MDS Items O0600 (Physician Examinations) and O0700 (Physician Orders)
As of 10-1-17, Version 1.15 of the RAI Manual went into effect. The RAI Manual now states CMS does not require completion of items O0600 or O0700, however, some States continue to require the completion of these items. The RAI Manual states if the State does not require the completion of these items, use the standard “no information” code (a dash, “–”).
Missouri does not require completion of items O0600 and O0700; staff in Missouri facilities may dash these items as the RAI Manual directs.
If you have any questions concerning this information, please contact Stacey Bryan, the State RAI Coordinator, at 573-751-6308 or Stacey.Bryan@health.mo.gov.
SNF QRP Confidential Feedback Reports for Claims-Based Measures
The SNF QRP Confidential Feedback Reports containing the claims-based IMPACT Act measures are now available via the CASPER Reporting System.
For more information on these reports, please refer to the September 28, 2017 presentation and audio and transcript on the SNF QRP Training website.
Please note that these reports only contain information for the following claims-based quality measures:
- Total Estimated Medicare Spending Per Beneficiary Measure
- Discharge to Community-Post Acute Care– SNF QRP
- Potentially Preventable 30-Day Post Discharge Readmission Measure
The full Confidential Feedback Reports or Quality Measure reports containing all SNF QRP quality measures (claims-based and assessment-based) will be released later this year and further training will be forthcoming.
If you have questions about the information contained in your report, please contact the SNF QRP Help Desk at SNFQualityQuestions@cms.hhs.gov.
Update: SNF QRP Review and Correct Reports & Confidential Feedback Reports Issues
We recently SNF providers that all data for assessment-based measures required for the SNF QRP in CY2017 would remain open to modifications until May 15, 2018, and that you would be notified when the Q1 2017 data that was “frozen” as of August 15, 2017 would be open and subject to updates again.
Please be advised that the submission deadline for Q3 2017 data has been modified to May 15, 2018. The SNF Review and Correct Report has been updated to reflect that both Q1 and Q2 2017 are “Open”. Data for all measures for Q1 2017 have been recalculated for any assessment records that have been received since the original Q1 2017 submission deadline of August 15, 2017.
The SNF Review and Correct report is available in the SNF Quality Reporting Program report category in the CASPER Reporting application. Providers are encouraged to request the report to view updated measure results. The updated report should replace versions of the report previously requested.
Note that when the report is run for more than one quarter, the Reporting Quarters are now displaying in random order, rather than being displayed in descending order (newest Reporting Quarter to oldest Reporting Quarter). The Start and End Dates, Data Correction Deadline Date, Date Correction Period as of Report Run Date and the quality measure data results associated to the Reporting Quarters are all correct. The issue is simply the way in which the Reporting Quarters are displayed in the table. This will be corrected in early December.
The remaining issue, affecting the calculation of the Application of Percent of LTCH Patients with Admission and Discharge Functional Assessment and a Care Plan that Addresses Function, is still being corrected and tested. You will be notified once this issue has been resolved in early December. At that time, the data for this measure will be recalculated and the updated results will be available on the Review and Correct Report.
View previous updates on the SNF Quality Reporting Program Data Submission Deadlines webpage.
If you have questions concerning this information, please contact the QTSO Help Desk at firstname.lastname@example.org or 1 (800) 339-9313.
International Infection Prevention Week: Oct. 15-21
During International Infection Prevention Week – help break the chain of infection by educating health care professionals, administrators, legislators and consumers about the importance of preventing infections and improving outcomes. Click on the following links for more information and resources about promoting infection prevention in long-term care.
Infection Prevention and You in Long-Term Care
APIC: Infection Prevention in Long-Term Care Fact Sheet (PDF)
CDC: Hand Hygiene in Health Care Settings
CDC: Infection Prevention Tools for Long-Term Care
New Section Administrators within the Division of Regulation and Licensure
Shelly Williamson has accepted the position of Administrator for the Section for Long Term Care Regulation.
Bill Koebel has accepted the position of Administrator for the Section for Health Standards and Licensure.
Reducing Antipsychotic Medication Use
Engaging residents in their care and providing treatment alternatives assists in reducing the unnecessary use of antipsychotics. Click on the following links to learn more about reducing the use of antipsychotic medications.
Reducing Antipsychotic Drug Use in Long-Term Care Settings (Video)
Create Connect: Creative Activity Workbook
QAPI: Mood/Behavior Symptom Log (Microsoft Word)
QIPMO – Emergency Preparedness
October 17, 2017: QIPMO Emergency Preparedness 101
Location: Friendship Village, Village Care Center, St. Louis
Please see the flyer QIPMO Flyer for details. Space is limited. Please RSVP!
Conversations with Carmen
October 20, 2017: Improving the Dining Experience for Residents – Honoring Choice, Exceeding Regulations
Guest Presenter: Suzanne Quiring, RD, CDM, SuzyQ Menu Concepts
Want to provide a great dining experience, preferences and choice – and be in compliance with new CMS requirements? Learn how to work within budget & time restrictions, tackle cold food, high food waste, endless food preference lists issues and how to move away from tray and pre-plate service to self-determined meal delivery that honors resident choice while saving money. Photos, real examples and many ideas will be shared to help communities implement practical culture change ideas with the confidence of the literature, best practices and federal requirements to back them up.
For more details, including times and full registration, please visit events.r20.constantcontact.com/register/eventReg?llr=aievf5bab&oeidk=a07eenu4xaq26132c77.
SLCR New Region 7 Manager
The Section for Long Term Care Regulation is pleased to announce that Lisa Sommerhauser will be the new Region 7 Manager. Lisa has a Bachelor Science in Nursing and a Master of Public Health & Certificate in Biosecurity. She has been a registered nurse for over 30 years, has experience in multiple areas of nursing and many years of experience in management and strategic planning. Most recently, Lisa has been a Facility Advisory Nurse with the complaint team in Region 7. Lisa’s first day as the Region 7 Manager will be October 1, 2017. Congratulations, Lisa!
CMS PowerPoint Presentation: 2017 RAI User’s Manual Provider Updates
A PowerPoint presentation that highlights the major changes to the October 1, 2017 version of the RAI Manual has been posted to the CMS MDS webpage at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursinghomeQualityInits/MDS30RAIManual.html. The presentation can be found as #6 in the Related Links section at the bottom of this webpage. Please note that the presentation provides an overview of the major changes but not all of the changes to the manual. Providers should also review the RAI Manual Change Tables and the manual itself to understand all of the changes.
Reducing Inappropriate Use of Antipsychotic Medications – Communication
Understanding dementia residents who are unable to communicate on the same level as others can aid in the reduction of inappropriate antipsychotic use. However, meeting their needs can become challenging if their behaviors are not understood. Click on the following links to learn more.
Do You KNOW Your Residents? (video)
Managing Personality and Behavior Changes
Communication and Alzheimer’s
MU Enhances Leadership Development Academy (ELDA)
November 2017-May 2018
A professional development certificate program for RNs, NHAs and Social Workers using a proven curriculum to improve leadership behaviors with a combination of face-to-face meetings and two webinars. Offered over 7 months, it features an innovative and evidence-based curriculum with a strong focus on application to practice and peer consultation.
This will be the last time the ELDA will be taught in a face-to-face format. If you prefer to learn in a live classroom, be sure to enroll now. Beginning in Spring/Summer 2018, we are pleased and excited to offer the ELDA in a mostly online format. You will receive a separate mailing on this option.
For more information, include brochure and registration, please visit nursingoutreach.missouri.edu/lda.aspx.
Influenza Vaccination Requirements
There has been legislation passed in the last couple years regarding influenza vaccination requirements. Homes should be implementing these requirements as applicable.
198.053. Assisted living facilities, notification of posting of latest Vaccine Informational Sheet. — No later than October first of each year, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, each assisted living facility, as such term is defined in section 198.006, shall notify residents and staff where in the facility that the latest edition of the Vaccine Informational Sheet published by the Centers for Disease Control and Prevention has been posted. Nothing in this section shall be construed to require any assisted living facility to provide or pay for any vaccination against influenza, allow the department of health to promulgate any rules to implement this section, or cite any facility for acting in good faith to post the Vaccine Informational Sheet.
198.054. Influenza vaccination for employees, facilities to assist in obtaining. — Each year between October first and March first, all long-term care facilities licensed under this chapter shall assist their health care workers, volunteers, and other employees who have direct contact with residents in obtaining the vaccination for the influenza virus by either offering the vaccination in the facility or providing information as to how they may independently obtain the vaccination, unless contraindicated, in accordance with the latest recommendations of the Centers for Disease Control and Prevention and subject to availability of the vaccine. Facilities are encouraged to document that each health care worker, volunteer, and employee has been offered assistance in receiving a vaccination against the influenza virus and has either accepted or declined.
S&C Memo: 17-43-ALL: Quality and Certification Oversight Reports (QCOR) Website Launch
New Website Platform and Data System: The Centers for Medicare & Medicaid Services (CMS) is releasing information related to the new QCOR website in an overarching initiative for increased transparency.
Please see the full memo at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-43.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending.
New MDS 3.0 RAI Manual Posted
CMS posted the MDS 3.0 RAI Manual v1.15 on their website on 8/31/17, which will be effective October 1, 2017. The new Manual can be found in the Related Links Section at the bottom of the following CMS website www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/NursingHomeQualityInits/MDS30RAIManual.html
The Related Links section at the bottom of this page contains:
- MDS 3.0 RAI Manual v1.15 October 1, 2017
- A Single PDF file of the entire RAI manual for use as an electronic version with bookmarks that you can click on to take you to each section of the manual.
- MDS 3.0 RAI Manual v1.15 and Change Tables October 1, 2017
- Traditional zip files of the RAI manual and the change tables that crosswalk the changes made to this year’s manual. Note: This is the same material as the first item above, except there are separate files for each chapter or subchapter.
- MDS 3.0 RAI Manual v1.15 Replacement Manual Pages and Change Tables October 1, 2017
- Replacement pages for this year’s manual changes for those that want to just update their existing paper based manual with the pages that have changed. It also includes the change tables that crosswalk the changes made to this year’s manual.
- MDS Forms (Item Sets) v1.15.1 October 1, 2017
- Two folders separate the v1.15.1 MDS forms (MDS item sets) into those used in long term care facilities (SNFs and NFs) and those used in swing bed facilities.
MDS 3.0 Section M in Advances in Skin & Wound Care
Elizabeth Ayello has published an article on the MDS 3.0 Section M in Advances in Skin & Wound Care, September 2017 – Volume 30 – Issue 9. This is a free access article, which means anyone can read the article free of charge. There is also an option for CEUs. Elizabeth’s article is available on the Advances in Skin & Wound Care website at journals.lww.com/aswcjournal/Pages/currenttoc.aspx, in the Clinical Management Section, and is titled: CMS MDS 3.0 Section M Skin Conditions in Long-term Care: Pressure Ulcers, Skin Tears, and Moisture-Associated Skin Damage Data Update.
SNF QRP Review and Correct Reports & Confidential Feedback Reports
SNF providers were recently notified of two issues affecting the SNF QRP Review and Correct Reports & Confidential Feedback Reports.
An issue was identified within the SNF Review and Correct Report, if one or more modification records are submitted for a patient stay, the most recent submitted assessment, which was accepted by the ASAP system on or prior to the submission deadline for Q1 and Q2 of CY2017, was not being used in the measure calculation.
All quality measure data has been recalculated and is now available in the SNF Quality Reporting Program report category in the CASPER Reporting application. Providers are encouraged to request the report to view updated measure results. The updated report should replace versions of the report requested prior to the issue notification.
The second issue that was identified in the technical coding, which affected our calculation of one measure contained in the SNF Review and Correct Report related to the measure Application of Percent of LTCH Patients with Admission and Discharge Functional Assessment and a Care Plan that Addresses Function, also affected the SNF QRP Confidential Feedback Report (SNF Quality Reporting Program (QRP) Quality Measure Report) is still being resolved and further guidance is forthcoming.
As a reminder, all data for assessment-based measures required in the SNF QRP in CY2017 will remain open to modifications until May 15, 2018. We anticipate that the data currently “frozen” as of August 15, 2017 to be subject to updates as of mid-September. Another notice will be issued once the Review and Correct Report Q1 2017 SNF QRP data is open again.
Further guidance and timelines has been posted to the SNF Quality Reporting Program Data Submission Deadlines webpage.
All facilities will receive an email blast notifying them of the above. We will continue to send follow-up announcements as further guidance can be given.
If you have any questions concerning this information, please contact the QTSO Help Desk at email@example.com or 1 (888) 477-7876.
You don’t have to be an MDS Coordinator to attend
Often, the topics discussed are beneficial not only for MDS Coordinators but also for floor nurses, Social Services staff, DONs, ADONS and Administrators. You can find a schedule of meetings and topics by going to the Nursing Home Help website found at www.nursinghomehelp.org/supgr.html. Some past topics have included Quality Measures, QRP requirements, Phase 1 and 2 Regulation Implementation, discussions with the State RAI Coordinator and State Surveyors, PPS Scheduling, CAA documentation, Care Plans, MDS Review for Social Workers, Wounds, Section GG Coding, Behavior Documentation and ICD-10 Coding. You are welcome to attend any meeting anywhere in the state, no RSVP needed.
Urinary incontinence can cause a variety of issues in older adults. Tools are available for identifying and improving incontinence such as assessment techniques and established care plans. Click on the following links to learn more.
Sample Care Plan: Urinary Incontinence (PDF)
Urinary Incontinence Assessment in Older Adults (PDF)
Low-Risk Residents Who Lose Control of Their Bowel or Bladder (Long Stay) Root Cause Analysis Tool (Excel)
September 25-28, 2017: Social Service Designee Workshop
Location: MHCA Office, Jefferson City
November 1-2, 2017: CNA/Nurse Leadership Conference
Location: Camden on the Lake, Lake Ozark
November 6-7, 2017: Federal Review Course for Nursing Home Administrators
Location: Embassy Suite Airport Hotel, Kansas City