DQA
Quarterly Information Update
July 2003
[PDF
Version of this month's Quarterly Update (PDF, 87
KB) - blue text indicates links
to other sections or to Internet pages]
Provider Directories on the Internet
We are pleased to announce the Internet posting of directories for
Wisconsin nursing homes, facilities for people with developmental
disabilities, home health and hospice agencies. As with the directories
for assisted living facilities, these are provided in PDF and Excel
format. The PDF documents are further provided in various sort orders (by
facility name or by county/city) to aid viewers in locating individual
providers.
All of the information for these directories comes from databases
maintained by BQA staff. Most directories will be updated quarterly,
although some of the assisted living directories are done monthly due to
higher rates of changes.
We plan to post other provider types, such as hospitals, over the rest
of the summer. We are taking the opportunity to go through and update
individual records. We appreciate the efforts providers make to inform us
of staff and office changes.
If you have any questions about the directories, please contact Todd
McCall by phone (608) 267-3808 or E-mail mccaltw@dhfs.state.wi.us.
Licensed Wisconsin Nursing Homes: www.dhfs.state.wi.us/bqaconsumer/NursingHomes/NHindex.htm
Licensed Facilities for People with Developmental Disabilities: www.dhfs.state.wi.us/bqaconsumer/FDDs/FDDindex.htm
Wisconsin Health Care Providers (home health and hospice): www.dhfs.state.wi.us/bqaconsumer/HealthCare/directories.htm
Assisted Living Facilities (adult day care, adult family homes, CBRFs
and Residential Care Apartment Complexes): www.dhfs.state.wi.us/bqaconsumer/AssistedLiving/AsLivPrvdr.htm
DHFS Web Site Changes
The Department of Health and Family Services (DHFS) is completing a
series of changes designed to make its website www.dhfs.state.wi.us
more accessible and easier to use. One of the additions is a Topics A-Z
listing designed to make it easier to find web pages. There is also a
Telephone Hotline directory and a database-driven Directory of Department
Services. For the latter, you can type in and submit the program name,
term or phrase you are interested in and if there is a match, a staff
name, phone number and E-mail address will be returned.
The DHFS Licensing page will soon be converted from its current
structure to function as an introduction to the wisconsin.gov
(exit DHFS) licensing information site with a focus on DHFS programs. Viewers seeking
information on becoming licensed, certified, registered or authorized to
operate BQA-regulated programs will be able to find the necessary web
pages more easily. The Wisconsin Licensing pages contain links to the
appropriate DHFS information pages. We suggest that all providers check
out wisconsin.gov
(exit DHFS) if they haven’t done so already.
BQA Numbered Memos Posted April-June 2003
Access all BQA memos via www.dhfs.state.wi.us/rl_DSL/Publications/
BQAnodMems.htm
or from individual providers' publications pages via www.dhfs.state.wi.us/licensing.htm.
|
Memo |
Title |
Providers Affected |
|
03-006 |
CMS Adopts Life Safety Code |
Ambulatory Surgical Centers, End Stage Renal Dialysis, Facilities
for People with Developmental Disabilities, Hospices, Hospitals,
Nursing Homes |
|
03-008 |
For All Facilities Performing Tests on Human Specimens: CLIA
Requirements |
Adult Family Homes, Adult Day Care, Ambulatory Surgical Centers,
Certified Mental Health & AODA Programs, Community Based
Residential Facilities, End Stage Renal Dialysis, Facilities for
People with Developmental Disabilities, Home Health Agencies,
Hospices, Hospitals, Laboratories, Nursing Homes, Outpatient
Rehabilitation Agencies, Residential Care Apartment Complexes, Rural
Health Clinics |
|
03-009 |
Medication Setup in Assisted Living
[Replaced by 04-006 03/04] |
Adult Day Care, Adult Family Homes, Community Based Residential
Facilities, Residential Care Apartment Complexes |
|
03-010 |
Hospital Responsibility and Physician Practice |
Hospitals |
|
03-011 |
Wisconsin Nurse Aide Registry and Competency Testing Services
Update |
Facilities for People with Developmental Disabilities, Home
Health Agencies, Hospices, Hospitals, Nurse Aide Training Programs,
Nursing Homes |
Upcoming Seminar/Training Opportunities
Brochures on upcoming training will be mailed to providers and posted
on the Internet. Check the Provider or What's Happening sections for
individual health care providers on the DHFS Website www.dhfs.state.wi.us
via the Licensing pages. For registration questions, contact the Bureau of
Quality Assurance Training Coordinator at (608) 267-1438.
|
Program(s) |
Locations and Dates |
|
Interpreting and Using the New 3-Bar OBQI Reports
|
Late Summer/Early Fall 2003 (tentative)
|
|
Resident Assessment Instrument
(RAI 2.0)-Minimum Data Set (MDS)
Basics [PDF]
|
October 23, 2003 – Eau Claire, Park Inn
|
|
Beyond Resident Assessment Instrument
(RAI) Basics - Assessment
and Care Planning
|
October 30, 2003 – Eau Claire, Park Inn
November 12, 2003 – Madison, Radisson |
|
The Power of Information – Using the Resident Assessment
Instrument to Improve the Quality of Nutrition and Hydration* |
November 4, 2003 – Tomah, Holiday Inn
November 20, 2003 – Fond du Lac, Holiday Inn
|
|
*This program is planned for nutrition/dietetic
professionals and others who conduct nutritional assessments,
develop plans of care and evaluated nutritional outcomes for nursing
home residents. This program will focus on using the Resident
Assessment Instrument (RAI) in conducting nutritional assessments by
reviewing the RAI process and related regulatory requirements,
accurately coding the MDS, and using the assessment information in
developing plans of care. |
|
Home Health 101 – Regulatory Update (State & federal
rules/regulations governing home health) – Changes in Conditions
of Participation
|
Fall 2003 |
Reminder: Revised Long Term Care Resident Assessment Instrument
Manuals Version 2.0 are available through the Bureau of
Quality Assurance. Ordering information is available on the DHFS Internet
site at www.dhfs.state.wi.us/rl_DSL/NHs/NHpubOrdr.htm [Sorry, no longer
selling, see BQA Update July 2004].
CMS Clarification of New Fire Safety Requirements - 2000 Life Safety
Code
The Centers for Medicare and Medicaid Services (CMS) has issued a
Survey & Certification letter 03-21 providing clarification in
response to additional concerns raised regarding the new requirements. You
may view the letter online at www.cms.gov/medicaid/survey-cert/sc0321.pdf
(exit DHFS; PDF).
This is in addition to BQA memo 03-006 at www.dhfs.state.wi.us/rl_DSL/
Publications/03-006.htm
and the Federal rule posted to www.dhfs.state.wi.us/rl_DSL/
Publications/FireSafety.pdf (PDF, 96 KB).
Nation-Wide Sprinkler Recall
The U.S. Consumer Product Safety Commission (CPSC) has announced a
nationwide recall of approximately 60,000 Star ME-1 brand dry sprinklers
manufactured by Chemetron Corporation. For details, see www.cpsc.gov/cpscpub/prerel/prhtml03/03116.html
(exit DHFS).
Resident Room Smoke Detection Question/Answers:
Q: If a resident room is sprinkler protected, will a smoke
detector still be required to address the upholstered furniture
requirement 19.7.5.2 found in the 2000 Life Safety Code?
A: The additional smoke detector requirement only applies to
resident rooms without sprinklers that contain resident
owned furniture.
Q: If a resident’s room is not sprinkler protected, and
the resident introduces upholstered furniture, is a battery-operated smoke
detector allowed?
A: Yes. CMS response: A battery operated smoke detector, purchased,
installed, and maintained by the facility, would be acceptable to comply
with the requirements of 19.7.5.2 and 19.7.5.3 of the 2000 Life Safety
Code (per James Merrill, Life Safety Code Specialist CMS, Baltimore, MD).
Administrative Rules Update
HFS 124 – "Hospitals"
The Department is proposing to modify provisions in Subchapter VI,
"Critical Access Hospitals" in HFS 124. An emergency order
became effective on March 21, 2003. The Department held a combined public
hearing on both the emergency and proposed permanent rulemaking orders in
Superior, Wisconsin on June 20, 2003, and is preparing to send the final
proposed rules to the Legislative Standing Committees for review. You
may view the emergency and proposed permanent rule orders on the DHFS
website at www.dhfs.state.wi.us/News/Rules/
Proposed_Final_Rules/Proposed_Rule_Index.htm.
HFS 129 – "Certification of Programs for Training and
Testing Nurse Assistants, Home Health Aides and Hospice Aides"
On June 1, 2003, the Wisconsin Administrative Register published the
"Statement of Scope" relating to the department’s proposal to
revise HFS 129. You may view the proposed revisions on the DHFS website at
www.dhfs.state.wi.us/News/Rules/Rules_Under_Development/
Rules_Under_Development.htm
Other Rule Revisons - "Omnibus Rulemaking Orders"
In the interest of keeping our administrative rules up to date, the
Department’s Rules Unit is in the process of sending its first annual
"Omnibus" Rulemaking Order to the Legislative Council Rules
Clearinghouse for comments. The Department held a public hearing on July
21, 2003 to consider the proposed permanent rules. The
omnibus package includes relatively minor revisions to the following BQA
rules: HFS 83 (CBRFs), HFS 124 (Hospitals), HFS 132 (Nursing Homes), HFS
133 (Home Health Agencies), and HFS 134 (Facilities for the
Developmentally Disabled). You may view the proposed "Omnibus
Rule" on the DHFS website at www.dhfs.state.wi.us/News/Rules/
Proposed_Final_Rules/Proposed_Rule_Index.htm
In addition to the above, the Department is drafting a "Statement
of Scope" that proposes to modify a variety of its caregiver and
health facility-related administrative rules via a single rulemaking
order. All of the proposed revisions will cover changes to rules
administered by BQA in some of the following chapters: HFS 13 (Caregiver
Misconduct), HFS 83 (CBRFs), HFS 124 (Hospitals), HFS 131 (Hospices), HFS
132 (Nursing Homes), HFS 133 (Home Health Agencies), and HFS 134
(Facilities for the Developmentally Disabled).
For questions about BQA-related rules, contact Cheryl Bell-Marek at
(608) 264-9896 or e-mail at bellmcj@dhfs.state.wi.us [replaced by Pat
Benesh]
Latest CMS Survey & Certification Letters
Below is a list of the Survey and Certification Letters distributed by
the federal Centers for Medicare and Medicaid Services (CMS) during the
last quarter. Please be aware that some letters pertain only to state
agency operations. If you have questions about individual letters, contact
Susan Hespen of BQA at (608) 266-0582 or E-mail hespesj@dhfs.state.wi.us.
|
Title |
Number |
Date |
|
Interim Guidance for the Hospital Quality Assessment and
Performance Improvement Condition of Participation (posted at www.cms.gov/medicaid/survey-cert/sc0316.pdf
(exit DHFS; PDF) |
03-16 |
4/10/03 |
|
Personnel Provision of the Critical Access Hospital
Emergency Services Requirement for Frontier Areas and Remote
Locations - ACTION |
03-17 |
4/10/03 |
|
Physician delegation of tasks in Skilled Nursing Facilities (SNFs)
and Nursing Facilities (NFs) |
03-18 |
4/10/03 |
|
Policy for Interim Period Between the Effective Date of
CMS-2226-F and Publication of Surveyor Guidelines [CLIA –
laboratories] |
03-19 |
5/8/03 |
|
Medicare Identification Number Assignment for End Stage Renal
Dialysis (ESRD) Facilities |
03-20 |
5/8/03 |
|
Adoption of New Fire Safety Requirements for Religious
Non-medical Health Care Institutions (RNHCIs), Ambulatory Surgical
Centers (ASCs), Hospice, Programs of All-Inclusive Care for the
Elderly (PACE), Hospitals, Long Term Care, Intermediate Care
Facilities for the Mentally Retarded (ICFs/MR), and Critical Access
Hospitals (CAHs) |
03-21 |
5/8/03 |
|
Clarification of CMS Payment Policies Regarding Ambulatory
Surgical Centers/Independent Diagnostic Testing Facilities
Conducting Business From the Same Location |
03-22 |
6/12/03 |
|
Clarification of Designations of "Distinct Part" in the
State Operation Manual, (Pub. 7) |
03-23 |
6/12/03 |
|
Long Term Care Medication Pass Survey Requirement Clarification |
03-24 |
6/12/03 |
|
Clarification of Issues Related to Informal Dispute Resolution |
03-25 |
6/12/03 |
|
Impact of the Health Insurance Portability and Accountability Act
(HIPAA) on the Nursing Home Requirement for Posting Survey Results |
03-26 |
6/12/03 |
Outcome and Assessment Information Set (OASIS) Updates
OASIS Implementation Manual Revised
The OASIS Implementation Manual is written for use by home
health agencies (HHAs) implementing OASIS. This manual has been updated to
incorporate changes for the reduced burden OASIS made effective January
22, 2003. This updated version includes the current OASIS –B1 (12/2002)
data set. The Centers for Medicare and Medicaid Services (CMS) recommend
that HHAs download the December 2002 revision so agencies can be assured
that their manual is complete and accurate. The December 2002 revision of
the OASIS Implementation manual can be accessed at www.cms.hhs.gov/oasis/usermanu.asp
(exit DHFS).
A comparison table at that website shows changes between the previous
version (April 2001) and the revised version (December 2002) if HHAs want
to download only pages that have changed.
Frequently Asked Questions and Answers (Q&As) Available
CMS recently published a new set of Q&As regarding the OASIS data
items. These Q&As provide guidance to clinicians in responding to the
data items. You can access these at: www.qtso.com/hhadownload.html
(exit DHFS) or under Bulletins on the State OASIS System Welcome Page.
Outcome-Based Quality Improvement (OBQI) Reports
3-column/3-bar Outcome Reports and Training Available
As of April 28, 2003, the OASIS-based OBQI reports contain new
information. A third column has been added to the OBQI case mix report and
a third bar graph added to the risk-adjusted and descriptive outcome
reports. The new report format allows home health agencies (HHAs) to
compare their "current" period patient data to a
"prior" period and also to a "reference" group.
The Bureau of Quality Assurance (BQA) will provide training in late
summer/early fall on interpreting and using the new case mix and outcome
reports. When training plans are finalized, BQA will provide additional
information in a brochure mailed to home health agencies and also placed
under Bulletins on the State OASIS System Welcome Page.
A supplement to the OBQI Implementation Manual that describes the new
3-column case mix report and the 3-bar outcome report is available on the
CMS website at www.cms.hhs.gov/oasis/hhnew.asp
(exit DHFS).
Patient Tally Report Workbook with Data Filtering Tool Available
The HHA OBQI reports include Patient Tally Reports. There are two
separate tally reports available: one presenting an individual patient’s
case mix data at the start or resumption of care episode, and the other
presenting outcome information for each patient case included in the
outcome report. These tally reports are helpful to HHAs in investigating
their care delivery.
A spreadsheet tool is now available for HHA users to explore the data
in their patient tally reports. The tool consists of a Microsoft Excel
workbook with automated procedures for importing case mix and outcome
tally reports and selecting cases according to user-specified outcome and
case mix criteria. It is designed to assist HHA staff to use the patient
tally reports for outcome-based quality improvement purposes by enabling
them to focus on patients with specific attributes and outcomes and avoid
manual review of lengthy printed reports. The workbook and instructions
can be downloaded from www.qtso.com/hhadownload.html
(exit DHFS) or under
Bulletins on the State OASIS System Welcome page. If you have additional
questions on how to use this tool, please contact MetaStar, your Quality
Improvement Organization. Your contact person is: Debra Morse, (608)
274-1940 or (800) 362-2320 or dmorse@metastar.com.
Risk-Adjustment Refinement
You may notice differences in data between OBQI reports requested
before and after March 8, 2003. A refinement of the risk-adjustment model
used to calculate the national reference values on the Risk-Adjusted
Outcome Report was implemented at that time. One of the refinements, an
improvement in the risk-adjustment model for the OBQI reports, has allowed
the outcome "Any Emergent Care" to be risk-adjusted. As a
result, the measure "Any Emergent Care" was moved from the
Descriptive Outcome Report to the Risk-Adjusted Outcome Report. This is
for your information only and no action on your part is necessary;
however, if you would like more information on these refinements, go to www.cms.hhs.gov/oasis/obqi.asp
(exit DHFS).
Home Health Information Online Resource for Medicare
The Centers for Medicare and Medicaid Services (CMS) are happy to
announce their new online "Home Health Information Resource for
Medicare." There are many features on the page, including an
alphabetical listing of topics, an OASIS section, listserv access and a
highlight section to emphasize current home health activities. The website
address is www.cms.hhs.gov/providers/hha/
(exit DHFS).
Caregiver Misconduct Registry Changes
BQA has decided to discontinue publishing on the Internet the
cumulative listing of findings placed on the Caregiver Misconduct
Registry. Information on individual non-credentialed caregivers is
available on the Wisconsin Nurse Aide Registry at www.promissor.com
(exit DHFS).
Click on "Registry Services" (listed under "Find Other
Services"), then select "Wisconsin Nurse Aides" from the
drop-down box, and finally on "Search the Nurse Aide Registry."
You can search by SSN or by the person’s last and first names and review
the results (be sure to match crucial information such as birth dates).
Information is also available by calling the Wisconsin Nurse Aide Registry
Interactive Voice Response (IVR) toll free at 877-224-0235.
We will continue to post monthly additions to the Caregiver Misconduct
Registry at www.dhfs.state.wi.us/caregiver/misconduct.htm and will
keep a year’s worth of these additions available. If you have questions,
please call the Caregiver Regulation and Investigation Section at (608)
243-2019.
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