DiraChart MDS item reference
Item Rationale
Use the item-specific response choices below when structured codes apply.
if the resident is on a Medicare and/or Medicaid certified unit, regardless of payer source (i.e., even if the
resident is private pay or has their stay covered under Medicare Advantage, Medicare
HMO, private insurance, etc.), the facility is required to submit MDS records (OBRA and
SNF PPS only) to iQIES for these residents. Consult Chapter 5, page 5-1 of this Manual
for a discussion of what types of records should be submitted to iQIES.
Review what the item asks, how to choose the response, and what should be verified before submission.
1. Ask the nursing home administrator or representative which units in the nursing home are
Medicare certified, Medicaid certified or dually certified (Medicare/Medicaid).
2. If some or all of the units in the nursing home are neither Medicare nor Medicaid certified,
ask the nursing home administrator or representative if there are units that are state licensed
and if the state requires MDS submission for residents on that unit.
3. Identify all units in the nursing home that are not certified or licensed by the state, if any.
A0410: Unit Certification or Licensure Designation (cont.)
•
Code 1, Unit is neither Medicare nor Medicaid certified and MDS data is
not required by the State: if the MDS record is for a resident on a unit that is
neither Medicare nor Medicaid certified, and neither CMS nor the state has authority to
collect MDS information for residents on this unit, the facility may not submit MDS
records to iQIES. If any records are submitted under this certification designation, they
will be rejected by iQIES.
•
Code 2, Unit is neither Medicare nor Medicaid certified but MDS data is
required by the State: if the nursing home resident is on a unit that is neither
Medicare nor Medicaid certified, but the state has authority under state licensure to
collect MDS information for residents on such units, the facility should submit the
resident’s MDS records per the state’s requirement to iQIES or directly to the state.
Note that this certification designation does not apply to swing-bed facilities.
Assessments for swing-bed residents on which A0410 is coded “2” will be rejected by
iQIES.
•
Code 3, Unit is Medicare and/or Medicaid certified: if the resident is on a
Medicare and/or Medicaid certified unit, regardless of payer source (i.e., even if the
resident is private pay or has their stay covered under Medicare Advantage, Medicare
HMO, private insurance, etc.), the facility is required to submit MDS records (OBRA and
SNF PPS only) to iQIES for these residents. Consult Chapter 5, page 5-1 of this Manual
for a discussion of what types of records should be submitted to iQIES.
See where this item applies across Nursing Home, Swing Bed, discharge, required-use, OBRA, and program or policy columns.
MDS Item Matrix v1.20.1 v4
MDS Item Matrix v1.20.1 v4
MDS Item Matrix v1.20.1 v4
MDS Item Matrix v1.20.1 v4
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