483.315—Specification of resident assessment instrument.
(a) Statutory basis.
Sections 1819(e)(5) and 1919(e)(5) of the Act require that a State specify the resident assessment instrument (RAI) to be used by long term care facilities in the State when conducting initial and periodic assessments of each resident's functional capacity, in accordance with § 483.20.
(b) State options in specifying an RAI.
The RAI that the State specifies must be one of the following:
(2)
An alternate instrument specified by the State and approved by CMS, using the criteria specified in the State Operations Manual issued by CMS (CMS Pub. 7) which is available for purchase through the National Technical Information Service, 5285 Port Royal Rd., Springfield, VA 22151.
(c) State requirements in specifying an RAI.
(1)
Within 30 days after CMS notifies the State of the CMS-designated RAI or changes to it, the State must do one of the following:
(2)
Within 60 days after receiving CMS approval of an alternate RAI, the State must specify the RAI for use by all long term care facilities participating in the Medicare and Medicaid programs.
(3)
After specifying an instrument, the State must provide periodic educational programs for facility staff to assist with implementation of the RAI.
(d) CMS-designated RAI.
The CMS-designated RAI is published in the State Operations Manual issued by CMS (CMS Pub. 7), as updated periodically, and consists of the following:
(2)
Care area assessment (CAA) guidelines and care area triggers (CATs) that are necessary to accurately assess residents, established by CMS.
(e) Minimum data set (MDS).
The MDS includes assessment in the areas specified in § 483.20(b)(i) through (xviii) of this chapter, and as defined in the RAI manual published in the State Operations Manual issued by CMS (CMS Pub. 100-07).
(g) Criteria for CMS approval of alternate instrument.
To receive CMS approval, a State's alternate instrument must use the standardized format, organization, item labels and definitions, and instructions specified by CMS in the latest issuance of the State Operations Manual issued by CMS (CMS Pub. 7).
(h) State MDS system and database requirements.
As part of facility agency responsibilities, the State Survey Agency must:
(2)
Specify to a facility the method of transmission of data, and instruct the facility on this method.
(i) State identification of agency that receives RAI data.
The State must identify the component agency that receives RAI data, and ensure that this agency restricts access to the data except for the following:
(3)
Transmission of data and reports to the State agency that conducts surveys to ensure compliance with Medicare and Medicaid participation requirements, for purposes related to this function.
(4)
Transmission of data and reports to the State Medicaid agency for purposes directly related to the administration of the State Medicaid plan.
(5)
Transmission of data and reports to other entities only when authorized as a routine use by CMS.
(j) Resident-identifiable data.
(1)
The State may not release information that is resident-identifiable to the public.
(2)
The State may not release RAI data that is resident-identifiable except in accordance with a written agreement under which the recipient agrees to be bound by the restrictions described in paragraph (i) of this section.
[62 FR 67212, Dec. 23, 1997, as amended at 74 FR 40363, Aug. 11, 2009]