Encore Available AHCA Free Webinar on MDS 3.0 Changes
In September 2011 AHCA sponsored a webinar on the MDS 3 changes. The webinar was a great success, close to 500 sites signed-on the call, and the feedback has been terrific. In case you didn’t catch the webinar and have interest in viewing, the archive can be found on the AHCA member page at: http://webinars.ahcancal.org/session.php?id=7226.
Fiscal Year 2012 implementation of a new SNF PPS assessment: The Change of Therapy Other Medicare-Required Assessment (COT OMRA)
To view the September 2011 CMS slide presentation detailing: 1) The new MDS Assessment Schedule; 2) Allocation of Group Therapy Minutes; 3) Revised Student Supervision Provisions; 4) EOT OMRA and New Resumption Items; and, 5) New PPS Assessment: COT OMRA click here.
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To view the transcript of the September 2011 CMS Presentation click here.
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To view the PPS Rule Effective October 1, 2011 click here.
MDS Nuggets Newsletter is Online!
The California MDS Nuggets newsletter is now posted on the website of the California Department of Public Health.
CDPH welcomes any ideas for articles, information and questions related to the MDS for inclusion in upcoming newsletters, which are scheduled to be published quarterly. For more information please call 
(916)324-2362. Staff contact: DeAnn Walters, (916)432-5213 or dwalters@cahf.org
Changes to MDS 3.0 Assessment Modification Rules
On July 1, 2011, CMS issued a memo to state agencies that summarizes assessment formatting and modification policies implemented by CMS made in February and April of 2011. The memo contains the reminder that QM data has been “frozen” using QM scores that reflect MDS 2.0 data submitted during the last quarter of 2010 and that obtained during the last quarter of MDS 2.0 and that MDS 2.0 QM data will be available early in 2012. Highlights include:
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Providers must “inactivate” to correct an event date or reason for assessment.
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jRaven 1.0.5 (CMS data entry software application) provides for more signature lines in Section Z.
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The print format provided by jRAVEN for a MDS 3.0 assessment is acceptable for review in the nursing home survey process. Click here to view the memo.
National Quality Forum 21 Proposed Quality Measures
In 2011 CMS will make a final determination about whether or not to accept these recommended measures. CMS could choose some or all of the recommended QMs. The National Quality Forum (NQF) endorsed 21 new quality measures that will be finally reviewed by CMS and potentially used for long-term and short-stay nursing home residents. Click here to view the entire list.
QTSO Memo on May 2011 Technical call with CMS
Page 6 of this memo details JRaven new releases and coming changes to MDS 3.0 this fall. To view the memo please click here.
QTSO Issues Memo on MDS Category Changes
This memo is a notice of MDS Provider and QI/QM Report Category Changes. These changes are effective June 8, 2011. The affected reports include MDS 2.0 data and will not be available after June 8, 2011. To view the details in the memo please click here.
CDPH MDS/Oasis Help Desk
To contact the MDS help desk, you may reach them at (916)324-2362(916)324-2362.
ASAP System Issue in MDS 3.0
Assessment Submission and Processing (ASAP) System Issue Identified in MDS 3.0 Error–3810. Presently, the transmission system is performing edit – 3810d for Comprehensive assessments; however, only edit -3810c applies to a comprehensive record. Edits –3810a, –3810b and –3810d do not apply to a comprehensive record. To correct the issue, the system will be enhanced to only apply edit –3810c for new (X0100=1) comprehensive assessments. A memo will be distributed when the issue has been corrected. Click here to view the notice. In the interim, advise providers to disregard error –3810d for NEW
Comprehensive assessments (A0310A = 01,03,04, and 05). Providers should not disregard error –3810c for comprehensive assessments, or –3810d for non-comprehensive assessments.
MDS 3.0 Roster and MDS 3.0 Missing Assessment Reports Issue
The QIES Technical Support Office has identified a problem in which discharged residents periodically appear on the MDS 3.0 Roster and Missing Assessment reports. QTSO is working to correct this issue. Meanwhile, the existing reports will continue to be available in the MDS 3.0 NH Provider report category in the CASPER Reporting application. Once the problem is corrected, the revised reports will be deployed to production, and a follow-up memo will be sent. Click here to view the notice.
Web Browser Update Required for QIES National Systems Access and Security Certificate Update
The following is clarification of the Security Certification information provided in QTSO Memo #2010-202, dated November 18, 2010: Providers need to install the most current cumulative security update for Internet Explorer. More information click here.
Important Updates Effective November 21, 2010 (TLS/Security Certificate Updates)
Effective November 21, 2010, the Transport Layer Security (TLS) 1.0 must be checked in your web browser in order to access QIES National Systems. This requirement applies to all parties that access QIES systems (MDS, OASIS, Swing Bed, IRF-PAI, etc.). This change must be made to connect after November 21, 2010. Click here to view the memo.
CMS Memo to State Agencies on Section Q On November 12, 2010 CMS issued a memo to State Medicaid Directors, Aging Directors, State LTC Ombudsman Programs, Money Follows the Person Project Directors, and others, which outlines key points in implementing MDS 3.0, Section Q - Return to the Community Referrals. The memo informs long term care, state personal about the purpose of Section Q and the expectations for state involvement. To view the memo click here.
Issue Alert: MDS 3.0 NH Provider and MDS 3.0 SB Provider Reports Temporarily Disabled
The reports in the MDS 3.0 NH Provider and MDS 3.0 SB Provider report categories in the CASPER Reporting application have been disabled. The disabling of these reports will assist in the research of the connectivity issues currently impacting the QIES systems. Click here to view this memo.
Issue Alert - QIES Systems Connectivity
The connectivity issues reported November 2, 2010 are ongoing at this time. We now have additional related information. Click here to view this report.
MDS 3.0 Website Help Document
This document contains consolidated information dealing with the various issues related to MDS 3.0 transmission, validation and error reports, RUG scores, and Section Q, where to report issues, information on common error messages and common technical issues, and survey concerns. Click here to view the document
CMS Survey and Certification Letter Timelines Extended For MDS 3.0 Submissions
Medicare/Medicaid certified LTC facilities. Since that date, an issue with the CMS MDS 3.0 ASAP system has been discovered, which causes record editing and validation report creation delays. In addition, it has been reported to CMS that there have been MDS 3.0 vendor software issues that have resulted in MDS transmission issues nationally. While CMS anticipates a resolution in the near future, the ability of LTC facilities to comply with one of the LTC requirements may be compromised. The Federal LTC requirement at §483.20(f)(3)-F287, requires LTC facilities to transmit MDS data within 14 days after completion. Due to the issues with the ASAP system, the time frames for submission of the assessment may not fall within the required transmission timelines. For the time period of October 1, 2010 through December 31, 2010, LTC surveyors will accept the ASAP system’s date stamp indicating the MDS file has been received as an indication of MDS 3.0 assessment transmission. To read the entire transmittal click here.
MDS Validation Reports
The MDS 3.0 Submitter Final Validation Report issue reported in QTSO Memo #2010-175 (dated October 26, 2010) has been partially resolved. Users can continue to submit report requests using a valid submission ID. Note: The submission ID must be associated with the user ID logged in to CASPER Reports at the time the report is requested. Users cannot submit this report if they did not submit the original MDS 3.0 file. Pending report requests submitted, including the date criteria, will be terminated. Click here to view the QTSO memo on this subject.
How To Access Validation Reports in CASPER
ACCESSING MDS 3.0 VALIDATION REPORTS: MDS 3.0 Validation Reports can be obtained in CASPER when you log in with your MDS INDIVIDUAL ID (The State assigned facility ID cannot retrieve Validation Reports).
1. You can find the automatically generated Validation Reports on the Folders page in the folder that ends with "VR". OR
2. You can open the Reports page and select the "MDS 3.0 Submitter's Final Validation Report or MDS 3.0 NH Final Validation Report" category and request a report using the Submission ID or Submission Date range.
Please see the MDS 3.0 Provider User's Guide found on QTSO.com at the bottom of the MDS 3.0 page www.qtso.com/mds30.html (click on link or copy and paste into your browser’s address bar). How to retrieve Validation Reports: MDS 3.0 Provider User's Guide, Section 4 – Reports. Validation Report errors: MDS 3.0 Provider User's Guide, Section 5 - Error Messages. The ASAP (MDS 3.0 Submission) system will not create or save the automatically generated Final Validation Report if certain errors are encountered during processing. When these errors occur, processing ceases. For a list of errors that cause file or record processing to cease, please refer to Section 5 - Error Messages, on pages 3 & 4 of the MDS 3.0 Provider User's Guide.
Section Q Lead Contact Agency (LCA) Information
When a resident expresses a wish to return to the community, and this triggers on MDS 3.0, Section Q, facilities must document that they have contacted the state’s designated LCA(s) and provided the LCA with information about that resident’s preference. California has not yet published a list of local LCAs. In the interim, when a “Section Q” return-to-community referral is necessary, facilities must contact: Therese Llanes, Chief of the DHCS Long-Term Care Section. By phone: (916) 558-1770(916) 558-1770 or via e-mail at: Sectionqpoc@dhcs.ca.gov
The postings that follow include an FAQ on the role and processes of lead contact agencies for California and outlines the protocols that LCAs will follow.
QTSO Memo on MDS 3.0 System Re-Start
According to CMS, the ASAP system issues have been resolved and the processing of the MDS 3.0 submission files were restarted late last week. CMS recommends that providers read and use the revised Final Validation Reports. Some key points include:
Click here for the CMS memo #2010-173 for information related to the system restart and the MDS 3.0 data reprocessing.
Update on CMS MDS 3.0 Validation Report Computer Glitch: To view the referenced memo click here.
MDS 3.0 Update Submission Now Resolved
IMPORTANT INFORMATION ON MDS 3.0 SECTION S
Until further notice from the State, every question on the CA Section S form must have a response to avoid rejection of an MDS. Any question left blank or with a dash filling is not allowed.
PLEASE ENTER THE FOLLOWING RESPONSES ON THE MDS 3.0 SECTION S
If resident does not have a POLST form, enter the following:
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S9040A
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0
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No
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S9040B
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9
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Not completed
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S9040C
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9
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Not completed
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S9040D
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9
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Not completed
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S9040E
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0
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No
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S9040F
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0
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No
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S9040G
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1
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Patient
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Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV).
The presentation reviewed key aspects of the new SNF PPS case mix system, RUG-IV, which will be put in place ON AN INTERIM BASIS effective October 1, 2010. CMS subject matter experts discussed coding procedures particularly related to the “look-back” for Extensive Services related triggers, and how facility staff should separately report individual, concurrent and group therapy time for RUG assignment. In addition, staff briefly discussed how changes to the ADL coding requirements impact the assignment of MDS 3.0 records to a RUG-IV group. To view the presentation click here.
CMS Train-The-Trainer Slides on Pre-Admission Screening and Resident Review (PASSR)
Click here to view the CMS train-the-trainer slides on MDS 3.0 changes related to PASSR completion. It is important to note that facility admission prior to a needed PASRR Level II is complete is a survey deficiency. Additionally, whenever a Significant Change in Status Assessment is triggered in a PASRR Level II NF resident, the facility must consider referral for a Resident Review (RR) and follow the State’s PASRR procedures for referral for Level II (RR).
National Association for Support of Long Term Care RUGS IV Model Presentation March 2010
These slides, presented by CMS representative Sheila Lambowitz, include information on the STRIVE data analysis used to support revised payment and coding processes within MDS 3.0. The slides also contrast RUG III payments for certain conditions with estimated RUG IV rates and discuss changes to therapy rates. To view the slide show presentation click here.
MDS TIMELINE
Publish final MDS 3.0 data specifications ( Including RUGs triggers). The QM/QI specifications will be released at a later date. CMS is still evaluating which quality measures may be revised. CMS remains hopeful that some of the QMs (to the extent possible) will be stated in a positive way instead of the negative statement of QM’s currently portrayed on Nursing Home Compare.
Publish MDS 3.0 data elements (includes admission, quarterly, swing bed and discharge MDS's)
Publish MDS 3.0 Resident Assessment Instrument User’s Manual. (Draft versions of the RAI manual emphasize falls prevention and quality of life and make increased references to ID Team planning as being key in the development of the resident care plan.) SEE NOTE ABOVE.
MDS SATELLITE BROADCASTS/WEBCASTS
CMS anticipates conducting three MDS 3.0 satellite webcasts in December 2009. In Spring 2010, webcasts detailing coding and assessment requirements. These webcasts will be available via the CMS MDS 3.0 website and will be recorded and archived. Further details on dates and times for the webcasts will also be posted to the same website. MDS 3.0 website: www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDDDS30.asp
MDS TRAIN THE TRAINER MATERIALS
Will be available on the Medicare Learning Network (MLN) (posting dates to be determined) but providers should watch that site for ongoing updates and materials. Medicare Learning Network: www.cms.hhs.gov/MLNGenInfo. In addition, MDS Web-Based training will be available on the MLN 24/7 and will include:
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Key terms relevant to each MDS clinical topic area
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Guide to conducting the assessment
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Coding instructions
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Coding practice (for selected sections)
As many key implementation dates and related information remain unknown at this time, CAHF recommends that facilities routinely check the CMS 3.0 website for ongoing updates on the RAI manual and dates for CMS information and training sessions. To view a September 2009 CMS PowerPoint update on MDS 3.0 implementation click here.