Effect or seriousness of deficient facility practice on care recipient/client/patient outcome. There are
four levels (as described in the Federal Enforcement Grid for nursing homes). - AnswersSeverity
Giving away property for less than it is worth or for the sole purpose of becoming eligible for Medicaid.
Transferring assets during the look back period results in disqualification for Medicaid payment of long-
term care services for a penalty period. - AnswersTransfer of Assets
A table developed by the Center for Medicare and Medicaid Services that defines severity and scope of
federal deficiencies and indicates wether plans of correction and remedies are necessary. -
AnswersEnforcement Grid
A tool to help facilities identify care recipient's needs and strengthens and develop an appropriate care.
The federal system includes: the MDS, CAAs, and utilization guidelines. - AnswersResident Assessment
Instrument (RAI)
A collection of nursing facility care recipient classification systems used in a variety of case mix indexed
reimbursement systems. Using assessment tools like the MDS 3.0, these systems group care recipients
by expected level of resource utilization, usually based upon staff time measurements per care recipient
per dat. Relative resource utilization is reflection in a case mix index (CMI) value assigned to each RUG
cell. - AnswersMinimum Data Set (MDS)
Changes to the Federal Social Security Act that significantly changed how nursing homes and home
health infancies are regulated for Medicare and Medicaid certification. - AnswersOmnibus Budget
Reconciliation Act of 1987 (OBRA)
Minor deficiencies or violations, but a facility generally meets the intent of federal or state regulations.
On the Federal Enforcement Grid, Substantial Compliance is equated to boxes A - C. -
AnswersSubstantial Compliance
National association that prescribes safety codes and definitions for state and local agencies to adopt as
building regulations. - AnswersNational Fire Protection Association (NFPA)
A core set of screening, clinical, and functional status elements, including common definitions and
coding categories, which forms the foundations of a comprehensive assessment for all residents of
nursing home certified to participate in Medicare or Medicaid. The items standardize communication
about resident problems and conditions within nursing homes, between nursing homes, and between
nursing homes and outside agencies. - AnswersMinimum Data Set (MDS)
Care given or supervised by registered nurses. Nurses provide direct care; manage, observe, and
evaluate a patient's care; and teach the patient and his or her family caregiver when appropriate. -
AnswersSkilled Nursing Care
, A system that uses residents (patient) attributes (e.g. functional status in ADLs or cognitive abilities) to
classify residents (patients) for purposes such as reimbursement OR a measure of the intensity of care
and services used by a group of residents in a nursing facility. - AnswersCase Mix
Each Related Utilization Group (RUG) is assigned a weight, or numeric score, which reflects the relative
resources predicted to provide care to a resident (patient). The higher the weight, the greater the
resource requirements are for the resident. It determines the payment (for each resident) made
monthly to the facility. - AnswersCase Mix Index
A program of the Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Health and
Human Services that complies information about nursing home care recipients on many
situations/conditions called quality measures (QM) and makes the information available to consumers. -
AnswersNursing Home Quality Improvement Initiative
Effect or seriousness of deficient facility practice on care recipient/client/patient outcome. There are
four levels (as described in the Federal Enforcement Grid for nursing homes), - AnswersSeverity
Program administered by CMS designed to ensure accuracy of MDS data accomplished through data
analysis, off-site review, on-site review, and provider education. - AnswersData Assessment and
Verification (DAVE)
Federally required screening of all nursing home residents, prior to admission, to determine if the
individual residents are mentally ill or mentally retarded. - AnswersPreadmission Screening and Resident
Review (PASRR)
Data-driven, practice approach to improving the quality of life, care, and services in nursing homes. The
actives of QAPI involve members at all levels of the organization to: identify opportunities for
improvement; address gaps in systems or processes; develop and implement an improvement or
corrective plan; and continuously monitor effectiveness of interventions. - AnswersQuality Assurance
Performance Improvement (QAPI)
Program administered by the Social Security Administration that provides financial assistance to needy
persons who are disabled or aged 65 or older. Many states provide Medicaid without further application
to persons who are eligible for SSI. - AnswersSupplement Security Income (SSI)
Washing oneself by sponge bath or in the bathtub or shower. One of the six Activities of Daily Living
(ADLs). - AnswersBathing
In skilled nursing facilities, the length of time the facility will hold a resident's bed in case he or she has
to leave the facility for care elsewhere, such as hospital, or for any other reason. - AnswersBed Hold
Policy
A table developed by the Center for Medicare and Medicaid Services that defines severity and scope of
federal deficiencies and indicates whether plans of correction and remedies are necessary. -
AnswersEnforcement Grid