DQA
Quarterly Information Update
February
2006
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Rhinelander Office Move
As of January 12th, 2006, BQA staff in the Northern Regional Office
(Rhinelander) have moved to a new address:
Bureau of Quality Assurance
2187 Stevens Street, Suite #C
Rhinelander, WI 54501-8036
This information has been updated on the appropriate Internet pages.
Phone numbers will remain the same.
As always, if you need up-to-date contact information for any BQA
office, please visit http://DHS.wisconsin.gov/rl_DSL/, select the
appropriate provider type, and then "Contacts."
BQA Personnel Changes
The Bureau has experienced a number of changes in its field supervisory
staff in recent months. In Milwaukee Regional Field Operations Director (RFOD)
Pat Benesh has been replaced by Katherine (Kitty) Friend, who had served
as a Regional Field Operations Supervisor (RFOS) for some years before
taking leave from state service. Pat is now working in BQA's Provider
Regulation and Quality Improvement section as BQA's Rules and Regulations
Coordinator.
After helping out in Milwaukee, Paul Peshek has now taken up his
permanent appointment as RFOD in the Southern Regional Office based in
Madison.
Dolores Zwiers returns to BQA as an RFOS in Green Bay, while Connie
Kuczmarski has been moved from Green Bay to a new RFOS position created in
Rhinelander.
Save the Date for FOCUS 2006 Conference
Plan now to attend BQA's 6th Annual Focus 2006 Conference for providers
and Bureau of Quality Assurance staff on August 30, 2006. The emphasis of
the conference sessions will be on culture change and person-directed
care. This year's conference will feature opening remarks by Helene
Nelson, DHS Secretary, and keynote speaker, Steve Shields, Chief
Executive Officer (CEO) and architect of long term care culture change at
Meadowlark Hills.
There will also be a pre-conference session on August 29. Holly Ramsey-Klawsnick
and Pam Teaster, nationally recognized researchers and trainers on elder
abuse, will present data gathered on incidents of elder sexual abuse
occurring in Wisconsin facilities. They will provide promising practice
recommendations, and will detail the skills staff need to ensure a
victim's physical and emotional safety. Attendees will come away with an
increased awareness of how to sensitively and appropriately handle any
report of sexual assault.
This conference will be beneficial to staff from assisted living
facilities, nursing homes, facilities serving people with developmental
disabilities, adult day services, and Bureau of Quality Assurance staff.
The Conference and pre-conference events will be held in Appleton, WI,
at the Radisson Paper Valley Conference Center.
Additional information will be provided on the BQA Internet Training
Information site at http://DHS.wisconsin.gov/rl_DSL/Training/index.htm
and in upcoming BQA Quarterly Updates. A complete conference brochure will
be mailed out in late May or early June 2006.
Reminder to All Nurse Aides
The Wisconsin Nurse Aide Registry must be kept informed of nurse aides'
current addresses and name changes. Staff should notify the Registry by
completing a Change or Correction form. This form is available on the
internet at www.promissor.com, or call the Registry at 1-877-329-8760.
If you or your staff have questions regarding their registry
information, you may call or write the Wisconsin Nurse Aide Registry at:
Promissor
Wisconsin Nurse Aide Registry
P.O. Box 13785
Philadelphia, PA 19101-3785
1-877-329-8760
CMS Internet Site Address Changes
The Centers for Medicare and Medicaid Services (CMS) have once again
updated their Internet site at www.cms.hhs.gov, changing many addresses in
the process. A number of sites that used to be available are not
accessible at this time. We have updated as many links as possible on our
Internet pages, but others have had to be removed. We will continue to
check the CMS site on a regular basis and will update our pages when links
become operable again or are replaced by more appropriate material.
Centers for Medicaid and Medicare Services (CMS) Webcasts
In 2005, CMS produced several webcasts on a variety of topics. If you
are interested in viewing any of them, you may access them at http://cms.internetstreaming.com.
Webcasts are available at this website for one year after the initial
release date.
| Date |
Title of Webcast |
|
3-18-05 |
Making Sense of Data |
|
4-29-05 |
Facilitating Communication in Individuals with Neurological
Disease |
|
7-22-05 |
Delivery of Care to a Diverse Population |
|
7-29-05 |
Hospice/End of Life Issues |
|
8-12-05 |
Hospitalization and Death |
|
9-8-05 |
Nursing Home Immunization |
|
9-23-05 |
Reducing the Use of Seclusion and Restraints in Psychiatric
Facilities |
|
10-21-05 |
2005 Survey & Certification's LTC Policy Year in Review |
|
11-4-05 |
Medicare Part D Impact on Nursing Home Surveys |
|
12-9-05 |
Medical Aspects of Neglect |
Redesigned National Provider Identifier (NPI) Page on CMS Website
The Centers for Medicare and Medicaid Services (CMS) recently announced
the redesigned web page (www.cms.hhs.gov/NationalProvIdentStand/)
dedicated to providing all the latest NPI news for health care providers.
This page also contains a section for Medicare Fee-For-Service (FFS)
providers with helpful information on the Medicare NPI implementation. A
new fact sheet with answers to questions that health care providers may
have regarding the NPI is now available on the web page. Bookmark this
page, as new information and resources will continue to be posted.
For more information on private industry NPI outreach, visit the
Workgroup for Electronic Data Interchange (WEDI) NPI Outreach Initiative
website at www.wedi.org/npioi/index.shtml.
BQA Numbered Memos November 2005 - January 2006
| Memo |
Title |
Providers Affected |
|
05-014 |
Wisconsin Coalition for Person-Directed Care |
Nursing Homes |
|
05-015 |
Names Removed from Wisconsin Nurse Aide Registry
[memo replaced by new site 08/06] |
Adult Family
Homes, Certified Mental Health and AODA Treatment Programs, Community
Based Residential Facilities, Facilities Serving People with Developmental
Disabilities, Home Health Agencies, Hospices, Hospitals, Nurse Aide
Training Programs, Nursing Homes, Residential Care Apartment Complexes,
Rural Health Clinics |
|
05-016 |
ICFs/MR Updates |
Facilities Serving People with Developmental
Disabilities |
|
06-001 |
Written Policies and Safety Precautions for Entities that Transport
Clients, Residents or Patients Outside the Facility |
Adult Day Care, Adult
Family Homes, Ambulatory Surgery Centers, Certified Mental Health and AODA
Treatment Programs, Community Based Residential Facilities, End Stage
Renal Dialysis, Facilities Serving People with Developmental Disabilities,
Home Health Agencies, Hospices, Hospitals, Nurse Aide Training Programs,
Nursing Homes, Residential Care Apartment Complexes |
|
Upcoming Memos: |
|
"Sharing of Toilet Facilities Between Sexes" (nursing homes) |
|
"Variance of Chapter 124, WI Administrative Code: Authentication of
Physician Orders" (hospitals) |
|
"Life Safety Information Release (citing policies for
engineers)" |
Access these memos via http://DHS.wisconsin.gov/rl_DSL/Publications/
BQAnodMems.htm,
or from individual providers' publications pages via http://DHS.wisconsin.gov/rl_DSL/.
The following BQA memo has been made obsolete:
04-010, "Bureau Personnel Changes & Communication with
Bureau Senior Management"
Governor's Health Care Facilities Stakeholder Summit
On January 18, 2006, the Governor's Health Care Facilities Stakeholder
Summit was held at Mendota Mental Health Institute. Topics covered
included emergency management, pandemic influenza, hospital preparedness,
mass evacuation planning, and identification of current gaps and needs in
emergency planning. Presenters included state officials responsible for
disaster planning from the Division of Public Health and Wisconsin
Emergency Management, among others.
Assisted Living Section Announces New Procedure for Determining
Financial Stability and Fit/Qualified Status of Licensees
On January 1, 2006, the Assisted Living Section implemented a new
procedure for determining if license applicants and licensees are fit and
qualified and exhibit financial stability. This procedure will be used for
all applicants for initial community based residential facility (CBRF) and
adult family home (AFH) licensure, and may also be applied to existing
CBRF and AFH licensees.
The Assisted Living Section developed this procedure to address growing
concerns about providers who do not meet existing fit and qualified
criteria, and/or do not exhibit sound financial stability. It is the goal
of the Assisted Living Section to ensure that providers are better
prepared to sustain a successful business, deliver quality services, and
provide a stable, secure home with sufficient resources to meet the needs
of vulnerable adults.
Information and requirements related to the new procedure have been
included on the Department's website. Questions related to the
implementation of this new procedure should be directed to the appropriate
Assisted Living Section regional office.
Assisted Living Survey Guide Resource List on the Web
The Assisted Living Section is pleased to announce the Assisted Living
Survey Guide Resources List is now available online. The Resource List,
which was previously handed out by surveyors, contains a list of useful
Internet websites, including Department of Health and Family Services
websites. The list is available from Providers pages via http://DHS.wisconsin.gov./rl_DSL,
or can be accessed directly via http://DHS.wisconsin.gov/rl_DSL/Providers/resources.htm.
Emergency/Involuntary Discharge
Within the past several years the Bureau has noted an increase in the
number of emergency/ involuntary discharges involving assisted living
consumers. This increase in discharges highlights the need for facilities
to complete thorough assessments at the time of admission to ensure proper
placement, and thorough reassessments to determine appropriate program
services to meet their on-going needs. The failure to do so, may adversely
affect the quality of life for the consumer, as well as others living in
the facility. Please review the following Community Based Residential
Facility (CBRF), Adult Family Home (AFH), and Residential Care Apartment
Complexes (RCAC) administrative codes regarding emergency/involuntary
discharges:
Community Based Residential Facility (CBRF)
HFS 83.04(23) Emergency discharge means the release of a resident from
a facility without a 30-day notice, because of the resident's
unanticipated hospitalization or a situation that creates an imminent risk
of serious harm to the health or safety of the resident, other residents
or to staff members.
HFS 83.20 (1)(b) A resident temporarily transferred to a hospital or
nursing home for treatment not available from the CBRF shall not be
involuntary discharged from the CBRF when the resident's absence is for 21
days or less.
HFS 83.20(2)(b) Initiated by a CBRF. 1. The following applies to both
involuntary discharges and emergency discharge. …the licensee shall
provide to the resident or the resident's guardian, designated
representative, or agent an explanation of the need for, or possible
alternatives to, the transfer or discharge, and shall provide assistance
in relocating the resident. A living arrangement suitable to meet the
needs of a resident shall be located prior to the transfer of the
resident.
HFS 83.20(2)(d) Department Review of Discharge or Transfer. A resident
or his or her guardian, agent, or designated representative may request
the department to review an involuntary discharge or transfer decision.
Every notice of discharge or transfer under par. (b) to a resident or the
resident's guardian, agent or designated representative shall be in
writing and include all of the following: 1-5 (appeals and department
review procedure).
Adult Family Home (AFH)
HFS 88.08 A licensee may terminate a resident's placement only after
giving the resident, the resident's guardian, if any, the resident's
service coordinator, the placing agency, if any, and the designated
representative, if any, 30 days written notice. Termination of a placement
shall be consistent with the service agreement under s. HFS 88.06 (2)(c)7.
The 30-day notice is not required for an emergency termination necessary
to prevent harm to the resident or other household members.
Residential Care Apartment Complex (RCAC)
HFS 89.29(3)(c)1b. Notice of termination shall include the ground for
termination and information about how to file a grievance consistent with
the termination and grievance policies and procedures contained in the
service agreement.
HFS 89.29(3)(c)2 No 30-day notice is required in an emergency. In this
subdivision, emergency means an immediate and documented threat to the
health or safety of the tenant or of others in the facility.
If the facility determines after a thorough assessment that the
discharge of a consumer is appropriate, the facility needs to provide
sufficient preparation and orientation to the consumer to ensure a
successful discharge. It is the responsibility of the facility to work
with the consumer, the consumer's placing agency, if any, the designated
representative, if any, and the receiving facility to ensure the
consumer's move is a success. Having a consumer admitted to a hospital as
a means to discharge a consumer from an assisted living facility is not
appropriate.
Hospitals regulations require any person seeking emergency medical
treatment to receive an initial medical screening. If this medical screen
does not reveal that an emergency medical condition exists, the hospital
is only then required to stabilize, treat, or transfer the patient. There
are no hospital regulations requiring inpatient admission if that level of
service is not determined necessary by medical professionals.
Revisions to the RAI Manual 2.0
The November and December 2005 Revisions to the RAI Manual 2.0 are now
available on the CMS MDS 2.0 website. Updates can be viewed and downloaded
at http://cms.hhs.gov/quality/mds20
(alternate address www.cms.hhs.gov/
nursinghomequalityinits/20_nhqimds20.asp?). The revisions contain many
changes associated with the transition from the 44 RUG-III Groups to the
53 RUG-III Group Version 5.2, as well as a new website address.
MDS QI/QM Reports in CASPER
The data on the MDS QI/QM reports in CASPER is calculated on a weekly
basis to add MDS assessment records that were submitted by nursing homes
the previous week. The calculations are performed early every Monday
morning. Keep in mind that MDS submissions received by the State MDS
System one week are not reflected in the MDS QI/QM reports until the
following week.
CMS added a new feature in CASPER to allow multiple PDF reports to be
combined into one PDF report that can be printed. The new Merge PDFs
button is located in the Folders tab of CASPER. A user would select the
completed PDF reports that they would like combined by using their mouse
to click on the boxes under the Select column in the Folders tab. The user
would then click on the new Merge PDFs button in the lower right-hand
corner of the screen. Adobe software will open all of the PDF reports that
were selected, and these reports will be merged into one file that can
then be viewed and printed. This new feature is especially beneficial in
allowing the user to combine several QI/QM reports into one print file
instead of having to print each QI/QM report separately. Note that these
reports will remain as separate files in the Folders tab of CASPER.
Hospice Medicare Conditions of Participation
On November 22, 2005, CMS released the final rule on Subparts B, F, and
G of the Medicare Hospice Conditions of Participation. These are sections
of the Conditions of Participation proposed for change in November of
2002.
Subpart B is specific to hospice admission criteria, certification of
terminal illness, revocation and discharge. Subpart F references covered
services, and subpart G references payment for hospice care. The majority
of these newly released regulations were updates from those changes in the
law by the Balanced Budget Act of 1997 (BBA '97), the Medicare, Medicaid,
and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), and the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).
The final rule goes into effect on January 23, 2006.
You may access this rule at http://a257.g.akamaitech.net/7/257/2422/01jan20051800/
edocket.access.gpo.gov/2005/pdf/05-23078.pdf .
NOTE: These regulations are NOT the proposed Hospice Conditions of
Participation published in May of 2005. Release of the final Hospice
Conditions of Participation, Subparts C and D is not expected until spring
of 2008.
Latest CMS Survey & Certification Letters
Below is a list of selected Survey and Certification (S&C) Letters
distributed by CMS during the last quarter. Titles pertaining only to
state agency operations are omitted. If you have questions about
individual letters, contact Susan Hespen of BQA at (608) 266-0582, or
e-mail hespesj@DHS.state.wi.us.
Please note that the CMS Internet site for all S&C letters has been
changed to www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/list.asp.
| Title |
Number |
Date |
|
Nursing Home Immunization Requirement |
06-03 |
11/14/05 |
|
Location and Relocation of Critical Access Hospitals (CAHs) and Relocation
of Necessary Provider CAHs |
06-04 |
11/14/05 |
|
Use of Foreign Acquired Drugs in Long-Term Care Facilities |
06-06 |
11/14/05 |
58 Critical Access Hospitals (CAHs) in Wisconsin
A program created by Congress in the Balanced Budget Act of 1997 (BBA)
established a new provider type (Critical Access Hospital or CAH) that
gave rural hospitals the opportunity to operate under reduced federal
hospital regulations, and to receive cost-based reimbursement while
downsizing to a maximum of 15 acute care beds, with an optional 10
additional swing beds. Wisconsin certified the first CAH in October 1999;
as of January 1, 2006, 57 additional hospitals located throughout rural
Wisconsin have transitioned to certified CAH status. The CAH program has
been responsible for saving some rural hospitals threatened by financial
difficulty and for preserving health care for rural Wisconsin citizens.
The Department of Health and Family Services, Bureau of Quality
Assurance staff partnered with the Wisconsin Office of Rural Health staff
to implement the CAH program in the state. They organized a CAH coalition
to develop a Wisconsin Rural Health Plan, including protocol for CAH
eligibility. This plan specified the criteria used to determine
"necessary provider designation." A necessary provider
designation permits a waiver of a federal CAH statutory requirement that a
CAH be located 35 miles from another hospital or CAH. Fifty-five of the 58
CAHs in Wisconsin have necessary provider designation. Bureau staff worked
at a fast pace with the CAH application and approval process while
implementing numerous federal regulatory enhancements of the program.
Currently, CAH regulations permit up to a maximum of 25 beds, plus
optional prospective payment system-excluded distinct part units of 10
beds each for rehabilitation and psychiatric services. The state's
authority to issue necessary provider designation has been eliminated as
of December 31, 2005. Refer to S&C 06-04 for current CMS CAH location
information and the methodology to be used by CMS regional offices for
determination of continued CAH certification with any proposed relocation.
The Internet address is a zipped file at www.cms.hhs.gov/SurveyCertificationGenInfo/
downloads/SCLetter06-04.zip , containing two Word documents and a PDF
file. Follow the instructions to open or save the files, then you will
find them loaded onto your computer's temporary or permanent drives, as
you select.
Administrative Rules Update
HFS 83 - "Community Based Residential Facilities"
The HFS 83 re-write workgroup has finalized the draft of the proposed
rules for Chapter 83. The goal of the workgroup is to eliminate
excessively prescriptive language and improve readability and
organization. The proposed rule clarifies medication administration
requirements and revises staff training standards, establishing a more
cost effective system for providers. The Rule Summary and draft rule are
currently under review with the DHS Office of Legal Council. For more
information, you may view the Statement of Scope of proposed rules on the
Wisconsin Administrative Rules web-site at http://adminrules.wisconsin.gov.
HFS 124 - "Hospitals"
The Wisconsin Administrative Register published a Statement of Scope of
proposed rules to amend Chapter 124 on April 1, 2005. The Department is
planning to update Chapter 124 to eliminate overly prescriptive
regulations, clarify the Department's enforcement authority, and make the
rule more consistent with the federal Medicare requirements. For more
information, you may view the Statement of Scope on the Wisconsin
Administrative Rules web-site at http://adminrules.wisconsin.gov.
HFS 132 - "Nursing Homes"
BQA convened an internal workgroup to update HFS 132 to reflect
standards of care and practice, and to eliminate duplicative state
regulations that are already in Wisconsin Statutes, Chapter 50, and the
federal nursing home regulations. The intent is to streamline the code by
eliminating regulations that provide unnecessary specificity and adopt the
applicable federal regulatory language. The proposed rule changes are
currently under review by interested stakeholders. For more information,
you may view the Statement of Scope on the Wisconsin Administrative Rules
web-site at http://adminrules.wisconsin.gov.
HFS 133 - "Home Health Agencies"
The HFS 133 re-write workgroup continue to work with the advisory
committee, consisting of providers, consumers, and association
representatives, to develop proposed rules to amend HFS 133. The goal of
the committee is to amend the rule to make the requirements more
consistent with federal regulations and to reflect current terminology. A
final draft of the proposed rule for submission to DHS Office of Legal
Council for review is anticipated by February 2005. For more information,
you may view the Statement of Scope on the Wisconsin Administrative Rules
web-site at http://adminrules.wisconsin.gov.
HFS 148 - "Cancer Drug Repository Program"
The Wisconsin Register published a Statement of Scope of proposed rules
to amend HFS 148 to include prescription drugs and supplies for chronic
disease in addition to cancer drugs. Comments are being solicited from
current participating facilities and members of the original advisory
committee. We anticipate public hearings will be held the first week of
April. For additional information, you may view the Statement of Scope of
proposed rules on the Wisconsin Administrative Rules web-site at http://adminrules.wisconsin.gov.
For additional information, you may view the BQA Cancer Drug Repository
website at http://DHS.wisconsin.gov/bqaconsumer/
cancerdrugreposy.htm.
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Last Revised: July 28, 2008 |
