Classifications

1. A facility shall complete a resident assessment for any resident occupying a licensed facility bed, except a respite care resident. 2. A resident must be classified based on the resident assessment. If a resident assessment is not performed in accordance with subsection 3, except for a respite care resident, the resident must be included in the default classification, until the next required resident assessment is performed in accordance with subsection 3. A resident, except for a respite care resident, who has not been classified, must be billed at the default classification established rate. The case-mix weight for establishing the rate for the default classification is 0.64. Days for a respite care resident who is not classified must be given a weight of one when determining standardized resident days. Therapeutic, hospital, or institutional leave days that are resident days must be given a weight of 0.64 when determining standardized resident days. 3. Resident assessments must be completed as follows: a. The facility shall assess the resident within the first fourteen days after any admission or return from an acute hospital stay. The assessment reference date must be between day seven and day fourteen. b. The facility shall assess the resident quarterly after any admission or return from an acute hospital stay. The quarterly assessment reference period ends on the day of the third subsequent month corresponding to the day of admission or return from an acute hospital stay, except if that month does not have a corresponding date, the quarterly assessment reference period ends on the first day of the next month. The assessment reference period begins seven days prior to the ending date of a quarterly assessment period. The assessment reference date used for the resident assessment instrument must be within the assessment reference period. 4. The resident classification is based on resident characteristics and health status recorded on the resident assessment instrument, including clinical complexity, functional status, need for restorative services, cognitive impairment, and comorbidities. 5. The classification is effective the date the resident assessment must be completed in all cases except an admission or for a return from an acute hospital stay. The classification for an admission or for a return is effective the date of the admission or return. 6. A facility complying with any provision of this section that requires a resident assessment shall use the minimum data set in a resident assessment instrument that conforms to standards for a resident classification system described in 42 CFR 413.333.