Approval Process

4145.6 - Approval Process (Rev. 1, 05-21-04) A State agency must not revise its specified RAI without first notifying CMS and receiving CMS’ approval. All State agencies must adopt any revisions to the RAI that are specified by CMS. All State agencies must inform CMS whether they intend to specify the RAI designed by CMS, or request approval for an alternative State instrument. When specifying CMS’ instrument, a State agency must include the following in its letter to CMS: • A plan for implementation that includes time frames (e.g., effective dates) and plans for training the facilities; and • The name, address, phone number, and e-mail address (if known) of the State RAI coordinator (i.e., the individual responsible for liaison and training of providers and State agency staff). When requesting approval for an alternative instrument, or modifications to an existing specified instrument, a State agency must include the following in its request to CMS: • A copy of the proposed instrument and any instructions that exceed CMS’ utilization guidelines; • A short narrative specifying how the instrument conforms with CMS’ designated MDS and utilization guidelines (including the RAPs); • A description of the items and their definitions that will appear in the State supplement section of the MDS; • A plan for implementation that includes time frames and plans for training the facilities; • The name, address, phone number, and e-mail address (if known) of the State RAI coordinator (i.e., the individual responsible for liaison and training of providers and State agency staff); and • The name, address, phone number, and e-mail address (if known) of the State agency’s contact for technical questions on the proposed alternate instrument. Please send all correspondence to: Centers for Medicare & Medicaid Services Center for Medicaid and State Operations Survey and Certification Group Technical Director, Division of Nursing Homes 7500 Security Boulevard Mail Stop S2-12-25 Baltimore, Maryland 21244 Once CMS has received a State agency’s request for use of an alternate instrument, or modifications to an existing specified instrument, CMS will review the proposed instrument to determine whether it is an acceptable alternate, and will communicate directly with the State agency’s representatives to clarify information, if necessary. The CMS will work with the State agency to meet its needs for resident assessment information. Once a State agency has received approval from CMS for the alternate instrument, the State agency must implement the approved alternate. Within 60 days of receiving CMS’ approval of the alternate RAI, the State agency must notify all long term care facilities participating in the Medicare and/or Medicaid programs in its State of the alternate instrument. This notification must include a copy of the approved specified instrument and the procedures for using the instrument. States that have specified the CMS-designated RAI as their specified instrument must notify all long-term care facilities participating in the Medicare and/or Medicaid programs in their States of the specified instrument and any updates issued by CMS, with sufficient time for the facilities to meet the effective implementation date. The State agency must ensure that all long-term care facilities participating in the Medicare and/or Medicaid programs in its State are using specified instrument within 90 days after a State agency has notified its providers of the specified instrument. To ensure that facilities are properly trained, each State agency must provide periodic educational programs for facility staff to assist with implementation of the specified RAI.