eets

all

th

e ap

pli

cabl

e T

MH

P fo

rm

requ

irem

ents

, TM

HP

wil

l pla

ce t

he

form

in

the

wor

kflo

w fo

r m

anu

al p

roce

ssin

g. (

rath

er

than

su

bmit

it t

o D

AD

S fo

r p

roce

ssin

g).

No

auto

mat

ed p

roce

ssin

g of

inac

tiva

tion

s w

ill b

e p

erfo

rmed

by

DA

DS.

o

Subs

equ

ent

prog

ress

of t

he

Med

icai

d p

roce

ss

can

be

obta

ined

by

usi

ng

the

For

m S

tatu

s In

quir

y fu

nct

ion

of t

he

LT

C O

nli

ne

Por

tal.

WC

omp

lete

d b

y th

e N

F w

hen

th

e H

HSC

, U

tili

zati

on R

evie

w (

UR

) U

nit

init

iate

s ve

nd

or h

old

. •

On

ly u

sed

du

rin

g on

site

co

mp

lian

ce v

isit

by

UR

•

Use

d d

uri

ng

For

m S

ubm

issi

on

Hol

d•

Pap

er p

roce

ss o

nly

A P

urp

ose

Cod

e W

wil

l no

lon

ger

be u

sed

as

the

mea

ns

of h

and

lin

g th

is c

orre

ctiv

e ac

tion

; th

eref

ore,

th

e n

eed

for

a P

urp

ose

Cod

e fi

eld

on

th

e L

TC

MI

for

this

sce

nar

io is

not

req

uir

ed.

HH

SC O

IG U

R is

in t

he

pro

cess

of

dra

ftin

g ru

les

for

han

dli

ng

the

For

m S

ubm

issi

on h

old

as

a re

sult

of

a h

igh

err

or r

ate.

XO

nly

use

d b

y H

HSC

UR

sta

ff fo

llow

ing

an o

nsi

te r

evie

w.

•36

52 d

ata

is e

nte

red

in M

FA

DS

CM

UR

sys

tem

not

th

e T

MH

P

LT

C O

nli

ne

Por

tal

•A

n in

terf

ace

file

is s

ent

to

DA

DS

SAS

to c

han

ge t

he

TIL

E

in t

he

Lev

el o

f Ser

vice

rec

ord

Th

e M

FA

DS

CM

UR

inte

rfac

e fi

le w

ill c

onti

nu

e to

be

sen

t to

DA

DS

SAS

to c

reat

e th

e L

evel

of S

ervi

ce r

ecor

d

wit

h t

he

new

RU

G v

alu

e fo

llow

ing

an o

nsi

te r

evie

w.

Th

e fi

le is

sen

t w

ith

: •

Th

e n

ew v

alu

e fo

r th

e R

UG

P

urp

ose

Cod

e X

ind

icat

ing

the

reas

on fo

r th

e ch

ange


Pag

e 11

of 1

2

*See

“M

DS

Rea

son

s fo

r A

sses

smen

t” a

t en

d o

f d

ocu

men

t.

MN

AN

ew P

urp

ose

Cod

e fo

r R

etro

acti

ve M

edic

aid

A

sses

smen

t. T

his

PC

can

be

sen

t w

ith

Ad

mis

sion

A

sses

smen

t, A

nn

ual

Ass

essm

ent

or Q

uar

terl

y R

evie

w

Ass

essm

ent.

MD

SAS

wil

l det

erm

ine

wh

eth

er o

r n

ot

the

reci

pie

nt

has

ret

roac

tive

Med

icai

d e

ligi

bili

ty.

Mis

sed

Ass

essm

ent

Star

t an

d E

nd

Dat

es a

re u

sed

by

the

pro

vid

er t

o id

enti

fy t

he

Ret

roac

tive

Med

icai

d

per

iod

.L

TC

MI:

S1e

= M

(P

urp

ose

Cod

e)

S1f =

Mis

sed

Ass

essm

ent

Star

t D

ate

S1g

= M

isse

d A

sses

smen

t E

nd

Dat

e

See

Ru

le 1

9.2

611

(a)

(1)

– (

5) A

ND

(b

) R

etro

acti

ve V

end

or P

aym

ent.


A New Resident is Admitted or

Transferred from another Nursing Facility

Submit AA8a=1 Admission assessment – required by day 14

If resident has a diagnosis of MI/MR/RC contact DADS at 512-438-4345 to verify that a PASARR is on file.

Form 3618 must be signed and electronicallysubmitted within 72 hours of admission.

Pag

e 12

of 1

2

MD

S R

ea

son

s fo

r A

sse

ssm

en

t Se

ctio

n A

A

8.

RE

ASO

NS

FO

R A

SSE

SSM

EN

T

a. P

rim

ary

reas

on fo

r as

sess

men

t

1.A

dm

issi

on a

sses

smen

t (r

equ

ired

by

day

14

) 2.

An

nu

al a

sses

smen

t 3.

Sign

ific

ant

chan

ge in

sta

tus

asse

ssm

ent

4.Si

gnif

ican

t co

rrec

tion

of p

rior

full

ass

essm

ent

5.Q

uar

terl

y re

view

ass

essm

ent

10.

Sign

ific

ant

corr

ecti

on o

f pri

or q

uar

terl

y as

sess

men

t 0

.N

ON

E O

F A

BO

VE

b. C

odes

for

asse

ssm

ents

req

uir

ed fo

r M

edic

are

PP

S or

th

e St

ate

1.M

edic

are

5 d

ay a

sses

smen

t 2.

Med

icar

e 30

day

ass

essm

ent

3.M

edic

are

60

day

ass

essm

ent

4.M

edic

are

90

day

ass

essm

ent

5.M

edic

are

read

mis

sion

/ret

urn

ass

essm

ent

6.

Oth

er s

tate

req

uir

ed a

sses

smen

t 7.

Med

icar

e 14

day

ass

essm

ent

8.

Oth

er M

edic

are

requ

ired

ass

essm

ent


A New Resident is Admitted or

Transferred from another Nursing Facility


If resident has a diagnosis of MI/MR/RC contact DADS at 512-438-4345 to verify that a PASARR is on file.



New Resident to Medicaid isAdmitted to Hospice


If resident has a diagnosis of MI/MR/RC contact DADS at 512-438-4345 verify that a PASARR is on file.

Form 3071 and 3074 must be on file.

Current Medicaid Resident is Admitted to Hospice

Form 3618 Discharge must be signed and electronically

submitted within 72 hours of hospice election date.

If a significant change in status has not occurred continue with current MDS schedule.

If a significant change in status has occurred submit MDS AA8a=3 (Significant Change in Status Assessment) With a check in Section P1a.o

Indicating hospice care

Complete Long Term Care Medicaid Information(LTCMI) Section S1d and Hospice contract number

Resident ReturnsPrior Discharge Indicates Return Not Anticipated





Resident ReturnsPrior Discharge Indicates Return Not Anticipated





Resident Returns Prior Discharge Indicates Return Anticipated

Resident returns to full Medicaid.

Complete AA8a=3 – Significant change in status assessment.

No

Has resident had a change in condition?

Yes

An MDS is not required until the current assessment

expires.

Yes

Has previous assessment expired?

Form 3618 must be signed and electronicallySubmitted within 72 hours of admission.

Submit next MDS as scheduled

No


Minimum Data Set (MDS) Quick Reference Guide

2008

MDS Phone Numbers

AT&T Global Dialer Helpdesk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-905-2069

MDS Automation/Report Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-512-438-2396

MDS Clinical Questions/Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-806-249-5579 Ext . 2

MDS/QI Technical Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-727-5436, Press 3

MDS/RAP/Care Plan Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-512-458-1257 / 1-512-467-2242

QI Clinical Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-806-249-5579 Ext . 2

QI Report Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-512-438-2396

RAVEN Helpdesk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-339-9313

Swing Bed Automation/Technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-339-9313

Swing Bed Clinical MDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-806-249-5579 Ext . 2

MDS Informational Websites

AT&T Global Dialer: www .qtso .com

Federal MDS site: www .cms .hhs .gov/MinimumDataSets20/

MDS Software Specifications: http://www .cms .hhs .gov/MDS20SWSpecs

MDS/RAP/Care Planning Training: www .tahsa .org

MDS/RAP/Care Planning Training: www .txhca .org

RAVEN Download: www .qtso .com/ravendownload .html

RAVEN: http://www .cms .hhs .gov/MinimumDataSets20/07_RAVENSoftware .asp#TopOfPage

Resident Assessment Instrument (RAI) Manual: www .cms .hhs .gov/nursinghomequalityinits/20_nhqimds20 .asp

State MDS Policy: www .dads .state .tx .us/providers/mds/index .cfm

Validation Report Message Descriptions: www .qtso .com/mdsdownload .html


MDS data is keyed

Connect to MDS website usingAT&T Global Network Dialer

Access MDS Welcome page

Initial Feedback report created

Fatal error-Data is not stored on the

MDS serverWarnings or no errors received

Make appropriate changes,and transmit

Data processed and finalvalidation report created

Warning receivedFatal error-

Data is not stored onthe MDS server

Change required?Make changes to theassessment and transmit

Data is stored on theMDS state serverNo

Yes

No errors

Create modification,request assessment, and

modify transmitFinal validationreport created

Transmit Assessments

MDS Submission ProcessMDS Submission Process