Citations Affected: IC 12-7-2-131.3 ; IC 12-15-43.
Synopsis: Annual review of Medicaid nursing home residents.
Requires a nursing facility certified to provide nursing facility care to
Medicaid recipients to submit minimum data set (MDS) information
for each of its patients annually to the office of Medicaid policy and
planning (OMPP). Requires OMPP to evaluate the information under
specified guidelines. Requires OMPP to counsel an individual on the
services available to the individual if OMPP determines that the
individual's needs can be met in a cost effective manner in a setting
other than a nursing facility. (The introduced version of this bill was
prepared by the joint commission on Medicaid oversight.)
Effective: July 1, 2002.
January 7, 2002, read first time and referred to Committee on Health and Provider
A BILL FOR AN ACT to amend the Indiana Code concerning
IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2002]: Sec. 131.3. "Minimum data set" or
"MDS", for purposes of
, has the meaning set forth in
SECTION 2. IC 12-15-43 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]:
Chapter 43. Annual Review of Medicaid Nursing Facility Residents
Sec. 1. "Minimum data set" or "MDS" means a core set of screening and assessment elements, including common definitions and coding categories, used as:
(1) a comprehensive assessment for all residents of nursing facilities certified to participate in the Medicaid program; and
(2) a standardized communication about resident problems, strengths, and conditions within the facilities, between
facilities, and between facilities and outside agencies.
Sec. 2. A nursing facility certified to provide nursing facility care to Medicaid recipients shall submit to the office annually minimum data set (MDS) information for each of its Medicaid residents.
Sec. 3. (a) The office or the office's designated contractor shall evaluate the MDS information submitted for each Medicaid resident. The evaluation must consist of an assessment of the following:
(1) The individual's medical needs.
(2) The availability of services, other than services provided in a nursing facility, that are appropriate to the individual's needs.
(3) The cost effectiveness of providing services appropriate to the individual's needs that are provided outside, rather than within, a nursing facility.
(b) The assessment must be conducted in accordance with rules adopted under IC 4-22-2 by the office.
Sec. 4. If the office determines under section 3 of this chapter that an individual's needs could be met in a cost effective manner in a setting other than a nursing facility, the office shall counsel the individual and provide the individual with written notice containing the following:
(1) The reasons for the office's determination.
(2) A detailed description of services available to the individual that, if used by the individual, would make the continued placement of the individual in a nursing facility inappropriate. The detailed description of services available must do the following:
(A) Include a determination of whether the provider of the services available has the capacity to provide the services.
(B) State the name of the provider of the services.
(C) Designate the specific site where the services are available.