Category: SLCR Guidance

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.

Regulation Update Notice

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The revisions to regulation 19 CSR 30-84.030 Level I Medication Aide Training Program, will be published in the Code of State Regulations on October 31, 2012.  The official new rules can 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.  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 573-526-8520.

Regulation Update Notice

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The revisions to regulations 19 CSR 30-85.022; 19 CSR 30-86.022; and 19 CSR 30-88.020 will be published in the Code of State Regulations on September 30, 2012.  The official new rules can be found on the Office of the Secretary of State’s website: http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp. 

The rules are located under Division 30 in Chapter 85, Chapter 86, and Chapter 88.  The effective date for the new rules will be October 30, 2012.   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 573-526-8520.

Approved Diet Manuals

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The 2012 Long Term Care Diet Manual published by Health Technologies, Inc. has been approved for use in long-term care facilities in Missouri.  You may visit the Health Technologies Inc. website at:  http://www.ht-ss.com/.  A list of approved diet manuals is available on the Department of Health and Senior Services website at:  http://health.mo.gov/seniors/nursinghomes/providerinfo.php/.

Reporting Changes of Administrator or Director of Nursing

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Reporting a change of Administrator or a change of Director of Nursing in your home is required per the Code of State Regulations, 19 CSR 30-81.010, and 19 CSR 30-82.010.  New forms for reporting these changes are now available on our website.  Change of Administrator/Manager in a Long-Term Care Facility and Change of Director of Nursing in a Long-Term Care Facility forms may be found at:  http://health.mo.gov/seniors/nursinghomes/appsforms.php.

Reporting personnel changes is mandatory; however use of these specific forms is not.  These forms are provided as an option for your convenience and to improve communications.  If you have questions concerning these regulations or notification procedures, please contact the Section for Long-Term Care Regulation, Licensure and Certification Unit at 573-526-8508, or send an E-Mail to:  LTCApplication@health.mo.gov.

Regulation Update Notice

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The revisions to regulations 19 CSR 30-81.015; 19 CSR 30-86.043; and 19 CSR 30-86.047 will be published in the Code of State Regulations on August 31, 2012.  The official new rules can 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 81 and Chapter 86.  The effective date for the new rules will be September 30, 2012.  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 573-526-8520.