A0410: Unit Certification or Licensure Designation

A0410: Unit Certification or Licensure Designation

Item Rationale

In coding this item, the facility must consider its Medicare and/or Medicaid status as well as the state’s authority to collect MDS records. State regulations may require submission of MDS data to iQIES or directly to the state for residents residing in licensed-only beds.

Nursing homes must be certain they are submitting MDS assessments to iQIES for those residents who are on a Medicare and/or Medicaid certified unit. Swing bed facilities must be certain that they are submitting MDS assessments only for those residents whose stay is covered by Medicare Part A benefits. For those residents who are in licensed-only beds, nursing homes must be certain they are submitting MDS assessments either to iQIES or directly to the state in accordance with state requirements.

Payer source is not the determinant by which this item is coded. This item is coded solely according to the authority CMS has to collect MDS data for residents who are on a Medicare and/or Medicaid certified unit and the authority that the state may have to collect MDS data under licensure. Consult Chapter 5, page 5-1 of this Manual for a discussion of what types of records should be submitted to iQIES.

Steps for Assessment

Ask the nursing home administrator or representative which units in the nursing home are Medicare certified, Medicaid certified or dually certified (Medicare/Medicaid).

If some or all of the units in the nursing home are neither Medicare nor Medicaid certified, ask the nursing home administrator or representative if there are units that are state licensed and if the state requires MDS submission for residents on that unit.

Identify all units in the nursing home that are not certified or licensed by the state, if any.

Coding Instructions

Code 1, Unit is neither Medicare nor Medicaid certified and MDS data is not required by the State: if the MDS record is for a resident on a unit that is neither Medicare nor Medicaid certified, and neither CMS nor the state has authority to collect MDS information for residents on this unit, the facility may not submit MDS records to iQIES. If any records are submitted under this certification designation, they will be rejected by iQIES.

Code 2, Unit is neither Medicare nor Medicaid certified but MDS data is required by the State: if the nursing home resident is on a unit that is neither Medicare nor Medicaid certified, but the state has authority under state licensure to collect MDS information for residents on such units, the facility should submit the resident’s MDS records per the state’s requirement to iQIES or directly to the state.

Note that this certification designation does not apply to swing-bed facilities. Assessments for swing-bed residents on which A0410 is coded “2” will be rejected by iQIES.

Code 3, Unit is Medicare and/or Medicaid certified: if the resident is on a Medicare and/or Medicaid certified unit, regardless of payer source (i.e., even if the resident is private pay or has their stay covered under Medicare Advantage, Medicare HMO, private insurance, etc.), the facility is required to submit MDS records (OBRA and SNF PPS only) to iQIES for these residents. Consult Chapter 5, page 5-1 of this Manual for a discussion of what types of records should be submitted to iQIES.