Category: MDS

Resident Assessment Instrument and Medicare Workshops

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October 8 – 9, 2013: RAI Process from Start to Finish

This workshop is for individuals in long-term care who coordinate and/or code the MDS and need a better understanding of the complexity of the RAI process.  New MDS Coordinators and those who need a refresher are strongly encouraged to attend. 

NEW – November 12, 2013:  Medicare from Start to Finish

This workshop will help the MDS coordinator and other members of the interdisciplinary team to understand the admitting criteria and the ongoing documentation needs of the Medicare resident.

Please view the informative brochure here: RAI and Medicare from Start to Finish Workshops, or visit www.mlnmonursing.org/MDS.

PEPPER for Skilled Nursing Homes to be Distributed August 30, 2013

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What is the Program for Evaluating Payment Patterns Electronic Report (PEPPER)?

  • PEPPER is developed and distributed by TMF Health Quality Institute, under contract with the Centers for Medicare & Medicaid Services (CMS). 
  • National Skilled Nursing Facility (SNF) claim data was analyzed to identify areas within the SNF Prospective Payment System (PPS) that could be at risk for improper Medicare payment.  PEPPER is a data report that contains a SNF’s Medicare claims data (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC) or Fiscal Intermediary (FI)). 
  • PEPPER contains provider-specific Medicare data statistics for discharges or services vulnerable to improper payments.  Target areas were identified based on a review of literature regarding SNF payment vulnerabilities, review of the SNF PPS, analysis of claims data and coordination with CMS subject matter experts.  PEPPER can support a facility’s compliance efforts by identifying potential overpayments or underpayments. 
  • All SNFs that have sufficient data to generate a report will receive a PEPPER.  The report shows how a SNF’s data compares to aggregate jurisdiction, state and national statistics.  If the SNF’s target area percent is at/above the national 80th percentile or at/below the national 20th percentile, the SNF is identified as at risk for improper Medicare payments.  PEPPER is only available to the individual SNF.

SNFs that are part of a short-term acute care hospital will receive their PEPPER electronically via QualityNet, sent to the hospital QualityNet Administrator.  All other SNFs will receive their PEPPER in hard-copy format via United States Postal Service first class mail.  The envelope will appear as the image below, addressed to the CEO/Administrator.  If still unable to locate, submit a request for assistance via the PEPPERresources.org Help Desk.

 

PEPPERresources.org is the official site for information, training and support.

Training & resources for Skilled Nursing Homes are now available on the website at www.pepperresources.org/TrainingResources/SkilledNursingFacilities.aspx.

If you have questions about the PEPPER reports, you may submit questions on this website through the Help/Contact Us tab.

Please do not contact your state QIO or state survey agency for assistance with PEPPER.

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.

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.

Using MDS 3.0 as an Engine for High Quality Individualized Care Webinar Series Five – Working Together for Better Outcomes

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National Learning Collaborative Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care:  SERIES 5: Working Together for Better Outcomes – Relational Coordination for Quality Improvement 

In Webinar Series Five of our National Learning Collaborative, teams of practitioners share how they have achieved better outcomes through key systems for relational coordination – consistent assignment, huddles, CNAs involvement in care planning, and Quality Improvement huddles among staff closest to the residents.

March 12, 2013 – Part 11:  It Takes a Team to Prevent and Heal Pressure Ulcers
Presenters: Teams from Glenridge Living Community, Augusta, Maine, and Oakview Terrace, Freeman, SD.  Staff from two homes will explain how they prevent and heal pressure ulcers by working better together.

May 7, 2013 – Part 12:  It Takes a Team to Provide High Quality Individualized Care
Presenters: Barbara Frank, B& F Consulting; Amy Elliot, Pioneer Network; and teams from nursing homes participating in the National Learning Collaborative on Using MDS 3.0 as the Engine for High Quality Individualized Care.  Staff from several homes that have participated in the National Learning Collaborative will share how engaging staff in individualizing care has led to better quality of care and quality of life for their residents.

Please visit www.pioneernetwork.net/Events/Webinars/MDS30_1112

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.

MDS 2013 Workshops – Registration Now Open

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  • February 19 – 20, 2013:  RAI Process from Start to Finish – Columbia, MO

This workshop will look at the RAI process from beginning to end.  The MDS is used for both a clinical assessment and a financial assessment and this workshop will discuss the rules on scheduling these assessments and meeting the requirements individually and combined.  Item-by-item coding will be reviewed.  From coding the MDS, we will then look at the CAA to care plan process.  An overview of the Medicare requirements that need to be followed for appropriate reimbursement will be discussed.  Finally, we will review how to stay up-to-date in this ever-changing world of MDS 3.0. 

  • April 23, 2013:  CMS Updates – Columbia, MO

This advanced RAI session will help participants identify tools that will facilitate improvements in patient/resident outcomes, both clinical and financial.  CMS hot topics and common survey issues will be reviewed as they pertain to the care of residents. 

To register and view the brochure, please visit:  www.mlnmonursing.org/MDS.

Revised MDS 3.0 Resident Assessment Instrument Manual

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CMS has posted a revised MDS 3.0 Resident Assessment Instrument (RAI) Manual V1.09, effective November 7, 2012.  Locate the entire manual and/or changes only, by visiting:   https://www.qtso.com/mds30.html.  Click on the MDS 3.0 RAI Manual link.  Scroll to the Downloads section at the bottom of this page and click:  MDS 3.0 RAI Manual V1.09 to obtain the entire manual, or click:  All Change Tables and Pages for V1.09 to obtain only the changes that have occurred.

The changes are not as extensive as in the past; however, it is still imperative that your facility review the change tables, as most relate to the PPS assessments that affect Medicare Part A reimbursement.  Facilities are expected to be familiar with these changes in order to correctly code the MDS and claim Medicare Part A reimbursement.  If you have any questions, you may contact Joan Brundick, BSN, RN, State RAI Coordinator at 573-751-6308 or email joan.brundick@health.mo.gov.

CMS Updates Workshop

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November 13, 2012:  Columbia, Missouri

This advanced RAI session will help participants identify tools that will facilitate improvements in patient/resident outcomes, both clinically and financially.  Using the QI/QM Reports for quality improvement, CMS hot topics and common survey issues are on the agenda.  For more details and registration information, please visit:  www.mlnmonursing.org/MDS.

Reducing Anti-Psychotics Through Individualized Care – Medical Perspective and Case Studies

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Series #4 of the National Learning Collaborative Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care

  • September 20, 2012:  Part Nine – Individualizing Care and Environments: Non-pharmacologic Interventions Instead of Anti-Psychotic Medications
  • October 18, 2012:  Part Ten – Promoting Mental Health Through Team-based Individualized Assessment and Care Planning

For additional information, please visit the website: http://www.pioneernetwork.net/Events/MDS30_910/.

Section Q: Error in Technical Specs

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MDS 3.0 Submission Specs Errata V1.11.0 for the October 1, 2012 Release [ZIP, 9KB]  

Technical information related to the MDS 3.0 is also available under the Downloads section of this page:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html.

CMS has identified an error in their technical specifications that needs to be corrected immediately.  The software is leading assessors to ask the resident about community discharge when there is already an active discharge plan in place.  This is the opposite of how the process should work.  The intent of Section Q is to ask those residents who do not have an active discharge plan in place if they would like to talk to someone about returning to the community.  Please check with your software vendor, as it is imperative that they are notified in order to correct your software and you are able to correctly complete Section Q.

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/

MDS Section Q Referral Process

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Please pass this information along to the social worker/social services individual, as well as the MDS Coordinator, as they are frequently the individuals who are completing Section Q:

DHSS is finding that many homes do not understand the Section Q referral process when a resident has an active discharge plan in place.  If the resident has a plan to return home (as in short stay rehab) then you code a 1 “yes” in item #Q0400.  When you code 1 “yes”, the MDS has a skip pattern that skips asking the resident the question in #Q0500 and leads the assessor to #Q0600 Referral question.  The expectation is that you do not need to refer a person who has an active discharge plan in place, so you would code 0 “No-referral not needed” in #Q0600.  Residents with active discharge plans already have plans/resources in place.  They do not need options counseling to help obtain more information.  Section Q is intended to capture those long stay residents, who no one has ever thought about discharging before.

If you have questions, please contact:  Joan Brundick, State RAI Coordinator, Missouri Department of Health & Senior Services (DHSS), Telephone 573-751-6308 or E-mail:  joan.brundick@health.mo.gov

Pioneer Network’s National Learning Collaborative Webinar Series THREE on Using the MDS 3.0 as an Engine for High Quality Individualized Care

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Pioneer Network’s National Learning Collaborative Webinar Series Three:  Operationalizing OBRA: A Performance Improvement Approach to Individualizing Care:

  • June 19, 2012: Part Seven MDS and Quality of Life: Operationalizing Customary Routines
  • July 19, 2012: Part Eight MDS and QAPI: How to Improve Outcomes through Just-in-Time Assessment, Care Planning and Quality Improvement by Staff Closest to the Residents

Pioneer Network continues its groundbreaking webinar series to introduce why and how to put in place the organizational culture changes necessary to integrate MDS 3.0 so that it contributes to strong organizational performance.  Hundreds of participants from around the nation heard up-to-date information from the CMS MDS team and concrete strategies presented by practitioners who have integrated culture change and the MDS to improve resident, staff and organizational outcomes.  Please visit: http://www.pioneernetwork.net/Events/MDS30_789/

 

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.

MDS 3.0 QM Data Availability and Updated RAI Manual

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The new Minimum Data Set (MDS) 3.0 Quality Measure (QM) data will be available to individual facilities and State Agency staff beginning April 1, 2012.  The QM’s will not be available to the public on Nursing Home Compare and factored into the Five Star Rating until July, 2012.  The April 1, 2012 release coincides with the Resident Assessment Instrument (RAI) manual update and a few changes in the MDS 3.0 Item Set.

MDS 3.0 QM Reports

The following reports will be available in the MDS 3.0 QM Reports report category in the CASPER Reporting application:

  • MDS 3.0 Facility Quality Measure Report
  • MDS 3.0 Monthly Comparison Report
  • MDS 3.0 Resident Level Quality Measure Report
  • MDS 3.0 QM Package Reports – this package includes:
      • MDS 3.0 Facility Quality Measure Report – automatically selected by default
      • MDS 3.0 Resident Level Quality Measure Report – automatically selected by default
      • MDS 3.0 Submission Statistics By Facility Report

MDS 3.0 RAI Manual and Item Sets

There are a few changes to the RAI Manual and Item Sets.  Facilities are required to use the new Item Sets with an Assessment Reference Date (ARD) of April 1, 2012 or later.  The new manual and change tables can be downloaded at:   http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp

The new item sets can be downloaded at:    http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp

802 and 672 Forms

Centers for Medicare & Medicaid Services (CMS) will soon be releasing a Survey and Certification (S&C) memo regarding changes in the 802 form and 672 instructions.  When the S&C memo is released, surveyors will again start pulling and using the new QM’s, along with the new 802 form and 672 instructions during offsite preparation.  Until the S&C memo is released, surveyors will not use QM’s nor the new 802 and 672 forms in the survey process.

 

MDS 3.0 Update Required

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MDS 3.0 requires new items on assessments with a Target Date of April 1, 2012 and later.  Failure to upgrade your software will result in fatal errors.  Contact your software vendor for a software upgrade prior to encoding assessments with a Target Date of 04/01/2012 and later.  The enhanced software should incorporate the changes contained in the MDS 3.0 Submission Specs V1.10.1, at: http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp

jRAVEN users will find jRAVEN 1.1.4 available for download after 03/27/2012 at: https://www.qtso.com/ravendownload.html.  This upgrade incorporates the changes beginning 04/01/2012.
If you have questions, please contact Joan Brundick, State RAI Coordinator, Missouri Department of Health & Senior Services at 573-751-6308.

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.

National Learning Collaborative – Using MDS 3.0 as an Engine for High Quality Individualized Care

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The Pioneer Network is now offering the second set of MDS 3.0 webinars.  Clinical Applications – An Interdisciplinary Team Approach to Health Promotion

February 9, 2012: Promoting Mobility and Reducing Falls by Individualizing Care and Eliminating Alarms

March 22, 2012: Individualizing Dining – New Practice Standards

April 19, 2012: Smooth Transitions in Care – Getting New Residents Off To a Good Start From Day One

For details and registration information please visit: http://www.pioneernetwork.net/Events/Webinars/MDS30_456/

MDS Information – When and how to establish the Assessment Reference Date (ARD)

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The ARD is defined as the specific end point of look-back periods in the MDS assessment process.  It allows for those who complete the MDS to refer to the same period of time when reporting the condition of the resident.  For SNF PPS assessments, this date also determines payment.  Chapter 6, Section 6.8, of the RAI manual speaks specifically to early, late, and missed assessments.  It states that the ARD must be “established” or “set” within well-defined windows of time.  Backdating the ARD because you forgot to set it in the defined window is not allowed.  In order to prove that you are not backdating assessments, CMS has commented that the MDS is the only acceptable documentation form for establishing or setting the ARD.  Please read the Establishment of ARD from the Federal Register.  This means that your facility needs to set the ARD by opening the assessment in the computer and entering the ARD date in A2300 during the defined window of time.  The facility still has 14 days from the ARD to then complete the assessment and have all signatures in place.  If you have any questions, please contact Joan Brundick, State RAI Coordinator, at joan.brundick@health.mo.gov.