CMS-P-0015A OMB Facility Specs Guide

Facility Instrument Specifications User’s Note

Starting in Fall 2019 Round 85, a small set of questions will be added to the Facility Questionnaire (FQ) and Health Status (HS) sections to verify whether the facility is Medicare- or Medicaid-certified and therefore meets CMS’ reporting requirements for MDS and CASPER administrative data. These new items, shown in green text and green highlighting in the FQ section specs, vary for Baseline and Continuing interviews as follows:

• For Baseline cases residing in a nursing home, skilled nursing facility (SNF), or rehabilitation facility, the facility respondent will be asked if their facility has a CMS Certification Number in the FQ section. If yes, the facility respondent will be asked for a document showing the CMS Certification Number. The interviewer will enter the CMS Certification number into the questionnaire. See items CCINTRO, CCNDOC, CCN, LU_CONFIRM, and NOTFOUND in the FQ section specs.

• For Continuing cases residing in a nursing home, SNF, or rehabilitation facility, the facility respondent will be asked to confirm their facility’s CMS Certification Number from the previous interview in the FQ section. If the number has changed, the facility respondent is asked to confirm that the facility has a CMS Certification Number and if so, if they have documentation showing that number. See items CCNCNFRM, CCNINTRO, CCNDOC, CCN, LU_CONFIRM, and NOTFOUND in the FQ section specs.

• For cases residing in a nursing home, SNF, or rehabilitation facility that is certified by Medicare or Medicaid and did not report a CMS Certification number in the FQ section, the facility respondent will be asked again whether their facility has a CMS Certification Number in the HS section. If yes, the facility respondent will be asked for a document showing the CMS Certification Number. The interviewer will enter the CMS Certification number into the questionnaire. See items CCINTRO, CCNDOC, CCN, LU_CONFIRM, and NOTFOUND in the HS section specs.

• If a facility’s certification and reporting status is confirmed, the Facility interview will skip approximately 122 questions in the Facility instrument that are redundant with CASPER and MDS administrative data. These items are highlighted in gray in the attached specifications.

• 40 questions in the Facility questionnaire (FQ) section

• 80 questions in the Health Status (HS) section, and

• Two questions in the Expenditures (EX) section.

For interviews conducted at facilities not certified by Medicare or Medicaid, the full Facility instrument will be administered. Survey-collected data elements will be combined with CASPER and MDS administrative data to provide complete information for all MCBS facility-dwelling beneficiaries. These changes to the Facility instrument will reduce burden for approximately 40% of annual facility cases, which are expected to reside in facilities meeting CMS’ certification and reporting requirements. Throughout the specification sections, additional questionnaire updates made since the last OMB clearance are shown in green text or green strikethrough.