Sec. 10.09.10.24. MDS Validation and Ventilator Care Validation

A. MDS Validation.

(1) In order to validate that the Nursing Service rate is supported by medical record documentation, accurately coded and submitted, the Department shall conduct periodic MDS validation reviews, which shall:

(a) Compare the MDS assessment coding with the corresponding medical record documentation to determine unsupported MDS assessments;

(b) Determine the completeness, timeliness, and accuracy of resident MDS assessments identified on the resident roster; and

(c) Determine the completeness and accuracy of the resident payment source listed on the resident roster.

(2) Findings from the MDS validation may be used to adjust a nursing facility’s per diem payment rate to reflect the validated case mix index used in the rate setting process.

B. Ventilator Care Validation.

(1) In order to validate that days paid for residents that meet the requirements for ventilator care are supported by medical record documentation of the need for ventilator care services, the Department shall conduct a periodic ventilator care validation.

(2) Findings from the ventilator care validation shall be used to recoup payments for days not supported by medical record documentation.