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WAC 388-96-738

What default case mix group and weight must the department use for case mix grouping when there is no minimum data set resident assessment for a nursing facility resident?

(1) When a resident:
(a) Expires before the facility completes the resident's initial assessment, the department must assign the assessment to the special care case mix group - HD2. The department must use the case mix weight assigned to the special care case mix group - HD2. The department will count the case as a medicaid resident;
(b) Is discharged to an acute care facility before the nursing facility completes the resident's initial assessment, the department must assign the assessment to the special care case mix group - HD2. The department must use the case mix weight assigned to the special care case mix group - HD2. The department will count the case as a medicaid resident; or
(c) Is discharged for a reason other than those noted above before the facility completes the resident's initial assessment, the department must assign the assessment to the case mix group BC1. The department will count the case as a medicaid resident.
(2) If the resident assessment is untimely as defined in RCW 74.46.501 and as defined by federal regulations, then the department must assign the case to the default case mix group of BC1. The department will count the case a medicaid resident.
[Statutory Authority: RCW 74.46.431(9). WSR 15-09-025, § 388-96-738, filed 4/7/15, effective 5/8/15. Statutory Authority: Chapter 74.46 RCW as amended by 1998 c 322 §§ 22, 24 and 25 and RCW 74.46.800. WSR 98-20-023, § 388-96-738, filed 9/25/98, effective 10/1/98.]
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