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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). - ✔✔Severity
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. - ✔✔Transfer 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. - ✔✔Enforcement Grid
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, 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. - ✔✔Resident 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. - ✔✔Minimum 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. - ✔✔Omnibus 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. - ✔✔Substantial Compliance
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