1. At the Finish Line: The Race to the MDS 3.0 Marcie Stoup, RN, WCC, NHA Affinity Health Services, Inc.

2. Objectives To assess your facilitys readiness for the MDS 3.0 To embrace change and celebrate successes To plan for growing pains To evaluate and re-energize To anticipate future challenges Meet the Nine Day Challenge

3. The Race to the MDS 3.0 Do you know? Every section on the MDS 3.0 has changed? That it takes an average of 62 minutes to complete the MDS 3.0 There are 4 major resident interviews that are scripted? That CAA is a Care Area Assessment and they replace the RAPs? That the Nursing Home Comprehensive Item Set is 38 pages? That Restorative Nursing is very important financially? That RUG-IV has 66 groupers? That there is a new Discharge Assessment? That the Quality Indicators Measures will not be available? That the MDS 3.0 is the catalyst to Culture Change initiatives and that Culture Change is the future of Quality of Care and Quality of Life?

4. The Race to the MDS 3.0 Roadmap checklist Contact your MDS software vendor Perfect your ADL coding now; assess your documentation / tracking process / are you getting accurate information or losing money Assess your current pain management program by utilizing the MDS 3.0 RAI Manual section J and update / check policies and procedures / Pain scale used? Provide wound care training on staging and documentation; investigate who is staging and is it accurate? Utilize pressure ulcer best practices with updated staging guidelines that includes DTI

5. The Race to the MDS 3.0 Roadmap checklist Prepare for the change in your pressure ulcer statistical information when the stages will suddenly change back to a Stage 2,3 or 4 Prepare for the changes to the physician documentation of Diagnosis Status; active or inactive Maintain quality of care and quality of life by conducting staff, resident and family satisfaction surveys Meet with your therapists and make sure they have copies of Section O / changes in coding / practice changes

6. The Race to the MDS 3.0 Roadmap checklist Meet with your Medical Director and review the upcoming changes; keep them informed Meet and discuss the changes with all your physicians and inform them of changes they will have to make Practice interviews and ensure all team members receive training and also practice Practice Section B0700 for determining the interviewable Initiate care plans based on the information derived from those interviews

7. The Race to the MDS 3.0 Roadmap checklist Utilize the BIMS and begin to care plan based on the information obtained Determine in advance what documentation practices need updated, what tools to use such as tracker forms – be ready to go Education

8. THE NINE DAY COUNTDOWN Assess – Plan – Implement- Celebrate

9. Countdown Orchestrate the Change Select a TEAM if you havent done so NHA and DON must be an active part of the team Determine your immediate transition needs Delineate assignments Make it a written plan – so little time left Communicate daily Be willing to change Celebrate each success

10. Countdown Provide the Team with current MDS 3.0 training materials Obtain the most recent MDS 3.0 Training Materials from the CMS website CMS Home > Medicare > Nursing Home Quality Initiatives >MDS 3.0 Training Materials https://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30Traini ngMaterial.asp https://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30Traini ngMaterial.asp September 3 rd updates available Includes Instructor Guides, Training slides, RAI Chapters and Sections CMS new naming convention for the RAI manual. Updated sections and chapters will have version numbers / dates MDS 3.0 Chapter 4 V1.03 August 2010 changing with an update to V1.04, V1.05, etc

11. Countdown Maintaining Assessments - Federal Regulation RAI MDS 3.0 Manual, Chapter 2, page 2-5 Storage space is a critical issue to maintain all resident assessments completed within the previous 15 months in the residents active clinical record regardless of the form of storage, (electronic or hard copy) The 15-month period for maintaining assessment data may not restart with each readmission to the facility: Discharge return anticipated & returns within 30 days Discharge return not anticipated – facility policy Demographic information Items A0500-A1600 must be maintained in the clinical record

12. Countdown Electronic signatures permitted for the MDS RAI Manual MDS 3.0, Chapter 2, page 2-6 Use of electronic signatures for the MDS does not mean your entire medical record must be electronic Written policies to ensure proper security measures to protect the use of an E-signature Electronic MDS and no E-signatures hard copies of signed and dated CAAs (V0200B) correction completion (Items X1100A-E), and assessment completion items (Items Z0400 to Z0500) in the active record

13. Countdown Therapy Major reimbursement change in therapy coding Section O RAI Manual Chapter 3, Section O, O-12 through O-26 Therapy codes – individual, concurrent and group Individual – one therapist to one resident at a time Concurrent – two residents at same time / two different activities and both are in line sight of the therapist Group – 2 to 4 residents who may or may not be doing the same therapy activity Section T the predictor is gone Short stay = discharge by Day 8 has special RUG groupers SOT = start of therapy OMRA OMRA = stop of therapy OMRA = Start and stop of therapy OMRA

14. Countdown Resident Scripted Interviews Systematic / Privacy / Confidentiality Section C - Cognitive status BIMS RAI Manual Chapter 3, C-1 through C-15 Section D – Mood PHQ-9 RAI Manual Chapter 3, D-1 through D-9 Section F – Preferences for Customary Routine and Activities RAI Manual Chapter 3, F-1 through F - 13 Section J – Health Conditions (pain) RAI Manual Chapter 3, J-4 through J-14

15. Countdown Resident / Family Informational Meetings Share the actual resident interview questions Share the interview questions that families can participate in Share and discuss Section Q Return to the Community Do you want to talk to someone about the possibility of returning to the community

16. Countdown CMS Transition Plan for your Medicare Part A residents Transition is all about PPS – Medicare Part A stay Transition does NOT apply to OBRA Transition applies to SEPTEMBER AND OCTOBER – MDS 2.0 FOR SEPTEMBER AND MDS 3.0 FOR OCTOBER – For Part A stays beginning prior to Sept 30 th that continue into October Presumption of Coverage continues ARD payment schedules the same Default payment will remain in effect Has 52 upper RUG groups During the transition the ARDs are SET ! Grace days are NOT to be used until December

17. Countdown CMS Transition Plan for your Medicare Part A residents Providers must complete all OBRA required assessments according to OBRA schedule The transition does not apply – When payment ends 09-30-10 or sooner – SNF PPS payment for assessment ends 9-30-10 – When payment begins 10-01-10 or later – Medicare care stay begins 10-01-10 or later – SNF PPS payment for assessment begins 10-01-10

18. Countdown CMS Transition Plan for your Medicare Part A residents Default Option: When a residents Part A stay ends 10-1 to 10-4, you may opt for default payment by not completing the applicable MDS 3.0 PPS assessment (for the October payment days) Option #1 no substitution May opt to complete MDS 2.0 and MDS 3.0 same type, to cover a single payment period MDS 2.0 in Sept. and MDS 3.0 in Oct. All covered days will have a RUG Safest but may be the most time consuming If resident remains skilled after that payment period, you would then complete the next required MDS 3.0

19. Countdown CMS Transition Plan for your Medicare Part A residents Option #2 substitute the MDS 3.0 for MDS 3.0 Similar to #1 in that you would complete an MDS 2.0 Unlike #1 in that you do not complete the same-type of MDS 3.0 but you do the next one MDS 2.0 covers RUG-III in Sept. and MDS 3.0 covers applicable Oct. RUG-IV payment days RISKY – you are skipping a MDS 3.0 of the same

20. Countdown CMS Transition Plan for your Medicare Part A residents Option #3 substitute the MDS 3.0 for MDS 2.0 May opt to substitute MDS 3.0 for same type MDS 2.0 You will not complete an MDS 2.0 for payment that spans both Sept. and Oct. You are completing the required MDS 3.0 for that payment period The MDS 3.0 will generate RUG-III to pay for days in Sept. and a RUG-IV to pay for days in October If resident remains skilled – complete the subsequent MDS 3.0 to cover remaining Oct. days Carries the Risks of both Option #1 and #2

21. Countdown Return to the Community Section Q RAI Manual Chapter 3, Section Q-1 through Q-16 Resident asked directly about whether they would like to speak to someone about the possibility of returning to the community Yes response – Local Contact Agency SNF has 10 business days to make contact the LCA! 3 days by phone; and within 10 days for on-site visit if needed Provide timely information about their choices, services, etc Collaborate with the NF to organize the transition

22. October 1, 2010 Evaluate and Re-energize Follow-up to ensure that the new systems continue to operate correctly Be prepared for failures or setbacks in your systems and ensure the team jumps right back in and makes necessary revisions Ask line staff how involved they feel in the overall facility plan When possible use technology to communicate, to share documents and information with team members on other shifts or days Identify all the successes – BIG and small Celebrate

23. Future Challenges I-Centered Care Plans Learning curve – CATs, CAAs and Care planning Best practices and industry standards Survey Process Pre QI-QM resident selection Survey outcomes Quality Indicators – Quality Measures Risk Identification High level data / benchmark Reimbursement – Medicare and Medicaid RUG-IV learning curve Hybrid RUG-IV challenges PA Case Mix new challenges

24. Future Challenges Continuous education Changes Additional education Staff retention and training needs

25. Affinity Health Services, Inc. Senior Community Management and Consulting Services Indiana, PA Toll Free (877) 311-0110 mstoup@affinityhealthservices.netmstoup@affinityhealthservices.net

27. Due to the frequent and subsequent changes to the RAI MDS 3.0 manual and regular CMS updates, the information contained in this presentation should only be considered current as of the date of the presentation. Each participant is responsible for the most current information from CMS. 09.22.10