dhss update
TRANSCRIPT
Kristen Edwards
Statewide Provider Meetings • Dates have been set:
Region 1 –September 15, 2016 Cox Medical Center, South Foster Auditorium 3801 South National Avenue, Springfield
Region 2 –November 4, 2016 Southeast HEALTH, Harrison Room 1701 Lacey Street, Cape Girardeau
Region 3 –September 28, 2016 Hilton Garden Inn Independence, Independence Room 19677 E. Jackson Drive, Independence
Provider Meetings Region 4 –September 27, 2016
Stoney Creek Inn, Frontier Room 1201 Woodbine Road, St. Joseph
Region 5 –September 22, 2016 Comfort Inn, Trophy/Maple Room 1821 North Missouri, Macon
Region 6 –October 17, 2016 Governor’s Office Building, Room 450 200 Madison Street, Jefferson City
Region 7 –October 6, 2016 Embassy Suites - St. Louis Airport, 11237 Lone Eagle Drive, Bridgeton
Provider Meetings This year we will have an overlapping agenda so we can
cover topics that effect all facility types without repeats in the program
RCF/ALF Program 8:45 am until 10:00 am
Topics Preparing for Annual Inspection and DSDS Overview
The SNF/ICF will join group for an Overlap session from 10:15 am-12:00 pm Topics: Involuntary Discharge and MSHP Presentation on
Active Shooter Training
Provider Meeting
SNF/ICF 1:30 pm until 4:30 pm
Topics:
DSDS Overview
Enforcement Updates
Self-Reporting and Abuse Neglect Policy Requirements
Survey Preparedness
2012 Life Safety Code Overview
MISCELLANEOUS Laura Smith joined Region 6 as the new Program
Manager
CNA Manual – exploring options for revision
Rules – working on RCF/ALF construction, physical plant and fire safety
Effective October 1, 2016 the Family Care Safety Registry Worker Registration fee will increase to $13.00
CMS Update CMS S&C Memo 16-31-NH: Mandatory Immediate
Imposition of Federal Remedies and Assessment Factors Used to Determine the Seriousness of Deficiencies for Nursing
CMS is implementing a national policy that requires the use of federal enforcement remedies when one or more residents suffer significant harm This is effective for all surveys completed on or after September 1, 2016.
What does this mean?
CMS Update The CMS RO must immediately impose, prior to
affording a facility an opportunity to correct deficiencies, one or more federal remedies for a facility in any one or more for the following circumstances:
Immediate Jeopardy (IJ); OR
Substandard Quality of Care (SQC) deficiencies that are not IJ; OR
Any G level deficiency in Resident Behavior and Facility Practices (F221-F226), Quality of Life (QOL) (F240-F258) or Quality of Care (QOC) (F309-F334); OR
CMS Update Double G situations (Deficiencies of actual harm or
above G, H, I, J, K, L) on the current survey as well as having deficiencies of actual harm or above on the previous standard health or LSC survey OR deficiencies of actual harm or above on any type of survey between the current survey and the last standard survey. These surveys must be separated by a period of substantial compliance.; OR
Classified as a Special Focus Facility (SFF) AND has a “F” level or higher deficiency on its current survey.
CMS Update CMS S&C Memo:16-33-NH: Protecting Resident
Privacy and Prohibiting Mental Abuse Related to Photographs and Audio/Video Recordings by Nursing Home Staff Each resident has the right to be free from all types of
abuse, including mental abuse. Mental abuse includes, but is not limited to, abuse that is facilitated or caused by nursing home staff taking or using photographs or recordings in any manner that would demean or humiliate a resident(s).
This CMS memo discusses the facility and State responsibilities related to the protection of residents
CMS Update
Facility Responsibility Each nursing home must review and/or revise their written abuse
prevention policies and procedures to include and ensure that nursing home staff are prohibited from taking or using photographs or recordings in any manner that would demean or humiliate a resident(s). This would include using any type of equipment (e.g., cameras, smart phones, and other electronic devices) to take, keep, or distribute photographs and recordings on social media.
Each nursing home must provide training on abuse prohibition policies for all staff who provide care and services to residents, including prohibiting staff from using any type of equipment (e.g., cameras, smart phones, and other electronic devices) to take, keep, or distribute photographs and recordings of residents that are demeaning or humiliating.
CMS Update State Responsibility
What our staff will be looking for:
At the time of the next standard survey, the survey team will request and review facility policies and procedures that prohibit staff from taking, keeping and/or distributing photographs and recordings that demean or humiliate a resident(s).
The S&C provides guidance to survey staff when investigating complaints related to unauthorized videos and photographs
Electronic Submission of Staffing Data
ACA requires facilities to electronically submit direct care staffing information (including agency and contract staff) based on payroll and other auditable data
CMS developed a system to submit staffing and census information – Payroll-Based Journal (PBJ). System allows staffing and census information to be collected on a regular and more frequent basis than currently collected. It will also be auditable to ensure accuracy. All long term care facilities will have access to this system at no cost.
Electronic Submission of Staffing Data
CMS Memo S&C 16-13-NH: Payroll-Based Journal (PBJ) -
Implementation of required electronic submission of Staffing Data for Long Term Care (LTC) Facilities
Mandatory submission begins July 1, 2016 Facilities may voluntarily submit data for period ending June 30, 2016
May submit voluntary data for any time-frame within the voluntary period – month, a few days, etc.
Voluntary data may be submitted at any time – does not have to be at the end of the quarter
Revised PBJ Manual and other information - http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html
MDS Focused Surveys
S&C 15-25-NH
Piloted in 2014, expanded to all states in 2015
Each survey takes two surveyors approximately 2 days
CMS works with states to determine specific facilities to be surveyed. Missouri has selected facilities to be surveyed.
Survey process modifications were made May and our staff have begun using the modified process in MDS survey’s
Infection Control Surveys
S&C 16-05-ALL
Three year pilot project to assess infection prevention efforts in hospitals and nursing homes
National contractor will perform
CMS will use survey as an educational pilot surveys
In FY 16, ten pilot surveys will be conducted in nursing homes
In FY17 and FY18, surveys will be conducted in nursing homes and hospitals
No citations will be issued - if an Immediate Jeopardy deficiency is noted, a referral will be made to the CMS Regional Office
Helpful Resources • Subscribe to the LTC Information Update Listserv by
visiting and following the prompts at: http://cntysvr1.lphamo.org/mailman/listinfo/ltcr_information_update
• To view past Listserv posts and the LTC blog, visit: http://health.mo.gov/blogs/ltcblog/
• Visit the site below to view newsletters and additional resources: http://health.mo.gov/seniors/nursinghomes/providerinfo.php
Helpful Resources • http://www.cms.hhs.gov/Medicare/Provider-Enrollment-and-
Certification/SurveyCertificationGenInfo/
CMS Survey and Certification (S&C Memos) – click on ‘Policy and Memos to States and Regions’ Normally released on Fridays
State Operations Manual Appendix P – Survey Process
Appendix PP – F Tags
• http://www.cms.hhs.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html
Forms referenced in Appendix P and used during survey process
Helpful Resources
• http://health.mo.gov/seniors/rulesregs.php State regulations for all levels of care
• http://health.mo.gov/safety/cnaregistry/ CNA, CMT and Insulin Administration Registry
QUESTIONS
Section for Long Term Care Regulation
573-526-6228
Terry Hildebrand
Division of Senior & Disability Services
Provide aid and assistance to the elderly and low-income disabled adults;
Administer and operate Medicaid Funded Home and Community Based Services (HCBS);
Investigates reports of abuse, neglect, and financial exploitation of eligible adults.
Medicaid Funded Home & Community Based Services (HCBS) State Plan Personal Care Services
Basic Personal Care In a private home
In a Residential Care Facility/Assisted Living Facility
Advanced Personal Care In a private home
In a Residential Care Facility/Assisted Living Facility
Authorized Nurse Visits In a private home
In a Residential Care Facility/Assisted Living Facility
Personal Care Assistance – Consumer Directed Services
Minimum Eligibility Requirements
Active Medicaid Status
At least
18 years of
age
Meet Nursing Facility Level of
Care
CDS ONLY Ability to
Self-Direct their own care
Medicaid Funded Home & Community Based Services (HCBS) 1915(c) Waiver
Independent Living Waiver (ILW)
Aged and Disabled Waiver (ADW)
Adult Day Care Wavier (ADCW)
ILW Requirements
Initial Entry: 18-64
Be physically Disabled
Nursing Facility LOC
Active Medicaid
Self-Direct
ILW Services
Personal Care Assistance
Financial Management Services
Case Management
Environmental Accessibility Adaptations
Specialized Medical Equipment
Specialized Medical Supplies
ADW Requirements
63 or older
Meet Nursing Facility LOC
Active Medicaid
ADW Services
Homemaker
Chore
Short-term/ Intermittent
Respite Care
Basic Respite: Unit (15 min) or Block (9-12 hours)
Advanced Respite Care:
Unit (15 min) or Block (9-12 hours) or Daily (17-24 hours)
Nurse Respite Care: Block (4 hours)
Home Delivered Meals
Adult Day Care
ADCW Requirements
Initial Entry: 18-63
Nursing Facility LOC
Medicaid
Eligible
ADCW Services
Limitations
10 hours per day;
5 days per week;
No more than 8 units per day of transportation to and from ADC facility.
Eligibility Determination - PreScreen
Centralized Intake –
HCBS New Referral Call Center
866-835-3505
8 a.m. to 5 p.m. M-F
CyberAccess HCBS Web Tool
Medicaid Eligibility Message
PreScreen LOC Determination
Eligibility Determination - PreScreen
Who can call in a referral?
* Self * Family
* Provider * Other agency
What should you be prepared to talk
about?
* Formal Supports (other services)
* Prescriptions
* Diagnoses
* ADLs
* Primary Physician Information
* Unmet needs
Eligibility Determination - PreScreen
* LOC Met – sent to Regional Assessment Team
* LOC Not Met – Necessary Action
LOC Determination
Eligibility Determination - Assessment
15 Business Days
In person assessment
Individual’s home or other location
Support Network/ anyone is welcome at Participants request
InterRAI HC
Eligibility Determination - Assessment
* LOC Met– Person Centered Care Planning Process
* LOC Not Met– Adverse Action
LOC Determination
Person Centered Care Planning Process
Functional Assessment
of Needs
Informal and Formal
Supports
Determination of Unmet
Needs
Review of all HCBS and
Appropriate Tasks for
Unmet needs
HCBS Restriction – Primary benefit to
Household
Authorization
Prior Authorization – CyberAccess – HCBS Web Tool Cost Restrictions
Agency Model Basic Personal Care – 60% of Statewide Average Cost of Nursing Facility Care, aka “Cost Cap”
Advanced Personal Care - 100% of Cost Cap
Consumer Directed Model – 100% of Cost Cap
Nurse Visits – Restricted to 26 visits in a 6 month period
Total State Plan Services must be less than 100% of Cost Cap
Eligibility Determination - Reassessment
Within 354 Days of last assessment
In person assessment
Individual’s home or other location
Support Network/ anyone is welcome at Participants request
InterRAI HC
