Statutory Requirements

4145.1 - Statutory Requirements (Rev. 1, 05-21-04) Sections 1819(b)(3), 1819(e)(5), 1819(f)(6)(B), 1919(b)(3), 1919(e)(5), and 1919(f)(6)(B) of the Act specify assessment requirements for SNFs for Medicare and NFs for Medicaid, which provide nursing, medical, and rehabilitative care to Medicare and/or Medicaid beneficiaries. These provisions require facilities to conduct comprehensive, accurate, standardized, and reproducible assessments of each resident’s functional capacity using an RAI that has been specified by the State. Facilities are required to examine their residents no less frequently than once every three months. These provisions place specific responsibilities on the Department of Health and Human Services, the State, and providers. The CMS is responsible for designating the minimum data set (MDS), common definitions and utilization guidelines, and for designating one or more RAIs for use by the States. The States are responsible for specifying the RAI for use by facilities in the State. The State may use an RAI designated by CMS or specify it’s own instrument provided that it includes the MDS and that it has been approved by CMS. All State RAIs must include the MDS of core elements, common definitions and utilization guidelines specified by CMS. (See §4145.2.) Providers are responsible for using the specific assessment instrument that has been specified by the State and approved by the Secretary.