December 2011 - Texas Department of Aging and Disability Services
Contents
1. Dashing through the snow in a one horse open sleigh COT evaluation every seventh day End of Therapy if three days have a lack but EOT R if in five days therapy is back Only if therapy resumes at the same level VOLUME 4 ISSUE 3 PAGE 5 Cheryl Shiffer BSN RN RAC CT JE Andy Alegria MDS Clinical Coordinator EE MDS Automation Coordinator COWIMCT US 11307 Roszell Street Room 1310 f i P O Box 149030 San Antonio TX 78217 Mail Code 279 4 Phone 210 619 8010 Fax 210 619 8100 Shared Fax Call First Austin TX 78714 9030 Mail Code E 345 Phone 512 438 2396 Fax 512 438 4286 Shared Fax Call First Useful Web Links DADS MDS Web Site Texas MDS site for MDS policy procedures and clinical and technical information including The MDS Mentor http www dads state tx us providers MDS Sign up for MDS Resource E mail updates Go to http www dads state tx us click on the E mail updates tab and follow the directions The DADS Texas Minimum Data Set MDS Resources emails are the key line of communication for MDS updates and alerts to nursing home and swing bed facilities from the DADS MDS staff Centers for Medicare amp Medicaid Services CMS MDS Web Site for MDS 3 0 MDS 3 0 Highlights RAI Manual Item Sets forms related MDS 3 0 materials and a link to MDS 2 0 http www cms gov NursingHomeQualityInits 25 NHOIMDS30 as QIES TECHNICAL SUPPORT OFFICE QTSO MDS 3 0 2 0 jR2. MDS3 0_V1 07_Errata pdf to correct errors in Chapters 2 3 Section O and 6 of the RAI Manual that was published in September 2011 Also on October 6 three new training vide os were posted on the CMS MDS 3 0 Training Ma terials web page with the titles Section V Care Ar ea Assessment Process of Care Planning for Res idents in Skilled Nursing Facilities and PASRR PAGE 4 On December 12 2011 MDS 3 0 data submission specifications V1 10 1 were posted on the CMS MDS 3 0 Technical Information web page which includes changes to MDS 3 0 that will be effective April 1 2012 Also posted was Version 1 10 4 of the MDS 3 0 Item Sets that will be effective April 1 2012 The updated MDS 3 0 RAI User s Manual has not yet been published Starting 1 3 2012 all Texas facilities are ex pected to begin switching over their secure broadband connection for transmission of MDS records to Verizon from AT amp T AT amp T broad band connections to transmit MDS records will be cut off on 2 3 2012 Without Verizon staff will not be able to transmit MDS records 2012 April Item Set Updates to MDS 3 0 The following instructions are for anyone who wants to start learning some of the changes to the MDS 3 0 Item Sets that that will be implemented in April 2012 but who is not inclined to sift through the MDS 3 0 Sub mission Specifications 1 Go to http www cms gov NursingHomeQualityInits 30 NHQIMDS30Technicallnformation asp
3. ities are not required to adjust the date of the ARD for the 5 day assessment or to combine the 5 day assessment with an EOT OMRA Another important clarification from the 11 3 11 NPCFUC document is related to when a resident s MDS is classified into a Rehab or Rehab plus Extensive Services ES RUG category and the resident does not receive any therapy services for three or more consecutive calendar days and the resident is discharged from the facili ty on the third day of missed therapy ser vices then no EOT OMRA is required While the guidance provided is correct it does not mean a resident can be main tained on Medicare Part A after all thera py has ended when therapy was the only skilled service and the reason for the Medicare stay for up to three days When therapy is the only skilled service CMS expectation is discharge from all therapy and discharge from Medicare Part A will occur concurrently Finally the 8 23 11 NPCFUC docu ment explains that an End of Therapy with Resumption EOT R is not a new assessment type An EOT R would be noted as an EOT in item A0310C on the MDS Item Set An EOT R simply refers to a subset of items on the EOT OMRA spe cifically 00450A and O0450B which al low staff to confirm that all therapy disci plines resumed at the previous level and the date of therapy regimen resumption CMS staff warn not to transmit the EOT R until sure the previous RUG level is met VOLUME
4. 2 Click on MDS 3 0 Item Subsets V1 10 3 for the April 1 2012 Release 3 Open MDS 3 0 Item Subsets V1 10 3_Part 1_20110926 4 Open MDS3 0_Item_Changes_v1 10 3 pdf Tips e The main set of changes starts on page 2 e Page 1 is updates to the main set of changes so start on page 2 read to the end then go back to page 1 e Itis easiest to track the changes by having a copy of the MDS 3 0 Item Subset titled All Item Listing against which to compare The Discharge Item Subsets may also be helpful The following is a small subset of those changes as examples to show you what the document contains e X0100 becomes A0050 but options stay the same e A0310G added planned or unplanned discharge A0310G is used in a few skip patterns e A1500 now required for all comprehensive OBRA records not just Admissions Skip pattern added to skip new A1510 unless A1500 Yes e A1510 added Serious mental illness Mental Retardation or Other related conditions e A1800 adds new option 09 Long Term Care Hospital LTCH e A2100 adds new option 09 Long Term Care Hospital LTCH e Alarge number of items have been removed from some or all Discharge assessments Item Sub sets ND NOD NSD SD SOD or SSD Compare the old and new Discharge Item Subsets or read the MDS30 ItemSubsetsforApril1 2012Release for a list For example B0200 is removed from all Dis charge assessments but B0700 is only removed from specific ones
5. 4 ISSUE 3 PAGE 3 Early Discharges Managing Their MDS Assessments They may forget If a resident discharges one hour or one day after admission does the facility have to Your name but they complete any MDS records If so which ones and how While most of the answers will will never forget how you made depend on payer source and facility policy this article addresses some possibilities them feel For the purpose of this article the term resident refers to an individual admitted to Maya Angelou a nursing home or swing bed facility If an individual does not complete the admission process then no MDS records need to be completed If an individual is admitted to a Nurses dispense nursing home or swing bed and becomes a resident then an entry tracking record and comfort either a discharge assessment or a death in facility record are required regardless of compassion and how long the resident stays N R re For nursing homes pages 2 17 to 2 18 of the RAIM3 note the following concerning i a a comprehensive assessments e Ifa resident is discharged prior to the completion deadline for the assessment completion of the assessment is not required Whatever portions of the RAI that have been completed must be maintained in the resident s medical record In closing the record the nursing home should note why the RAI was not complet ed e Ifa resident dies prior to the completion deadline for the assessment comple tion of th
6. AVEN RAVEN and AT amp T Client Software information Validation Report Messages Guides Training and DAVE DAVE 2 Tip sheets https www atso com Quality Reporting System QRS DADS information site on Texas nursing homes http facilityquality dads state tx us Nursing Home Compare CMS site that compares nursing homes in a given area http www medicare gov NHCompare Include DataSection Questions SearchCriteria as 5 Star Technical Manual Explains data used to create the 5 Star Report C CE E E C http www cms gov CertificationandComplianc 13 FSORS as This guidance is being provided on the published date of The MDS Mentor The reader should be aware that guidance regarding topics in The MDS Mentor may be time limited and may be superseded by guidance published by CMS or DADS at a later date Itis each provider s responsibility to stay current with the latest CMS and DADS guidance
7. INSIDE THIS ISSUE The MDS Mentor Cheryl Shiffer BSN RN RAC CT Change of Therapy COT Clarifications Change of Therapy COT Clarifications End of Therapy EOT Clarifications eae Early Discharges MDS Clinical Coordinator Andy Alegria Influenza Vaccine Coding Department of Aging and Disability Service MDS Automation Coordinator MDS News in Review 2012 April Item Set Updates to MDS 3 0 VOLUME 4 ISSUE 3 DECEMBER 2011 The MDS Mentor is published in March June September and December each year ACRONYMS Assessment Reference Date ARD Centers for Medicare and Medicaid Services CMS CMS Long Term Care Facility Resident Assessment Instrument User s Manual Version 3 0 RAIM3 Leave of Absence LOA Minimum Data Set MDS Omnibus Budget Reconciliation Act OBRA Prospective Payment System PPS Skilled Nursing Facility Nursing Facility SNF NF a Pl PL wl ni ininiyt Contact Us and Useful Web Links Change of Therapy COT Clarifications continued on page 2 In order to understand and correctly complete a COT Other Medicare Required Assessment OMRA it is essential to read Chapter 2 of the RAIM3 and both of the National Provider Call Follow Up and Clarifications NPCFUC documents The first NPCFUC document is dated 8 23 11 while the other is dated 11 3 11 Both documents can be accessed at http www cms gov SNFPPS 03 RUGIVEdu12 asp under Downlo
8. T OMRA is set for day 7 of the COT observation period 2 Day 7 of the COT observation period is a valid ARD for the scheduled PPS assessment 3 The requirements for a COT OMRA are met However when facility staff elect not to combine the COT with the scheduled PPS MDS when a COT OMRA is due and only complete the scheduled MDS alone with an ARD on or earlier than the date the COT was due staff should monitor the resident s stay Facility staff need to en sure at least one payment day based on the scheduled assessment occurs If the resident is to be discharged on or before the first payment day of the scheduled PPS assessment then the COT which was not completed becomes a required PPS assessment The ARD for the COT like all Medicare PPS MDS must be set while the resident is still on Part A Additionally the ARD for the COT like all unscheduled VOLUME 4 HELPFUL HINT When a resident is discharged and the correct date of dis charge coded for Item A2000 is on or prior to Day 7 of the COT observation period then no COT OMRA is required NPCFUC 11 3 11 ISSUE 3 PAGE 2 Change of Thera py COT Clarifications Continued from Page 1 PPS MDS must be set no later than 14 days after the appropriate ARD for the COT A scheduled PPS MDS that has no pay ment days should not be completed or transmitted If it is already transmitted staff may inactivate it Inactivation en sures the COT if it has
9. ads An essential point from the 8 23 11 NPCFUC document informs staff when a COT OMRA is required Day 7 of the COT observation period occurs 7 days follow ing the ARD of the most recent PPS as sessment used for payment regardless if a LOA occurs at any point during the COT observation period Guidance for billing is found on page 2 70 of the RAIM3 the day preceding the midnight on which the resident was absent from the nursing home is not a covered Part A day How ever whether the days are billable or not any days that the resident is on a LOA are still counted when determining the ARD for the COT because the COT ARD is de termined using calendar days not Medi care days For example what if a resident had a 14 day scheduled PPS assessment ARD set on day 14 but was in the Emergency Department on a LOA at midnight on day 16 and was on a therapeutic LOA at mid night on day 20 If the requirements for completing a COT were met e g the therapy Resource Utilization Group RUG changed categories then the COT OMRA would have an ARD of 7 calendar days after the ARD of the 14 day PPS MDS despite the fact that day 16 and day 20 would not be Medicare Part A billable days Another important point which both the RAIM3 and the 8 23 11 NPCFUC doc ument note is a COT OMRA is correctly combined with a scheduled PPS assess ment when all the following are true 1 The ARD for the scheduled PPS as sessment CO
10. e assessment is not required Whatever portions of the RAI that have been completed must be maintained in the resident s medical record In closing the record the nursing home should note why the RAI was not completed However to bill for Medicaid the facility must complete an OBRA Admission assess ment To bill for Medicare Part A the facility must complete a PPS 5 day assessment An assessment completed for billing purposes might have incomplete data but it is still necessary for Medicaid or Medicare billing Refer to the The Use of Dashes in Complet ing the MDS 3 0 Assessment document on the CMS Training Materials website for more information on the use of dashes when a resident is discharged unexpectedly Influenza Vaccine item 00250 Coding As states including Texas are in the midst of the 4 Ifvaccination status cannot be determined ad annual influenza flu season it is an opportune time minister the vaccine to the resident according to to discuss the coding of item 00250 Influenza Vac standards of clinical practice cine From page O 6 of the RAIM3 the Steps for As sessment for item 00250 are as follows One of the most commonly asked questions re 1 Review the resident s medical record to deter garding item 00250 is when should staff stop coding mine whether an Influenza vaccine was received the resident received the influenza vaccine in the fa in the facility for this year s Influenza season If cili
11. the same ARD as the scheduled PPS MDS will be accepted by the CMS MDS database As directed on page 2 71 of the RAIM3 once a resident is no longer on Medicare Part A discharged from the facility discharged from Part A but remains in the facility staff can no longer set the ARD for any Medicare as sessments scheduled or unscheduled So if facility staff do not set an ARD for the COT prior to or when the resident is discharged all the days of the COT obser vation period and until the resident is discharged off Part A become Medicare non billable days To avoid the situation addressed in the previous two paragraphs CMS staff recommend that facility staff combine the COT and the scheduled PPS MDS when the dates overlap End of Therapy EOT Clarifications The RAIM3 and both of the 8 23 11 and the 11 3 11 NPCFUC documents also contain important information for sched uling and completing the EOT OMRA One educational item from the 11 3 11 NPCFUC document explains since an EOT OMRA is only required when the resident s MDS is classified into a Rehabilitation Rehab or Rehab plus Extensive Services RUG category an EOT OMRA is not neces sary for residents who have not yet been classified into such a RUG category ona scheduled or unscheduled PPS MDS Fur thermore for residents who do not receive therapy for three consecutive calendar days during the allowable ARD window for the 5 day scheduled PPS assessment facil
12. ty for this year s flu season The answer is staff do vaccination status is unknown proceed to the not stop coding whether the resident received the next step influenza vaccine for this year s flu season until the next year s flu season begins For example Septem ber 2010 and September 2011 are when Texas flu ae ae season began last year and this year A resident re Influenza season If vaccination status is still un ceived the flu vaccine on 10 5 10 Every MDS with RTO DECEE EG ROMS TERE IED an ARD on or after 10 5 10 through 8 31 11 3 Ifthe resident is unable to answer then ask the should indicate in 00250A that yes the resident same question of the resident s responsible par received the flu vaccine for this year s flu season in ty guardian or primary care physician If vac the facility and should indicate in 00250B the date of cination status is still unknown proceed to the 10 5 10 in the required format of 10 05 2010 next step 2 Ask the resident if he or she received an Influen za vaccine outside of the facility for this year s VOLUME 4 ISSUE 3 MDS News in Review On October 1 2011 the newest version of MDS 3 0 V1 00 6 Item Sets became effective for all MDS with an ARD on or after 10 1 2011 On October 5 2011 the DRAFT MDS 3 0 Tech nical QM User s Manual was posted on the CMS MDS 3 0 Technical Information web page On October 6 2011 CMS posted an errata docu ment called
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