Category: CMS Memo

CMS Memorandum: Updates to the Nursing Home Compare Website

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Centers for Medicare & Medicaid Services (CMS) Memorandum Ref: S&C: 12-37-NH:

Nursing Home Compare: CMS will launch a re-designed Nursing Home Compare website on July 19, 2012.

With the Nursing Home Compare website release, CMS is adding several new types of information:

  • Quality measures based on MDS 3.0 data.  The MDS 3.0 assessments will replace the MDS 2.0-based quality measures previously posted on Nursing Home Compare.  In addition, CMS will post data on two measures of use of anti-psychotic medication use (short-stay incidence and long-stay prevalence).
  • Detailed Inspection Reports (Form CMS-2567).
  • Ownership information.  CMS will post information on the legal business names of nursing homes.
  • Information on Physical Therapist staffing levels.  Physical Therapist hours per resident day will be reported.

Click here to view memo:  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-12-37.html.

Click here to visit the Nursing Home Compare website: http://www.medicare.gov/NursingHomeCompare/

Use of Insulin Pens in Health Care Facilities CMS S&C 12-30-ALL

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Centers for Medicare & Medicaid Services Memorandum Ref: S&C: 12-30-ALL

The Centers for Medicare & Medicaid Services (CMS) has recently received reports of use of insulin pens for more than one patient, with at least one 2011 episode resulting in the need for post-exposure patient notification.  These reports indicate that some healthcare personnel do not adhere to safe practices and may be unaware of the risks these unsafe practices pose to patients.  Insulin pens are meant for use by a single patient only.  Each patient/resident must have his/her own.  Sharing of insulin pens is essentially the same as sharing needles or syringes, and must be cited, consistent with the applicable provider/supplier specific survey guidance, in the same manner as re-use of needles or syringes.  Please view here:  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-12-30.html

CDC Clinical Reminder: Insulin Pens Must Never Be Used for More than One Person:  http://www.cdc.gov/injectionsafety/clinical-reminders/insulin-pens.html

MDS Section Q

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Please note that effective May 1, 2012 all MDS Section Q referrals will be made via the following web link:  https://dssapp3.dss.mo.gov/mfpnursinghome/Login.aspx

Recently, Missouri’s Money Follows the Person program staff presented a webinar to help educate nursing facility staff on use of a new Section Q web referral system and information on changes to MDS Section Q effective 4/1/2012.  MFP also provided a brief overview of the MFP program.  If you were unable to participate in the live webinar, you can access the recorded webinar here: http://stateofmo.adobeconnect.com/p4t0nnwz5ny/

If you have any questions, please contact Program Assistant Anna Duncan at anna.duncan@dss.mo.gov or at 573-522-1591.

RAI Manual Errata Document to be posted

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CMS will be posting a new errata document on the RAI manual page of their website.  It is designed so that you can remove the old page of the RAI and insert the new corrected page.  Items in the clarification memo will be posted in a RAI Manual errata document within the next few weeks.  An updated notification will be sent when this errata document is posted with the RAI Manual.  These changes became effective April 1, 2012.  The changes can be found in the clarification memo, however the errata document is not yet posted with the RAI Manual.  If you have any questions, you may contact:  Joan Brundick, BSN, RN, State RAI Coordinator, Department of Health & Senior Services, Telephone  573-751-6308 or E-mail  joan.brundick@health.mo.gov

New Expedited Determination Notices Posted

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Providers must start using new notices before May 1, 2012

All Medicare beneficiaries (including those who are enrolled in a Medicare health plan) receive a Generic Notice prior to termination of Medicare-covered skilled nursing facilities, home health, hospice, and comprehensive outpatient rehabilitation facility services.  The notice informs individuals of their right to an immediate, independent review of the proposed discontinuation of covered services.  A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.

 A new combined Notice of Medicare Non-Coverage will replace the CMS 10123 (Original Medicare notice) and the CMS 10095 (Medicare Advantage notice).  These specific notices are a requirement, effective now with a grace period to begin using by May 1, 2012.

 New notices have been published by CMS – links to the notices can be found below.  There is now only one set of notices, but they are posted on two separate pages (Original Medicare and MA), each with a link below.  Providers have until May 1, 2012 to begin using the NOMNC/DENC.  After May 1, the previous versions of the CMS-10123/23 and the CMS-10095 will be invalidated by the QIO. http://www.cms.gov/BNI/

http://www.cms.gov/BNI/06_FFSEDNotices.asp#TopOfPage

http://www.cms.gov/BNI/09_MAEDNotices.asp#TopOfPage

 Please direct any questions on the new NOMNC to Janet Miller janet.miller3@cms.hhs.gov

 Primaris is the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services.  If you have questions about this change in the CMS Notices of Non-coverage and their requirements, contact the Primaris Clinical Review Department at 800-347-1016. www.primaris.org

Reporting to Law Enforcement of Crimes Occurring in Federally Funded Long-Term Care Facilities

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CMS Guidance:  The following summary is included in the Centers for Medicare and Medicaid Services (CMS) SC 11-30NH  memorandum dated June 17, 2011 and REVISED August 12, 2011.  (Please click on S&C 11-30NH attachment above regarding the entire contents of the memorandum.)

  • Reporting Suspicion of a Crime:  Section 1150B of the Social Security Act (the Act), as established by section 6703(b)(3) of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), requires specific individuals in applicable long-term care facilities to report any reasonable suspicion of crimes committed against a resident of that facility.   
  • Reporting to State Survey Agencies (SAs) and Law Enforcement:  Reports must be submitted to at least one law enforcement agency of jurisdiction and the SA (in fulfillment of the statutory directive to report to the Secretary).    
  • Applicability of This Memo:  This memorandum discusses applicability of this provision to the following Medicare and Medicaid participating long-term care provider types that are collectively referred to as “facilities” or “LTC facilities” in this memorandum:
  • Nursing facilities (NFs),
  • Skilled nursing facilities (SNFs),
  • Hospices that provide services in LTC facilities, and
  • Intermediate Care Facilities for the Mentally Retarded (ICFs/MR).  
  • LTC Facility Policies and Procedures:  LTC facilities should have policies and procedures to comply with this law.  The obligations of the facility are different than the obligations of a covered individual.  

What does this mean for you as a facility? 

This law must be followed for all federally (Medicare and/or Medicaid) certified SNF and ICF facilities and does not apply to assisted living or residential care facilities.  

According to the S&C, facilities have an obligation to comply with the law at it is plainly written without any delay in the administrative rule-making process. 

Effective implementation of section 1150B of the Act may promote a timely response to potential crimes, thereby protecting residents of such facilities. The statute requires that:  

  • Covered individuals timely report any reasonable suspicion of a crime against a resident of, or who is receiving care from, a LTC facility;
  • If the events that cause the reasonable suspicion result in serious bodily injury, the report must be made immediately after forming the suspicion (but not later than two hours after forming the suspicion).  Otherwise, the report must be made not later than 24 hours after forming the suspicion;
  • Covered individuals are subject to civil money penalty and exclusion sanctions for failure to meet the reporting obligations of the statute;
  • LTC facilities are ineligible to receive Federal funds for any period that they employ an individual classified as an excluded individual under sections 1150B(c)(1)(B) or 1150B(c)(2)(B) of the Act; and
  • LTC facilities are also subject to civil money penalty and exclusion sanctions for retaliating against any employee who makes a lawful report, causes a lawful report to be made, or for taking steps in furtherance of making a lawful report pursuant to the statute.

 REQUIRED LTC Facility Responsibilities:

1)     Annually notify each covered individual (defined as anyone who is an owner, operator, employee, manager, agent or contractor of the LTC facility) of that individual’s reporting obligations.

2)     Conspicuously post, in an appropriate location,  a notice for its employees specifying the employees’ rights, including the right to file a complaint with the State Agency under this statute.  The notice must include a statement that an employee may file a complaint with the SA against a LTC facility that retaliates against an employee as specified above, as well as include information with respect to the manner of filing such a complaint.   

The notice must also include information about what must be reported, the timeframes for reporting and how to file the report with law enforcement.  The notice should include information about how to report to the SA including the hotline number (1-800-392-0210) and the hours of operation of 8:00 a.m. – 8:00 p.m. This notice must be posted in a place that is readily available for all employees.  (i.e. an employee break room, time clock, etc.) (The size and type for the sign should be no less than the minimums required for other required employment related signs.) 

3)     The facility may not retaliate against an individual who lawfully reports a reasonable suspicion of a crime under section 1150B.  A LTC facility may not discharge, demote, suspend, threaten, harass, or deny a promotion or other employment-related benefit to an employee, or in any other manner discriminate against an employee in the terms and conditions of employment because of lawful acts done by the employee, or file a complaint or a report against a nurse or other employee with the appropriate state professional disciplinary agency because of lawful acts done by the nurse or employee.  

LTC Facilities Should:

1)     Meet with your local law enforcement entity to determine what actions are considered crimes in their political subdivision and how those reports should be made to be in compliance with this law.

2)     Develop and maintain policies and procedures that ensure compliance with the requirements Section 1150B of the Social Security Act (the Act), as established by section 6703(b)(3) of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act).

Facility policies and procedures should address the mechanism for documenting that all covered individuals have been notified annually of their reporting obligations.  Examples of such documentation may include a copy of a notice or letter sent to covered individuals or a completed training/orientation attendance sheet specifying reporting obligations.

Time Period for Individual Reporting:

Section 1150B establishes two time limits for reporting of reasonable suspicion of a crime depending on the seriousness of the event that leads to the reasonable suspicion.

Serious Bodily Injury – 2 Hour Limit:  If the events that cause the reasonable suspicion result in serious bodily injury to a resident, the covered individual shall report the suspicion immediately, but not later than 2 hours after forming the suspicion to local law enforcement and by following the guidance noted above to notify the SA. 

All Others – Within 24 Hours:  If the events that cause the reasonable suspicion do not result in serious bodily injury to a resident, the covered individual shall report the suspicion not later than 24 hours after forming the suspicion to local law enforcement and by following the guidance noted above to notify the SA.

NOTE: The SA can be notified by calling either the Adult Abuse Hotline or in the case of facility self report you are encouraged to call your regional office directly during business hours or shortly after the next available business hours begin to file this report.  If the Regional Office is closed, but the Adult Abuse Hotline is open, the report should then be called to the hotline.

When was the effective date of this law:

March 23, 2011

What will survey staff do when investigating a complaint with allegations that include the suspicion of a crime?

  • Determine whether the facility notified each covered individual at least annually of that individual’s reporting obligations.
  • Determine whether the facility has conspicuously posted the required information as noted above
  • In cases that allege facility retaliation determine whether or not the facility retaliated against an individually who lawfully reported a reasonable suspicion of a crime.
  • Determine whether the facility is developing policies and procedures to ensure compliance with Section 1150B.
  • Ask each employee interviewed under the A/N protocol what their response would be if they had reasonable suspicion that a crime had occurred against a resident. 
  • Continue to follow all existing survey guidance and federal  requirements regarding complaints alleging abuse, neglect, or misappropriation (F226).
  • Citations regarding the failure to notify, post, retaliate, etc could be appropriately cited at F492 (adherence with federal, state and local laws)  and/or F493 (governing body)

If you have additional questions regarding the requirements for “Reporting to Law Enforcement of Crimes Occurring in Federally Funded Long-Term Care Facilities” please contact your legal counsel.        

 

 

 

CMS Quality Measure Reports

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The Centers for Medicare & Medicaid Services (CMS) recently released provider preview reports where facilities can view their individual Quality Measures (QMs) that will be factored into their Five Star Rating.  QMs will not be made public until April 19, 2012.  To preview your facility’s QM report you must access and log into the CASPER Reporting link located at the top of your MDS State Welcome page.  Remember that your CASPER log in ID is the same as your MDS submission log in ID.  Once you are logged in, click on the ‘Folders’ button and access the Five Star Report in your ‘st LTC facid’ folder, where st is the 2-digit postal code of the State in which your facility is located and facid is the State assigned facility ID of your facility.  (For Missouri, it should look like MO LTC #####)  You will find the QMs on page 2 of the Five Star preview.  For assistance in viewing these QM preview reports, please contact Joan Brundick, State RAI Coordinator, Missouri Department of Health & Senior Services at 573-751-6308.