1. Assessments for the RAI: MDS for New Facilities, Changes in Ownership and Transfers Presented for the DOH by Catharine B. Petko, RN BSN Myers and Stauffer LC July 9, 2015

2. Updates MC PPS Proposed Rule for 10/1/15 –Minimal changes this year –ICD-10 implementation AIDS adjustment continues; B20 is ICD-10 code –New QM calculated from claims data: SNF 30-day All-Cause Readmission Measure –Payroll Based Journal: Report staffing and census data quarterly. 10/1/15 voluntary; 7/1/16 mandatory –http://www.gpo.gov/fdsys/pkg/FR-2015-04- 20/pdf/2015-08944.pdfhttp://www.gpo.gov/fdsys/pkg/FR-2015-04- 20/pdf/2015-08944.pdf

3. New Facility Complete all required MDS assessments just as if facility was certified (A0410 = 3) –Schedule determined based on resident’s date of admission –Medicare cannot be billed for any care provided prior to the certification date –If survey finds the facility in substantial compliance, the facility is certified as of the last day of the survey.

4. Residents and the MDS An Entry Tracker (A0310F = 01) and a Discharge assessment (A0310F = 10, 11 or 12) must be completed for every resident admitted to the facility An RAI (MDS, CAA Process and Utilization Guidelines) must be completed for any individual residing more than 14 days on a MC/MA certified unit (42 CFR 483.20)

5. Special Population Considerations Hospice Residents: –Assessed using the RAI, have a care plan and be provided with services required –Cooperation between hospice and LTC facility staff for care planning and care Short-term or Respite Residents –RAI completed if in facility more than 14 days –Facility must have a process in place to identify the resident’s needs and must initiate a plan of care to meet these needs on admission

6. Special Population Considerations Pediatric residents or residents with a psychiatric diagnosis –Certified facilities are required to complete an RAI for all residents who reside in the facility regardless of age or diagnosis Swing bed facility residents –In non-critical access hospitals, beds may be designated as hospital or SNF beds –For residents receiving Part A SNF level of care, facility must complete Entry Tracker, PPS assessments and Discharge records

7. Necessary Steps Obtain software in facility capable of editing MDS and submitting data Pass certification survey. Obtain CCN Account established in QIES ASAP system Password/connectivity letter sent Establish CMS/Network connection Establish Individual access/passwords Submit MDS records If MA, establish account in NFRP

8. Getting Connected – www.qtso.comwww.qtso.com

9. Provider User’s Guide https://www.qtso.com/mdstrain.html Chapter 3 – Functionality Chapter 4 – Reports Chapter 5 – Error Messages

10. Application for New Account

16. http://www.dhs.state.pa.us/provider/pro mise/enrollmentinformation/index.htm

17. MA Qualifications Licensed by PA DOH Complete enrollment as a provider DHS mails enrollment letter to the facility and to Myers and Stauffer –Usually mailed within 3-4 months of the date of the facility’s certification –Create account on the CMS MDS Data Collection System –M and S sends Password and Connectivity letter to facility – needed to set up individual user accounts

18. Nursing Facility Report Portal Participating in MA program –Download CMI Reports until correct version is created –Upload signed Certification Page https://cmi.panfsubmit.com

20. NFRP Accounts Facility Account –Set up by NFRP System Administrator for each MA facility –Username (Facility ID) and password to access the NFRP provided to NHA in certified mailing –NHA can establish individual user accounts –Username and password remain the same; should be kept securely by NHA

21. NFRP Accounts Individual User Accounts –NHA requests Individual User Accounts for up to 5 facility staff/corporate/consultant personnel responsible for CMI Reports –Each staff person must have own account –Username is user’s work e-mail address –Password established by user after temporary password received from NFRP –Must be changed every 60 days –May view/download CMI Reports and upload signed CMI Report Certification pages

22. Log-in Screen 6/14/201622

23. NHA Screen 6/14/201623

24. NHA File Selection Screen 6/14/201624

25. Individual User Screen 6/14/201625

26. Accessing CMI Reports 6/14/201626

27. Upload Certification Page 6/14/201627

28. Upload Certification Page 6/14/201628

29. Changing Passwords 6/14/201629

30. Changing Your Password 6/14/201630 1 2 3

31. Changing Your Password Requirements: –Must be at least 8 characters –Must not contain or resemble Username –Must contain at least one letter and one number –Must not contain dictionary words –Must contain both upper- and lower-case letters –Must contain at least one non-alphanumeric character –Must not match any of the previous 5 passwords 6/14/201631

32. Sign Out 6/14/201632

33. Adding Certified Beds Medicare procedure –Submit request/floor plans to the Department of Nursing Care Facilities MA procedure –Complete the Bed Request Application for the Division of Rate Setting and Auditing at http://www.dhs.state.pa.us/provider/doingbusinesswithdhs/longter mcarecasemixinformation/bedrequests/index.htm http://www.dhs.state.pa.us/provider/doingbusinesswithdhs/longter mcarecasemixinformation/bedrequests/index.htm –S0120 and S0123 ZIP Code and County of Prior Primary Residence may be reviewed –Will receive letter from M & S acknowledging bed size change –Monitor Occupancy calculations on CMI Report MC and MA residents should not be placed in a new bed until the bed is certified

34. Change of Ownership (CHOW 1) Assumes assets and liabilities of the previous owner –Beds remain certified –OBRA and PPS Assessment schedules for existing residents continue –User IDs stay the same –MA Number changes –National Provider Number (NPI) changes All other numbers remain the same If MDS Target Date is before CHOW, use old NPI If MDS Target Date is after CHOW, use new NP I –May continue submitting MDSs

35. Change of Ownership (CHOW 2) Does not assume assets and liabilities of previous owner –No links to prior provider including sanctions, deficiencies, resident assessments, QMs, debts, provider numbers, etc. –Beds no longer certified –All numbers will change including MA Number –Must apply for new user IDs

36. CHOW 2 and the MDS Process Previous owner discharges residents –DRNA (A0310F = 10) –Discharge date (A2000) and ARD (A2300) is date of ownership change –Discharge status (A2100) = 02 Another nursing home or swing bed

37. CHOW 2 and the MDS Process New owner admits residents –Entry tracking forms required (A0310F = 01) Entry Date (A1600) = date of ownership change Type of Entry (A1700) = 1 Admission Entered from (A1800) = 02 Another nursing home or swing bed Admission Date (A1900) = date of ownership change –Admission assessments (A0310A = 01) must be completed

38. MDS Submission If target date is before CHOW –Use old FACID, CCN, NPI, and old User IDs If target date is after CHOW –No data transmission until new CCN number is received and new User IDs are obtained –Use new FACID ID, CCN, NPI numbers with OBRA assessments Begin scheduling quarterlies as soon as Admission assessments completed

39. Resident Transfers Discharging facility –Provide necessary medical records including appropriate MDS assessments to assure continuity of resident care Admitting facility –Complete Admission and/or MC 5-day using information gained during look back periods –Use information accompanying resident to understand history and promote continuity of care

40. Emergency Transfers Should have Emergency Procedures well established and staff trained in processes –Stress resident safety –Have receiving facility identified –Save records as able http://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/index.htmlhttp://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/index.html

41. Emergency Transfers (2) If residents expected to return after natural disaster, e.g., flood, contact Region III office (Jonanna.Bryant@cms.hhs.gov) or 1-215-861-4140Jonanna.Bryant@cms.hhs.gov If residents will not return, complete DRNAs and Admission assessments as of the Admission Date to the receiving facility

42. Maintaining MDS Data Nursing homes must maintain all resident assessments completed within the previous 15 months in the resident’s active clinical record “Active record” –Easily retrievable by clinical staff, surveyors, CMS or others as authorized by law Electronic: Passwords; back-up system Hard copy: Supplemental notebooks must be readily available –Demographic information (A0500-A1600) from latest Admission assessment must be maintained in active record –After 15 months, may be thinned to medical records

43. Maintaining MDS Data If DRA and returns within 30 days. –New or continuing record must contain 15 months of MDS assessments 15-month rule applies even if CHOW has occurred If DRA and does not return within 30 days –Have facility policy as to whether to copy the previous RAI into new record

44. Electronic Signatures May be used for MDS in PA –Does not require that entire record be maintained electronically –Have written policies in place to ensure proper security May store any/all clinical records electronically whether or not electronic signatures are used –Must have hard copy of V0200B-C, X1100A-E and Z0400-Z0500 if no electronic signatures

45. Assessments for the RAI Homework –Review pages 2-15 and 2-16 which provide the details for completion and transmission of OBRA assessments –Pages 2-43, 2-44, 5-3 and 5-4 provide comparable information for PPS assessments –Page 2-81 identifies the Item Set Code required if you want to combine assessments –Extensive material in Chapter 2

46. Questions Next teleconference: October 8, 2015 qa-mds@pa.gov