1. Division of National Systems Operationalizing Data Submission for ACA Section 3004 Stacy Mandl, RN Division of National Systems

2. 2 Who Are We? The Division of National Systems is located within the Data and Systems Group (DSG). DSG is located within the Center for Medicaid and CHIP (Children’s Health Insurance Program) Services (CMCS) at CMS.

3. What Do We Do? Support CMS’ fulfillment of statutory quality assurance responsibilities under the Social Security Act. Support major initiatives, such as Home Health Compare and Nursing Home Compare. Develop, evaluate and implement data systems. Support operations related to the submission of the data collected for CMS using specified assessment tools, e.g., the IRF-PAI. 3

4. What Do We Do? 2 Maintain and collect quality data on certified providers /suppliers, e.g. Home Health Agencies. Support Survey & Certification efforts, e.g. Skilled Nursing Facilities. Provide data system operations for data that is used to improve the quality and effectiveness of services provided by Medicare/ Medicaid/ CLIA. 4

5. What Do We Do? 3 DNS supports the submission of data files to CMS systems: –Quality Improvement and Evaluation System (QIES) –Part of QIES is the Assessment Submission and Processing (ASAP) System which will be used to collect LTCH submission. This data is stored in the QIES National Database. 5

6. QIES… What Is QIES? Quality Improvement and Evaluation System (QIES) serves as the focal point for resident and patient assessments, quality indicators, survey and certification, complaint, and enforcement information concerning providers and suppliers. Using QIES we maintain and collect quality data on certified providers/suppliers. 6

7. QIES QIES permits information to be shared quickly and conveniently between federal and state governments. QIES users total over 100,000. Contains data on 17 different types of providers/ suppliers totaling over 291,100 active facilities (as of 2/2011). 7

8. 8 QIES: The Data QIES already provides data submission for all Certified Inpatient Rehabilitation Facilities, Home Health Agencies, Skilled Nursing Facilities/ Nursing Facilities, and Swing Bed units. Beginning October 1, 2012, QIES will also provide for data submission for all certified LTCHs as well.

9. Data Assessment Tools Assessment Data instruments currently submitted by specific provider types are: o Inpatient Rehabilitation Facility Patient Assessment Instrument, IRF-PAI o Minimum Data Set, MDS 3.0 o Outcome and Assessment Information Set, OASIS-C o Newest: LTCH CARE Data Set Provide free software for all of these settings o jRAVEN, IRVEN, HAVEN, LASER 9

10. Assessment Data Uses and Users Depending on the provider type, this data is used for purposes such as payment, fraud investigation, quality measurement, and survey and certification purposes, care planning, public reporting, and research. Enables CMS to monitor and report on the quality and effectiveness and services provided to beneficiaries. 10

11. Data Uses Enables consumers to make educated choices about providers (e.g., Nursing Home Compare). Enables quality improvement within providers. Users include providers, CMS CO, State and Regional Survey and Certification, OIG, Ombudsmen, researchers, and others. 11

12. Our Partners We serve as liaison between policy staff and developers State Survey Agencies Regional Offices CMS Stakeholders (e.g., Office of Clinical Standards and Quality, Survey & Certification, Centers for Medicare, Office of Information Systems) Providers/ Suppliers 12

13. Our Partners Quality Improvements Organizations Fiscal Intermediaries/ Medicare Administrative Contractors Regional Home Health Intermediaries Accrediting Organizations Vendors Corporations and Researchers Other Federal Agencies 13

14. Provider Stakeholders QIES supports data for over 291,100 providers/suppliers –Hospitals, e.g. acute, LTCHs, IRFs, CAHs, etc.: 6,179 –Skilled Nursing Facility (SNF): 15,104 –Nursing Facility (NF): 609 –ICF/MR: 6,430 –Home Health Agency (HHA): 11,556 –Hospice: 3,522 –Outpatient Physical Therapy (OPT): 2,513 –Comprehensive Outpatient Rehabilitation Facility –(CORF): 339 –X-Ray: 564 14

15. …And… –End-Stage Renal Dialysis Facility (ESRD): 5,653 –Rural Health Clinics (RHC): 3,875 –Ambulatory Surgical Centers (ASC): 5,324 –Organ Procurement Organization (OPO): 58 –Community Mental Health Centers (CMHC): 641 –Federally Qualified Health Centers (FQHC): 4,819 –Psychiatric Residential Treatment Facilities (PRTF): 366 –Clinical Laboratory Improvement Amendments (CLIA): 223,625 15

16. Submissions We will now hear more about the QIES data submissions process as it relates to your data submission. 16