MDS Section Q Referral to Local Contact Agency Referral Process and Automated Submission

PDF Version of DQA 12-009  (PDF, 58 KB)

MDS Section Q Referral to Local Contact Agency Process Program Update

This memo describes changes made to the MDS Section Q referral process and revisions to the MDS 3.0 Section Q Referral form.  These Changes include:

• Effective August 1, 2012, all MDS 3.0 Section Q referrals made by nursing homes to local contact agencies (LCA) must be made using the automated Nursing Home MDS 3.0 Section Q Referral Management System. The automated reporting system is available now for use to provide a transition period prior to formal implementation on August 1, 2012.
  
  
• The instructions for the MDS 3.0 Section Q Referral form were revised to reflect the automated submission of the referral and to omit special instructions when a resident's county of residence is different than the county where the nursing home is located. Electronic referrals are to be sent to the LCA serving the county or tribe where the nursing home is located.
  
  
• A training program that demonstrates the automated referral system and how to obtain access to the system is available on-line at this site: http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm. This information is also provided in the Resource Information section of this memo.

Summary 

Under the code of federal regulations at s. 42 CFR 483.20 nursing homes that participate in the Medicare or Medicaid programs must complete the Minimum Data Set (MDS) assessment for all residents admitted to the facility and periodically thereafter. Nursing homes are required to make a referral to the designated local contact agency for any resident who, in response to the Section Q questions, indicates he/she wishes to talk to someone about returning to the community. Nursing homes were required to begin making these referrals upon implementation of MDS 3.0 on October 1, 2010. In an effort to reduce the time and effort of such referrals and to provide a more effective means for nursing homes and local contact agencies to complete the referral process, we are pleased to announce an electronic submission process that replaces the paper-based, fax system that has been in place since the 2010 effective date.

Background

The Americans with Disabilities Act of 1990 and the 1999 Olmstead decision state that residents have a right to receive care in the least restrictive setting. Providing residents with choices through information about care options and supports that are available in the community to meet their preferences and needs helps to ensure those residents have the opportunity to access the least restrictive setting appropriate for them. The Section Q referral process is intended to further assist individuals in being informed about possible care options and supports, as not all states and settings have as robust of an information and options process as we have in Wisconsin.

Designation of the Local Contact Agency

The Wisconsin Department of Health Services (DHS) designated the Aging and Disability Resource Centers (ADRCs) as the local contact agencies for their service area. For counties not served by an ADRC, the county Medicaid long term care waiver agency or tribal long term support agency are the designated local contact agencies until the county or tribe is served by an ADRC.

MDS 3.0 Section Q Referral Process

Nursing homes and local contact agencies are expected to continue to perform the duties necessary to fulfill the following responsibilities.

Nursing Home Responsibilities

• The nursing home is required to complete Section Q of the MDS in accordance with instructions from CMS and the Department (DHS). The response to questions in Section Q will determine whether a nursing home is required to make a referral to the local contact agency. When a resident indicates that he or she does not want to talk with someone about the possibility of returning to the community or if the result of the Section Q questions is that a referral is not needed, the process in this memo does not apply.
  
  
• When a resident indicates that they would like to talk with someone about the possibility of returning to the community, within ten (10) business days of completing Section Q, the nursing home is required to send referral information to the Local Contact Agency. Starting August 1, 2012, nursing homes are to send Referral form, F-00311 via the Automated Nursing Home MDS Section Q Referral Management System to the local contact agency serving the county where the nursing home is located. The referral form and instructions are available online at: http://www.dhs.wisconsin.gov/forms/f0/f00311.pdf
  
  
• A copy of the completed referral form or the information electronically submitted to the local contact agency must be kept in the resident's medical record. 
  
  
• In accordance with federal and state discharge planning requirements, the nursing home is expected to continue working with the resident to achieve his/her goal of returning to the community.

Local Contact Agency Responsibilities

• The local contact agency will receive an e-mail message indicating that an MDS Section Q referral has been received from a nursing home. An authorized employee enters the Program Participation System (PPS) to access the Section Q referral. Upon receipt of the e-mail message, the local contact agency is expected to contact the resident within ten (10) business days. This contact may be made by phone or in person at the discretion of the local contact agency.
  
  
• The local contact agency provides the resident information about long term care options and supports for community living available locally, whether the individual plans to pay privately for care or is eligible for publically funded programs. The contact agency employee enters the PPS Nursing Home Referral Management Module to complete the process by documenting referral outcomes and making copies when required by the agency.
  
  
• When the resident seeks information about services and supports in a region not served by the local contact agency, the local contact agency provides general information about community supports, services and resources to determine the resident's continued interest in community living and the county preferred. The local contact agency employee enters the PPS Referral Management System to document the referral outcomes, makes a copy for agency records and transfers the referral form via the Automated Nursing Home Referral Management System to the resident's county of preference.
  
  
• The local contact agency may provide other assistance as appropriate to the resident to help the person fulfill his/her desire to relocate to community living.

Referral Automation

Effective August 1, 2012, all MDS 3.0 Section Q referrals made by nursing homes to local contact agencies (LCA) must be made using the automated Nursing Home Referral Management System¹. The automated reporting system is available for use now to provide a transition period prior to formal implementation on August 1, 2012.

A training program demonstrating the automated referral system and how to obtain access to the system is available and may be viewed on-line at the convenience of nursing home and local contact agency staff. This training is customized for nursing homes and contact agencies and is available at: http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm

Before using the automated system nursing homes and local contact agencies must first obtain access to the system for staff that will be making or receiving referrals. Access to the automated system is obtained by receiving authorization through the Web Access Management System (WAMS). Nursing homes and local contact agency staff should obtain their WAMS authorization in July 2012 so they are prepared to use the automated system on August 1, 2012. Information explaining how to receive WAMS authorization is located at: https://pps.wisconsin.gov/

Steps to complete the process:

Nursing Homes

1. Using the form, Nursing Home Authorization for Access to Automated MDS 3.0, Section Q Referral Management System, F-00580, provide DHS with the name of the administrator, supervisor or security officer and alternate who will authorize access to the Nursing Home Referral Management System to nursing home staff. Please use the form to transmit the name(s) of the person(s) to the Department by July 15, 2012. Please include a cover sheet with the nursing home's letterhead to fax the information to DHS at (608) 267-2437. The authorization form and instructions are available online at: http://www.dhs.wisconsin.gov/forms/f0/f00580.doc
   
   
2. Determine who will be entering referral information into the Nursing Home Referral Management System. DHS recommends that nursing homes have at least two employees who can enter referrals into the system.
   
   
3. Employees designated to complete the data transmission need to complete the two-step process to request access to the Nursing Home Management Referral System and receive WAMS authorization. Online training is available at http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm in the link entitled Requesting WAMS ID and PPS Access. This process will produce a form that the person designated in Step 1 will sign and fax to DHS to complete this process. Please include a cover sheet with the nursing home's letterhead to fax the information to DHS at (608) 267-2437.
   
   
4. Employees designated to enter referral information and any other nursing home staff who should be familiar with the process should view the on-line training designated for nursing homes at: http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm
   
   
5. Please notify DHS when your facility needs to add staff to the list of persons who are authorized to access the Nursing Home Referral Management System and when a person is no longer involved in the referral process or employed by your facility so that DHS can deny continued access to the system.

Local Contact Agencies

1. Determine local contact agency employees that will be involved with MDS Section Q electronic referral process in the Program Participation System (PPS) Nursing Home Referral Management System. The electronic referral processes for local contact agencies include receiving notification of the referrals, assigning the referral to staff, transferring the referral to another contact agency when appropriate, documenting referral outcomes and generating reports.
   
   
2. Employees designated to participate in the above tasks are to obtain a WAMS ID (for staff who do not have the WAMS ID) and obtain access to the Nursing Home Referral Management System module. Online training for these processes is available at http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm in the link entitled Requesting WAMS ID and PPS Access. Local contact agency employees who have a WAMS ID and access to other PPS modules must obtain access to the Nursing Home Referral Management System module.
   
   
3. Employees designated to use the Nursing Home Referral Management System and other local contact agency staff who should be familiar with the process should view the on-line training webcast designated for local contact agencies found at this site: http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm. The companion webcast for nursing home employees does not need to be viewed.

Memo Summary and Effective Dates

Beginning October 1, 2010, federally certified nursing homes are required to submit a referral to a local contact agency for all residents with whom they have completed the MDS Section Q assessment and when the result of that Section indicates a referral is required. Local contact agencies will receive and respond to referrals by providing information and assistance to residents who request a community living option.

Effective August 1, 2012, all MDS 3.0 Section Q referrals made by nursing homes to the local contact agencies must be made using the automated Nursing Home MDS Section Q Referral Management System.

Resource Information

• MDS 3.0 Section Q Automated Referral Process: http://www.dhs.wisconsin.gov/rl_dsl/nhs/sectionq.htm
  
  
• Wisconsin RAI/MDS 3.0 Information is available at: http://www.dhs.wisconsin.gov/rl_dsl/nhs/mds30.htm
  
  
• MDS 3.0 Section Q Referral form, F-00311 is available at: http://www.dhs.wisconsin.gov/forms/f0/f00311.pdf
  
  
• Nursing Home Authorization for Access to Automated MDS 3.0 Section Q Referral Management System form, F-00580 is available at:
  http://www.dhs.wisconsin.gov/forms/f0/f00580.doc
  
  
• For a list of county and tribal local contact agencies see:
  http://www.dhs.wisconsin.gov/LTCare/adrc/pdfdocs/SectionQCountyContactsList.pdf

Central Office Contacts:

¹The Nursing Home Referral Management System is a component of a bigger system known as the Program Participation System (PPS). Nursing home staff using the Nursing Home Referral Management System will only have access to those functions.

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Last Updated: June 29, 2012