C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS › Subpart J—Prospective Payment for Skilled Nursing Facili…

42 C.F.R. § 413.343

Resident assessment data

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(a) Submission of resident assessment data. SNFs are required to submit the resident assessment data described at § 483.20 of this chapter in the manner necessary to administer the payment rate methodology described in § 413.337. This provision includes the frequency, scope, and number of assessments required.

(b) Assessment schedule. In accordance with the methodology described in § 413.337(c) related to the adjustment of the Federal rates for case-mix, SNFs must submit assessments according to an assessment schedule. This schedule must include performance of an initial Medicare assessment with an assessment reference date that is set for no later than the 8th day of posthospital SNF care, and such other interim payment assessments as the SNF determines are necessary to account for changes in patient care needs.

(c) Noncompliance with assessment schedule. CMS pays a default rate for the Federal rate when a SNF fails to comply with the assessment schedule in paragraph (b) of this section. The default rate is paid for the days of a patient's care for which the SNF is not in compliance with the assessment schedule.

[63 FR 26309, May 12, 1998, as amended at 64 FR 41682, July 30, 1999; 84 FR 38832, Aug. 7, 2019]
Notes of Decisions
Cited in 2 cases, 2018–2020 · leading case: Angela Ruckh v. Salus Rehabilitation, LLC
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Angela Ruckh v. Salus Rehabilitation, LLC (2020) ca11 · cites it 2× “§ 1395i- 3(b)(3)(C); 42 C.F.R. §§ 413.343 , 483.20(b)(2). The final day of the assessment interval is referred to as the “assessment reference date,” or “ARD.”
United States ex rel. Crockett v. Complete Fitness Rehabilitation (2018) ca6 “42 C.F.R. § 413.343 . As part of this determination, a medical professional assessing a patient will categorize that patient into a Resource Utilization Group (“RUG”).”
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