MDS-HC (Bulletin 83) at a glance
What it is: The Minimum Data Set - Home Care (MDS-HC) is a new form required for approving referrals for long-term-care services.
Where to get it: You may photocopy the forms as needed. To obtain supplies of the forms, mail or fax your request, including your provider number, address, telephone number, the exact title of the form, and the desired quantity.
A filled-in MDS-HC (Bulletin 83) example: a nurse fills in the first three sections
How to fill out MDS-HC (Bulletin 83), box by box
Name and identification numbers
Under NAME OF CLIENT, enter the (Last/Family Name), (First Name) and (Middle Initial); then enter the CASE RECORD NO., the Pension (Social Security) Number and the Health insurance number (or other comparable insurance number).
Personal items
Section BB, PERSONAL ITEMS, is completed at intake only. Under GENDER, enter 1 for Male or 2 for Female; under BIRTHDATE, enter the Month Day Year.
Referral items
Section CC, REFERRAL ITEMS, is completed at intake only. Enter the DATE CASE OPENED/ REOPENED as Month Day Year, and the REASON FOR REFERRAL as 1 for Post hospital care, 2 for Community chronic care, 3 for Home placement screen, 4 for Eligibility for home care, 5 for Day care or 6 for Other.
More rules for MDS-HC (Bulletin 83)
The registered nurse or social worker must be licensed by the Massachusetts Board of Registration.
The MDS-HC assessment requires the use of the ICD-9-CM codes for medical diagnoses.
Please discard all previous versions of the Long Term Care Assessment form.
Before you go
On the Request for Services (RFS-1) page: For nursing facility providers: Attach the most recent comprehensive MDS, current quarterly MDS, and current physician orders.
On the Request for Services (RFS-1) page: For community providers: Attach the MDS-HC and Physician's Summary form according to provider's regulations/guidelines.
Common questions about MDS-HC (Bulletin 83)
Who signs it?
Bulletin 83, January 2003, Page 2: each person who completes a portion of the MDS-HC must sign and certify the sections he or she completes in Section R - Assessment Information (Other Signatures, Title, Sections, Date).
Is there a deadline?
Chronic disease and rehabilitation hospitals must begin using these new forms by February 1, 2003.
What am I certifying when I sign?
The MDS-HC must be completed by an assessment coordinator, who must be a registered nurse who certifies the accuracy and completeness of the MDS-HC.
Sources
[1] MassHealth Chronic Disease and Rehabilitation Hospital Bulletin 83 (Rev. 10/02), Massachusetts Division of Medical Assistance (the Official source link on this page).