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Which Employees Must be Reported on the CMS Long Term Care Facility Application for Medicare and Medicaid?

The Section for Long-Term Care Regulation has received questions regarding which facility staff must be reported on the CMS-671 Long Term Care Facility Application For Medicare and Medicaid form. 

Only facility staff should be reported on the CMS 671.  Homes should not report hours for feeding assistants, hospice staff (even if the company is owned by the corporation) or private-duty aides that are paid by the residents’ family. 

If the facility director of nursing or administrator worked 90-hours during the last two weeks, then it should be reported as such.  Always report actual hours worked. 

Contract staff should also be reported.  The form instructions state:  “Contract includes individuals under contract, (e.g., a physical therapist) as well as organizations under contract (e.g., an agency to provide nurses).” 

For nursing homes that are not fully certified, report staffing hours for certified beds only.  The form instructions state:  “For the purpose of this form ‘the facility’ equals certified beds (i.e. Medicare and/or Medicaid certified beds).”  

Please note that staffing hours included in the Five-Star Quality Rating System are obtained from the CMS 671 application at the time of facility recertification. 

It is important to report staffing hours accurately.  Certain CMS programs and reports are dependent upon the data homes report.  If you have any questions, you may contact Joan Brundick, State RAI Coordinator at 573-751-6308 or send an email to joan.brundick@health.mo.gov

The CMS 671 form is available online: http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS006581.html.

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