405 Ind. Admin. Code 1-15-5

Current through October 31, 2024

Section 405 IAC 1-15-5 - MDS review requirements

Authority: IC 12-15-1-10; IC 12-15-21-2

Affected: IC 12-13-7-3; IC 12-15

Sec. 5.

(a) The office shall periodically review the MDS assessments and supporting documentation data maintained by a nursing facility for its residents, regardless of payer type. The reviews shall be conducted as frequently as considered necessary by the office, and each nursing facility shall be reviewed not less frequently than every thirty-six (36) months. Advance notification shall be provided by the office for the MDS reviews, except for follow-up reviews intended to ensure compliance with validation improvement plans.

(b) MDS assessments data, regardless of payer type, are based on an MDS review.

(c) When conducting MDS reviews, the office shall consider the MDS supporting documentation data provided by the nursing facility and available to the reviewers before the exit conference. MDS supporting documentation data provided by the nursing facility after the exit conference begins shall not be considered by the office.

(d) A nursing facility shall be required to produce, on request by the office, a computer generated copy of the MDS assessment transmitted under section 1 of this rule, which shall be the basis for the MDS review.

(e) Suspected intentional alteration of clinical documentation, or creation of documentation after MDS assessments data have been transmitted, shall be referred to the Indiana Medicaid fraud control unit for investigation of possible fraud. This investigation may result in a felony or misdemeanor criminal conviction.

405 IAC 1-15-5

Office of the Secretary of Family and Social Services; 405 IAC 1-15-5; filed Mar 2, 1999, 4:42 p.m.: 22 IR 2249; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Mar 18, 2002, 3:30p.m.: 25 IR 2471; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; filed Nov 1, 2010, 11:37 a.m.: 20101201-IR-405100183FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA

Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA

Filed 10/13/2017, 12:09 p.m.: 20171108-IR-405160327FRA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA

Filed 8/20/2024, 9:11 a.m.: 20240918-IR-405240088FRA