Category: CMS Memo

Nursing Home Quality Initiatives – Questions and Answers

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The Centers for Medicare & Medicaid Services (CMS) and Advancing Excellence in America’s Nursing Homes national campaign coordination group developed a set of common questions and answers for nursing homes, in order to clarify how some of the many initiatives relate to and are aligned with each other.  The purpose is to help nursing homes better understand how to participate in and benefit from various initiatives.

  • Quality Assurance and Performance Improvement (QAPI)
  • National Nursing Home Quality Care Collaborative (NNHQCC)
  • National Partnership to Improve Dementia Care in Nursing Homes
  • Advancing Excellence in America’s Nursing Home’s Campaign
  • Alignment of Quality Initiatives

Questions include:

  • Must nursing homes use CMS QAPI tools and resources to be considered in compliance with the QAPI regulation?
  • What is the National Nursing Home Quality Care Collaborative (NNHQCC)?
  • What is a LAN?
  • How does the mission of the National Partnership to Improve Dementia Care in Nursing Homes align with non-pharmacological, person-centered care approaches?
  • What does a nursing home have to do to become part of Advancing Excellence?
  • How does QAPI overlap or align with topic specific initiatives such the NNHQCC, the National Partnership to Improve Dementia Care in Nursing Homes, and Advancing Excellence in America’s Nursing Homes?
  • If we participate in the NNHQCC or Advancing Excellence or the National Partnership to Improve Dementia Care in Nursing Homes, are we implementing QAPI?

Find the answers to these questions and more – click on the link below

CMSFAQsNHQualityInitiatives

This document is also available for download by visiting http://www.nhqualitycampaign.org/.

Cardiopulmonary Resuscitation (CPR) in Nursing Homes

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CMS Memo S&C: 14-01-NH

The Section for Long-Term Care Regulation wants to make certified providers aware that this Memo requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  CMS’ guidance had previously been that an on-duty staff member be able to perform CPR appropriately at all times.  If a question arose during a federal process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically wasn’t necessary.

One point that remains unaddressed in this new S&C Memo is that many different CPR training agencies offer “certification” of their own, and this Memo doesn’t specify which agency’s certifications are acceptable to CMS and which are not.  SLCR has requested a clarification of this point from the CMS Central Office, and so has the Kansas City Regional CMS office.  Neither of our offices have received a response.  When we receive further guidance, we will provide it to you via this Listserv.  Until then, we will not be altering our current survey practices, but we want to make providers aware that this new S&C Memo has been issued by CMS, and that depending on their answer to our questions, it’s likely that some of your staff may need to obtain CPR certification with very short notice.

Because this memo references the American Heart Association as a standard-setting organization with regard to CPR, it is our belief that provider certification through the AHA will almost certainly be deemed acceptable by CMS.  Whether other certifications will suffice is less clear at this time.  As soon as we have some clarification on this point, we will share it with you.  We apologize that we can’t offer more specific guidance at this time, and appreciate your patience.

View the CMS Memo S&C: 14-01-NH here:  Survey-and-Cert-Letter-14-01 or click here. 

UPDATED GUIDANCE HAS BEEN POSTED – PLEASE REFER TO:

https://wp2.mo.gov/health-ltc/2014/02/24/cardiopulmonary-resuscitation-cpr-in-nursing-homes-guidance-clarification-update/

 

Transition Guidelines for SNF PPS Policy and MDS 3.0 Effective October 1, 2013

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The memo “Transition for Implementation of FY 2014 SNF PPS MDS 3.0 Policy Changes” describing the transition guidelines for SNF PPS policy and MDS 3.0 changes effective FY 2014 related to the final rule, is located on the SNF PPS Spotlight webpage, under the Downloads section: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Spotlight.html.

Reminder: MDS 3.0 Discharge Assessments

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This reminder is available on the CMS MDS 3.0 RAI Manual webpage:

www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html.

CMS is providing an opportunity to rectify the current situation related to missing and incomplete discharge assessments.  Homes must complete missing discharge assessments as soon as possible, but no later than September 30, 2013.  Homes can self-audit their MDS assessments by accessing the CASPER system and requesting a MDS 3.0 Resident Roster or a MDS 3.0 Missing Assessment Report.  If you need assistance accessing or interpreting these reports, please contact the State MDS Unit at 573-751-6308, joan.brundick@health.mo.gov or 573-522-8421, denise.mueller@health.mo.gov.

New Data Show Antipsychotic Drug Use is Down in Nursing Homes Nationwide

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Nursing homes are using antipsychotics less and instead pursuing more patient-centered treatment for dementia and other behavioral health care, according to new data released on Nursing Home Compare in July by the Centers for Medicare & Medicaid Services (CMS).  Please read this press release on the CMS website:  www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-08-27.html.

Minimum Data Set (MDS) 3.0 Discharge Assessments – Not Completed and/or Submitted

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Completing MDS 3.0 discharge assessments has been a requirement since October 1, 2010.  However, many homes are not completing these assessments. 

The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification memorandum on August 23, 2013, which clarifies the assessments are required.  The memo helps surveyors understand what nursing homes should do when they have inactive residents on their resident roster, and how nursing homes can ensure compliance with these requirements. 

CMS is providing an opportunity to rectify the current situation related to missing and incomplete discharge assessments.  Homes must complete missing discharge assessments as soon as possible, but no later than September 30, 2013.  Homes can self-audit their MDS assessments by accessing the CASPER system and requesting a MDS 3.0 Resident Roster or a MDS 3.0 Missing Assessment Report.

If you need assistance accessing or interpreting these reports, please contact the State MDS Unit at 573-751-6308, joan.brundick@health.mo.gov or 573-522-8421, denise.mueller@health.mo.gov.

Please review the CMS Memo – Ref: S&C: 13-56-NH online at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-56.html.

CMS Memorandum – Public Release of the Five-Star Quality Rating System Three-Year Report

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Ref: S&C:  13-44-NH:  To access this report, visit the website at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html

Scroll to the Downloads Section,

select: NHC Five Star Quality Rating System Report 2009-2011 [PDF, 2MB]

View the CMS memo here: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-44.html?DLPage=1&DLSort=2&DLSortDir=descending

CMS Memorandum – Changes to the Nursing Home Compare Website July 2013

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CMS Memorandum – Changes to the Nursing Home Compare Website

Ref: S&C: 13-43-NH:  In July 2013, all users of the Nursing Home Compare website that wish to download nursing home data will be redirected to the new website, https://data.medicare.gov/.  The website will contain new data layouts and additional nursing home data not previously available.

View the CMS memo here: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-43.html?DLPage=1&DLSort=2&DLSortDir=descending

CMS Memorandum – Reminder: Access and Visitation Rights in Long Term Care (LTC) Facilities

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Ref: S&C: 13-42-NH:  This memorandum reviews current interpretive guidelines for F-Tag 172, reiterating resident rights surrounding access and visitation.

View the CMS memo here: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-42.html?DLPage=1&DLSort=2&DLSortDir=descending

New MDS 3.0 RAI Manual Effective May 20, 2013

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Nursing homes are expected to be aware of and implement the most current CMS policies regarding the MDS 3.0 RAI Manual.  The following website lists changes on change tables for quick reference.  The actual manual pages that have changed are also included.  Please visit the CMS website: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html and scroll to the Downloads Section:

MDS 3.0 RAI Manual v1.10 Replacement Manual Pages and Change Tables.zip [ZIP, 5MB]

MDS 3.0 RAI Manual v1.10 and Change Tables.zip [ZIP, 22MB]

MDS 3.0 RAI Manual v1.10 Appendix B Rev 5.15.2013.pdf [PDF, 108KB]

Please note the effective date is May 20, 2013, although previously noted as May 8, 2013 on the CMS website.  If you have any questions, you may contact Joan Brundick, BSN, RN, State RAI Coordinator, Missouri Department of Health and Senior Services, Telephone (573) 751-6308 or email joan.brundick@health.mo.gov.

Hand in Hand: A Training Series for Nursing Homes – SLCR Reminder

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(Person-Centered Care of Persons with Dementia and Prevention of Abuse)

Section 6121 of the Affordable Care Act requires the Centers for Medicare & Medicaid Services (CMS) to ensure that nurse aides receive regular training on caring for residents with dementia and on preventing abuse.  CMS created Hand in Hand training in order to address the annual requirement for nurse aide training.  While homes are not required to use Hand in Hand for their dementia and abuse training, it is a wonderful, free resource that CMS has provided to every nursing home in the nation.  CMS sent the packet containing videos and training techniques to all homes in December of 2012.

The Section for Long-Term Care Regulation realizes that the information appears voluminous, but encourages homes to take a closer look and try to implement at least some of the videos for your direct care staff.  The videos show staff how to relate to residents with dementia and how to appropriately respond to behaviors.  The training is also timely with the CMS initiative to reduce the use of antipsychotics in nursing homes.  The videos show staff how to get to know the person and understand why they are behaving a certain way, so that they can use alternative methods, rather than asking for an antipsychotic medication.  Everyone’s time is valuable; however, there is no sense in reinventing the wheel when CMS has done it for you.  We encourage you to take a look at the Hand in Hand information and try to implement some of the videos in your required training on dementia and abuse prevention.

http://www.cms-handinhandtoolkit.info/Index.aspx

 

CMS Promotes New Dining Practice Standards

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CMS Memo S&C: 13-13-NH

The Centers for Medicare and Medicaid Services (CMS) has issued a survey and certification memo announcing the New Dining Practice Standards.  An accompanying training video is available for surveyors and the public.  The New Dining Practice Standards document is available for download by visiting Pioneer Network at www.pioneernetwork.net/Providers/DiningPracticeStandards/. 

Please view the Dining Standards Open Letter 03-15-2013 to our readers.

Quality Assurance and Performance Improvement (QAPI)

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Section 6102(c) of the Affordable Care Act requires that all nursing homes develop Quality Assurance and Performance Improvement (QAPI) programs.  These are different from Q.A. programs. 

QAPI emphasizes prevention of adverse events rather than reaction to adverse events.  It emphasizes promotion of safety and quality throughout the entire organization (not just nursing) and focuses on reducing risks to residents and caregivers both. 

Please visit the Centers for Medicare & Medicaid Services (CMS) website for more information at cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/QAPI.html. 

Primaris is Missouri’s federally designated Quality Improvement Organization (QIO).  QAPI information is available online at www.primaris.org/qapi. 

More updates regarding QAPI will be announced over the next several months.

Insulin Pen Safety – One Insulin Pen, One Person

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The Centers for Disease Control (CDC) has been working to promote safe use of insulin pens, in light of growing awareness of the risk of reuse.  Insulin pens are meant for one patient only, but there have been recent occurrences of insulin pens being used for more than one patient.  The CDC’s injection safety campaign recently introduced a brochure and poster for clinicians and patients about the safe use of insulin pens.  The brochure and poster as well as other resources can be found on the Insulin Pen Safety web page.

                                      www.oneandonlycampaign.org/

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

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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.

CMS Reminder: Revisions to Forms 672 and 802

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Effective December 1, 2012 CMS instructed surveyors to return to the “Traditional Survey Process” of reviewing Quality Measures during offsite preparation.  

This change also implemented the use of the new “Form CMS 802 (04/12) ROSTER/SAMPLE MATRIX” and “Form CMS-802P (04/12) ROSTER/SAMPLE MATRIX INSTRUCTIONS FOR PROVIDERS.”  

This change has also implemented instructional updates to “Form CMS 672 (05/12) RESIDENT CENSUS AND CONDITIONS OF RESIDENTS.”  

If your facility automates forms from the MDS software, please ensure to present the new forms to the facility surveyors.  You may need to contact your vendor if your software does not generate the new forms.  

Facilities are required to utilize the new forms.  Upon survey entrance, surveyors will provide the administrator with the forms to be completed.  The new forms are also available for download online:  www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html.

Hand in Hand: A Free Training Series for Nursing Homes

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Person-Centered Care of Persons with Dementia and Prevention of Abuse

CMS MEMO SC12-44 Hand in Hand-A Training Series for Nursing Homes 09-14-12

Reminder from CMS – Toolkits provided at no charge

The Centers for Medicare & Medicaid Services (CMS) has been made aware that some nursing homes may be returning Hand in Hand because they believe they will be charged money to keep it.  These Toolkits will be distributed FREE to all nursing homes, CMS Regional Offices and State Survey Agencies by January 2013. 

Section 6121 of the Affordable Care Act requires CMS to ensure that nurse aides receive regular training on caring for residents with dementia and on preventing abuse.  CMS, supported by a team of instructional designers and subject matter experts, created Hand in Hand, the training you will be receiving soon, to address the annual requirement for nurse aide training on these important topics. 

Our mission is to provide nursing homes with one option for a high-quality program that emphasizes person-centered care for persons with dementia and also addresses prevention of abuse.  Person-centered care is about seeing the person first, not as a task to be accomplished or a condition to be managed.  It is the fulfillment of the Nursing Home Reform Law to consider each resident’s individual preferences, needs, strengths, and lifestyle in order to provide the optimum quality of care and quality of life for each person. 

The Hand in Hand training materials consist of an orientation guide and six one-hour video-based modules, each of which has a DVD and an accompanying instructor guide.  Though Hand in Hand is targeted to nurse aides, it has real value for all nursing home caregivers, administrative staff, and anyone who touches the lives of nursing home residents.  Thank you for your commitment to encouraging the use of available materials such as Hand in Hand for the required annual training for nurse aides.  We anticipate that these enhanced training programs will enable you to continuously improve dementia care and prevent abuse, as well as enhance resident and staff satisfaction in your community.

Hand in Hand: A Training Series for Nursing Homes

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(Person-Centered Care of Persons with Dementia and Prevention of Abuse)

S&C: 12-44-NH  09.14.12

CMS Memorandum Summary

The Affordable Care Act:  Section 6121 requires the Centers for Medicare & Medicaid Services (CMS) to ensure that nurse aides receive regular training on how to care for residents with dementia and on preventing abuse.  CMS created this training program to address the requirement for annual nurse aide training on these important topics.

Course Content:  The Hand in Hand training materials consist of an orientation guide and six one-hour video-based modules, each of which has a DVD and an accompanying instructor guide.  Though Hand in Hand is targeted to nurse aides, it may be valuable to all nursing home caregivers, administrative staff and surveyors.

Please review the CMS Memo here:  CMS MEMO SC12-44 Hand in Hand-A Training Series for Nursing Homes 09-14-12

Request to Convey Information: Partnership to Improve Dementia Care in Nursing Homes

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S&C: 12-42-NH:  Revised 08.31.12

Memorandum Summary

  • Partnership to Improve Dementia Care in Nursing Homes – In 2012, Centers for Medicare & Medicaid Services (CMS) launched the Partnership to Improve Dementia Care in Nursing Homes to promote comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors.
  • Stakeholder Letters – Stakeholders are sending letters to support the Partnership to Improve Dementia Care in Nursing Homes.
  • Please Share – Please share information about these documents as you communicate with facilities in your State and in other appropriate communication media (such as State website).

Download the CMS memo here:  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-12-42.html