AGING AND DISABILITY SERVICES ADMINISTRATION
Washington State Specific Vendor Specifications
Last Revised July 12, 2007
- No Section 'S' is in use at this time in Washington State.
- No Section 'U' is in use at this time in Washington State.
- Section T is entitled, ‘Therapy Supplement for Medicare PPS’. Data contained in the T1 ‘Special Treatments and Procedures’, T2 ‘Ordered Therapies (first 14 days)’, and T3a ‘Medicare’ fields are not used by The State of Washington, but are passed on to CMS. As stated in the RAI manual for T3. Casemix Group, the intent is that it “Records the RUG-III Classification calculated from the facility software.” According to T3a ‘Medicare’, the RAI manual (RAI Manual 2.0, June 2006 Update, Chapter 3) says:
- The software calculated RUG-III Classification for the Medicare program using the 53 Group Version 5.2. The first three characters entered in the boxes represent one of the 53 RUG-III groups. The last two numbers are an indicator of the version of the RUG-III Classification system. Currently, this version is 09. This 09 comes directly from the software and will appear on every assessment.
- The T3b ‘State’ field is not a required field and any entries in this field are not used by the State of Washington because the Washington State Medicaid casemix is determined by the use of an index maximizing calculation based upon the raw MDS data.
- RAPs may be included (where not currently required by CMS) but RAPs outside the federal requirement are in no way required by the State of Washington.
- For 'Partial Quarterly Option', select 'Standard + Options'. Then select All Options.
- For SUB_REQ settings, select '3' which represents a resident in a 100% Medicare/Medicaid Certified unit. '2' is not a valid field. '1' is a valid field, however, it represents a resident on a unit not certified for Medicare and/or Medicaid for which the state lacks authority to collect MDS information. If '1' is selected for a record, the record is rejected from system upload because inclusion is not allowed in the state or national repository.
- The MPAF is allowed for Medicare assessments only - those where the reason for assessment is one of the items in item AA8b of the Minimum Data Set (MDS) - 1, 2, 3, 4, 5, 7, or 8. Nursing facilities may complete the full MDS 2.0, at their option, however only those items identified on the MPAF will be retained in the database - all other items are discarded. Include AB5 in MPAF.
- Other Assessment Requirements:
- A full assessment (minus the RAPS, Section V) is required for quarterly reviews.
- A full assessment (minus the RAPS, Section V) is required for a Medicare 90-day assessment when it is combined with an OBRA quarterly assessment or other 'Primary Reason for Assessment', under AA8a, 'Reasons for Assessment' on the full assessment form.
- The MPAF is not accepted for quarterly reviews.
- The MPAF is accepted for 90-day Medicare assessments as long as there is not also a non-Medicare reason for assessment.
- A MDS RUG based casemix system is in place for Medicaid and Medicare. The State of Washington utilizes the payment index maximizing grouper: RUGs III grouper 5.12b with an A01 Medicare PPS Rural 44 group system or A02 Medicare PPS Urban 44 group system. To determine the appropriate Urban versus Non-Urban designation for Medicare, please refer to this link, starting at page 256 for Washington State: www.cms.hhs.gov/snfpps/downloads/cms-1282-f-display.pdf Background: RCW 74.46.506 (e), (f) states that the department will separate the facilities within at least these two classes. The Urban versus Non-Urban designation is used for Medicaid only through the median lids in the rate computation worksheet completed by the department. The median lids do not have an affect on RUGs. As described in RCW 74.46.496, RUG weights are developed from time studies and wages. For further information on Medicaid payment, see: WA State Nursing Facility Medicaid Payment Rate Setting July 2003
Urban/Non-Urban Designation
For WA State MedicaidCounty Name County Code County Type OUT OF STATE 0 NON-URBAN ADAMS 1 NON-URBAN ASOTIN 2 URBAN BENTON 3 URBAN CHELAN 4 URBAN CLALLAM 5 NON-URBAN CLARK 6 URBAN COLUMBIA 7 URBAN COWLITZ 8 URBAN DOUGLAS 9 URBAN FERRY 10 NON-URBAN FRANKLIN 11 URBAN GARFIELD 12 NON-URBAN GRANT 13 NON-URBAN GRAYS HARBOR 14 NON-URBAN ISLAND 15 URBAN JEFFERSON 16 NON-URBAN KING 17 URBAN KITSAP 18 URBAN KITTITAS 19 NON-URBAN KLICKITAT 20 NON-URBAN LEWIS 21 NON-URBAN LINCOLN 22 NON-URBAN MASON 23 URBAN OKANOGAN 24 NON-URBAN PACIFIC 25 NON-URBAN PEND OREILLE 26 NON-URBAN PIERCE 27 URBAN SAN JUAN 28 NON-URBAN SKAGIT 29 URBAN SKAMANIA 30 URBAN SNOHOMISH 31 URBAN SPOKANE 32 URBAN STEVENS 33 NON-URBAN THURSTON 34 URBAN WAHKIAKUM 35 NON-URBAN WALLA WALLA 36 NON-URBAN WHATCOM 37 URBAN WHITMAN 38 NON-URBAN YAKIMA 39 URBAN
- Field AA7
- Require 9 numeric characters (no more and no less) that correspond to the ACES "Client ID#" at the bottom of the award letter. (This award letter begins with, "You are approved for institutional and medical benefits...".) This number is in the bottom right hand corner of the last page of the letter. This number should always be 9 digits. Do NOT delete leading or trailing zeros. Any leading or trailing zeros entered by nursing home staff should be retained in this text field to be recognized as a valid Medicaid number. The Client ID# should be left justified. That means that data entry should start in the left-hand box of the AA7 field, leaving the last 5 boxes of the 14-digit field blank;
- An additional re-entry tracking form is
required when a resident returns following a discharge coded 08, 'Discharged
prior to completing initial assessment' in AA8a, if they return within
120 days of the discharge. DSHS has developed a tracking flow sheet in
an attachment to a "dear provider letter" 2003-004,
dated March 10, 2003 that clearly identifies the tracking form requirements.
- FAC ID and LOGIN ID for a facility may or may not be identical. For most Washington State facilities, both of the IDs start with the letters WA.
- Facilities need to have the ability to enter dashes, or those other "information not available" codes that are specified in the manual for any MDS item. The data specifications identify that a dash "-" is a valid value and also identify which MDS items the dash applies to.
- Facilities in Washington State must transmit data within 10 days of completion to be considered timely.
- Washington State system backup for MDS is conducted in Olympia, Washington each evening beginning at 11:00 PM and is usually completed by 5:00 AM. MDS submissions are not accepted during this time. (Washington State system backup is not a substitute for nursing facility local backup.)
- The historical Washington State Case Mix weights are in an attached Excel spreadsheet in several worksheets.
- Federal Internet link of software specifications for vendors issued by Centers for Medicare and Medicaid Services (CMS): http://cms.hhs.gov/medicaid/mds20/mdssoftw.asp
- State law prohibits the collection of data in fields I2d ‘HIV infection’ and I2h, Sexually transmitted diseases’. If transmitted, the data is not retained.
- The State of Washington does not use the assessment type of “other state required assessment” in any assessments. Facilities should never select “other state required assessment”.
