Category: SLCR Guidance

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/

 

New Generations – Autumn 2013 Quarterly Newsletter

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The Section for Long-Term Care has published New Generations – Volume 11, Issue 4, Autumn 2013.  This issue is now available on our website, along with an archive of previous newsletters.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

Regulation Update Notice

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The revision to regulation 19 CSR 30-82.070 Alzheimer’s Demonstration Projects (Rescinded September 30, 2013) has been published in the Code of State Regulations.  The official new rule can be found on the Missouri Secretary of State’s website at: http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp.  The rule is located under Division 30 in Chapter 82.  The effective date for the new rule is September 30, 2013.  If you have any questions regarding implementation of the rules, please contact the Section for Long-Term Care Regulation, Policy Unit Manager Carmen Grover-Slattery, at 573-526-8570.

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.

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 Generations – Summer 2013 Quarterly Newsletter

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The Section for Long-Term Care has published New Generations – Volume 11, Issue 3, Summer 2013.  This issue is now available on our website, along with an archive of previous newsletters.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

MC5 Regional Meetings – July 2013

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East – July 12, 2013:  Is our Iceberg Melting too?  An Expedition Toward Consistent Assignment

Brentwood Community Center, Room 104, 2505 S. Brentwood Blvd., Brentwood.  RSVP to Ruthie, rrochman@alz.org or 314-801-0446.

Southwest – July 16, 2013:  Food and Dining – Dining with Friends

Council of Churches, 627 N. Glenstone, Springfield.  RSVP to cindybutler@mchsi.com.

Northwest – July 17, 2013:  Life Safety Code and Culture Change

East Hills Library, 502 N. Woodbine Rd., St. Joseph.  RSVP to Karen Fletchall, wccc.karen@yahoo.com, 660-564-3304, or Freda Miller, fmiller@nwmoaaa.org, 660-822-6209.

Route 71 – July 19, 2013:  Interact III

Community Center, 200 N. Ash, Nevada.  RSVP to sghouser@medicalodges.com.

West – July 24, 2013:  Staff Turnover and Open Forum with DHSS

St. Mary’s Manor, 111 Mock Ave., Blue Springs.  RSVP to Kathy Vogt or Leslie Carter at 816-228-5655.

Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website for details!

2013 Annual Long-Term Care Provider Meetings

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Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation

2013 Annual Long-Term Care Provider Meetings 

 

Presentations

Risky Business – Honoring Controversial Resident Choices

Appropriate Responses Resident to Resident Altercations

Putting Your Best Forward for IDR

QAPI – From Introduction to Application

ELDA The Bluffs Admission-Discharge Journey

How CPS can Help you Implement QAPI in a Confidential Environment

 

 Agendas available below – times vary for each regional meeting

 
  • July 12 (Friday) 9:30 a.m. – 1:30 p.m. – Region 1:  Cox Medical Center South, Foster Auditorium, 3801 S National Ave, Springfield
PROVIDER MEETING 2013 AGENDA REGION 1 SPRINGFIELD

 

  • July 15 (Monday) 1:00 p.m. – 5:00 p.m. – Region 2:  Drury Lodge, State Room, 104 S Vantage Dr, Cape Girardeau
PROVIDER MEETING 2013 AGENDA REGION 2 CAPE GIRARDEAU

 

  • July 22 (Monday) Noon – 4:00 p.m. – Region 7:  Crowne Plaza St. Louis – Clayton Hotel, Windsor Room, 7750 Carondelet Ave, St Louis
PROVIDER MEETING 2013 AGENDA REGION 7 ST LOUIS

 

  • July 23 (Tuesday) Noon – 4:00 p.m. – Region 6:  Governor’s Office Building, Room 450, 200 Madison St, Jefferson City
PROVIDER MEETING 2013 AGENDA REGION 6 JEFFERSON CITY

 

  • July 25 (Thursday) 1:00 p.m. – 5:00 p.m. – Region 4:  Stoney Creek Inn, Frontier Room, 1201 Woodbine Rd, St Joseph
  PROVIDER MEETING 2013 AGENDA REGION 4 ST JOSEPH

 

  • July 26 (Friday) 9:00 a.m. – 1:00 p.m. – Region 3:  Truman Medical Center Lakewood, Truman Room II (Lakewood Entrance), 7900 Lee’s Summit Rd, Kansas City
PROVIDER MEETING 2013 AGENDA REGION 3 KANSAS CITY

 

  • July 29 (Monday) 1:00 p.m. – 5:00 p.m. – Region 5:  Quality Inn & Suites, Paradise Room, 120 Lindsey Dr, Hannibal
PROVIDER MEETING 2013 AGENDA REGION 5 HANNIBAL 

 

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.

Annual Long-Term Care Provider Meetings 2013 – Save the Date

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Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation.   

Coming to a location near you: 

  • July 12 (Friday) 9:30 a.m. – 1:30 p.m. – Region 1
Cox Medical Center South, Foster Auditorium, 3801 S National Ave, Springfield
 
  • July 15 (Monday) 1:00 p.m. – 5:00 p.m. – Region 2
Drury Lodge, State Room, 104 S Vantage Dr, Cape Girardeau
 
  • July 22 (Monday) Noon – 4:00 p.m. – Region 7
Crowne Plaza St. Louis – Clayton Hotel, Windsor Room, 7750 Carondelet Ave, St Louis
 
  • July 23 (Tuesday) Noon – 4:00 p.m. – Region 6
Governor’s Office Building, Room 450, 200 Madison St, Jefferson City
 
  • July 25 (Thursday) 1:00 p.m. – 5:00 p.m. – Region 4
Stoney Creek Inn, Frontier Room, 1201 Woodbine Rd, St Joseph
 
  • July 26 (Friday) 9:00 a.m. – 1:00 p.m. – Region 3
Truman Medical Center Lakewood, Truman Room II (Lakewood Entrance), 7900 Lee’s Summit Rd, Kansas City
 
  • July 29 (Monday) 1:00 p.m. – 5:00 p.m. – Region 5
Quality Inn & Suites, Paradise Room, 120 Lindsey Dr, Hannibal 

Registration is not required. 

A QAPI and Compliance Approach to Eliminating Alarms and Preventing Falls

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May 17, 2013

Conversations with Carmen – Eliminating Alarms and Preventing Falls Webinar Series

Guest:  Matt Younger, Administrator, Section for Long-Term Care Regulation, Missouri Department of Health and Senior Services.

Our conversation will revolve around looking at root cause analysis and quality assurance / process improvement as they pertain to regulatory compliance and alternatives to alarms.  We will review how and why alarms are falling out of favor among both researchers and regulators and how alarm usage can invite additional scrutiny during survey.  We will also analyze whether alarms can conceivably be a restraint in some cases and potentially meet CMS’ own definition of convenience at Tag F221 Restraints.

Please visit the website at www.actionpact.com/calendar/event_details/conversations_with_carmen_webinar.

New Generations – Spring 2013 Quarterly Newsletter

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The Section for Long-Term Care Regulation’s quarterly newsletter, formerly known as the LTC Bulletin, now has a new title:  New Generations.  

This title reflects a new era in long-term care, an increased focus on culture change initiatives and our commitment to be responsive to the demands that a new generation of residents, their families and the public are making on nursing homes and regulatory agencies.  Person-centered care and the creation of true “home” environments are fast becoming the expectation rather than the exception and the Section must continue to provide relevant regulatory guidance applicable to every type of person who resides in Missouri’s Skilled Nursing, Intermediate Care, Assisted Living and Residential Care homes – and to the people who work in them, too.

Like the homes we strive to serve, our newsletter continues to evolve and improve based on feedback from readers and our own efforts toward quality assurance.  We hope you find the special feature about pets in our spring issue useful.  New Generations (Volume 11, Issue 2, Spring 2013) is now available on our website, along with an archive of previous newsletters.  A free, professional color copy will be mailed to each licensed entity next week.  If it’s useful, we hope you will share it with others; if you think there are ways it could become more useful, we hope you will share those ideas with us.

Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

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.

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.

Level I Medication Aide Training Program Regulation Update

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The revisions to regulation 19 CSR 30-84.030 Level I Medication Aide Training Program, were published in the Code of State Regulations on October 31, 2012.  The official new rules may be found on the Missouri Secretary of State’s website at http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp.  The rules are located under Division 30, Chapter 84.  The effective date for the new rules will be November 30, 2012.  The following information outlines some of the requirement changes: 

  • The Level I Medication Aide (LIMA) course shall include a minimum of sixteen (16) hours of integrated formal instruction and practice sessions directly supervised by an approved LIMA Instructor. 
  • LIMAs shall participate in a minimum of four (4) hours of medication administration training every two (2) years in order to remain active and administer medications in a Residential Care Facility (RCF) or in an Assisted Living Facility (ALF).  LIMAs certified on or before September 30, 2012 shall have until September 30, 2014 to comply with the biennial training requirements, or their name will be removed from the registry and they will be required to take the full 16-hour course.  Forms are located on our website at the address below. 
  • Medication Aides (MAs) certified through the Department of Mental Health will be able to apply for DHSS certification through a Certifying Agency.  MAs will be required to provide certification documentation proof and pay the certification fee.  The Certifying Agency will submit the names to DHSS to be added to the registry. 
  • To be a LIMA course instructor, the individual must currently be an approved LIMA Instructor (verification is available online).  Instructors must be a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) licensed to practice in Missouri, not subject to any disciplinary action, and shall have one (1) year experience working as a nurse and shall attend and successfully complete a “Train the Trainer” workshop through a Certifying Agency.

As individuals complete their biennial updates or are newly certified, their certification information will be available on the online registry at the website address below. 

Links to the regulations, approved training manuals, forms, certifying agency information and more is available online at:   http://health.mo.gov/safety/cnaregistry/lima.php.  If you have any questions, please contact the Section for Long-Term Care Regulation, Health Education Unit, at 573-526-5686.