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DQA Quarterly Information Update

January 2010

PDF Version of this month's Quarterly Update (PDF, 192 KB)

NEW THIS ISSUE

REGULAR  FEATURES

UPCOMING  EVENTS


NEW THIS ISSUE

Change in Hospital and Non-LTC Complaint Information
Bureau of Health Services

Due to the retirement of Helen Brewster, Hospital and Non-Long Term Care Complaint Coordinator, her direct telephone number will no longer be used. Please remove Helen's direct number --- 608-266-0224 --- from your list of resources and refer complainants to 1-800-642-6552 (hotline) or 608-266-8481 (DQA main number).

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DHS 83 Implementation Continues
Bureau of Assisted Living

With the promulgation of DHS 83 effective April 1, 2009, DQA/BAL has implemented a number of initiatives to ensure a smooth transition to this major rule change. Following is a list of DQA Numbered Memos and materials that provide summaries of some of those changes:

09-005 Training
http://www.dhs.wisconsin.gov/rl_DSL/Publications/09-005.htm

09-007 Previously Issued Memo Crosswalk
http://www.dhs.wisconsin.gov/rl_DSL/Publications/09-007.htm

09-031 Statewide Waiver
http://www.dhs.wisconsin.gov/rl_DSL/Publications/09-031.htm

09-045 Department Designee for CBRF Approved Training
http://www.dhs.wisconsin.gov/rl_DSL/Publications/09-045.htm

09-046 Department-approved Assisted Living Administrator Training Course
http://www.dhs.wisconsin.gov/rl_DSL/Publications/09-046.htm

DHS 83 Q & A Document
http://www.dhs.wisconsin.gov/rl_DSL/CBRF/dhs83Q&A09.pdf

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Bureau of Assisted Living Wins AHFSA Awards
Bureau of Assisted Living

Wisconsin won first place from the Association of Health Facility Survey Agencies (AHFSA)in the Education Category for its submission, "Medication Management Initiative", a web-based resource available at: http://www.dhs.wisconsin.gov/rl_dsl/MedManagement/asstlvgMMI.htm

Wisconsin also won first place in the Quality Improvement Category for its submission, "Facilitating Compliance with Deferred Revocation". Kevin Coughlin, Director, accepted the awards at the AHFSA annual conference in San Antonio, Texas on October 6th.  http://ahfsa.org/Promising%20practices.htm

In addition, Wisconsin was featured in two assisted living conference breakout sessions for "Medication Management in Assisted Living" and "State Collaboration with Other Agencies - Assisted Living". More information can be found at the AHFSA website: http://www.ahfsa.org/

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Approved Sprinkler Systems for Small Class C Community Based Residential Facilities
Bureau of Assisted Living

With the promulgation of DHS 83 on April 1, 2009, DHS 83.49 requires that all small Class C CBRFs must have an approved Sprinkler System by 4/1/2014. In addition, DHS 83.63 requires a plan review for the installation of a sprinkler system. Chapter DHS 83 is available at: http://www.legis.state.wi.us/rsb/code/dhs/dhs083.pdf

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Calumet County to Have Managed Care
Administrator's Office

Effective January 1, 2010: Calumet County

On June 19, 2009, the Division of Quality Assurance issued DQA memos 09-023 (CBRFs), 09-024 (RCACs), and 09-025 (Nursing Homes) outlining the Preadmission Consultation (PAC) requirements for providers, effective July 1, 2009. The memoranda are available at:

http://www.dhs.wisconsin.gov/rl_dsl/Publications/11-023.htm

http://www.dhs.wisconsin.gov/rl_dsl/Publications/09-024.htm

http://www.dhs.wisconsin.gov/rl_dsl/Publications/09-025.htm

The memoranda identify certain information dissemination and referral responsibilities that affect facilities in counties with Managed Care/IRIS (self-directed supports waiver) and in counties where Medicaid Waiver programs are available. Currently, managed care is not available in all counties.

When managed care is made available in a county, the new PAC requirements take effect. DQA will continue to publish the Managed Care Organization (MCO) start dates in the DQA Quarterly Information Update to inform providers when the new PAC requirements go into effect.

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Home Health: OASIS-C
Bureau of Technology, Licensing and Education

For all federally certified Home Health Agencies (HHAs), the OASIS-C dataset is replacing the OASIS-B1 dataset, effective January 1, 2010. HHAs must collect OASIS information on their patients in order to participate in the Medicare program. 

Comprehensive assessments containing OASIS questions will transition as determined by the M0090 completion date: M0090 dates of 12/31/09 or before will use the B1-dataset; M0090 dates of 1/1/2010 or after will use the C-dataset. 

If the wrong dataset is used, the State OASIS System will reject the assessment. HHAs can include both OASIS-B1 and OASIS-C assessment records in the same submission file. HHAs should obtain/print the updated Error Message and Description Guide that is available on the QIES Technical Support Office website at: www.qtso.com

Under the OASIS-C guidelines, OASIS questions --- as part of each patient's comprehensive assessment --- will still apply only to Medicare/Medicaid skilled adult non-maternity patients. Previously, HHAs could submit assessment records for patients where OASIS did not apply. These records would appear on the Final Validation report as "masked" records and actual patient identifiers were not saved in the State OASIS database. Effective with OASIS-C, records transmitted where OASIS data was not required will be rejected on the Final Validation report.

In 2010, CMS will implement security regulations that will change the way HHAs login to the State OASIS System, including CASPER. Currently HHAs use an agency-assigned shared login ID and password. When the security changes are deployed, each user will be required to register for an individual user ID using a link on the State OASIS Welcome page. HHAs should regularly check the OASIS Welcome page for additional information about this upcoming security change.

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OASIS Resources
Bureau of Technology, Licensing and Education

The Center for Medicare and Medicaid Services (CMS) provided three free national Medicare Learning Network (MLN) "OASIS-C Train-the-Trainer" conference calls on topics related to OASIS-C. Although these calls have been completed (one each in October, November, and December), transcripts of these calls are --- or will be --- posted on the CMS website under 'Downloads'at: http://www.cms.hhs.gov/HomeHealthQualityInits/03_EducationalResources.asp#

Handouts/slides for these conference calls are available under 'Downloads' at: http://www.cms.gov/

CMS announced that the new OASIS-C Guidance Manual will be updated as a result of questions that arose during the three MLN conference calls. Though the revision is not yet posted, the "content" that will be changed can be found in the document "OASIS-C Guidance Manual Errata" under 'Downloads' at:
http://www.cms.hhs.gov/HomeHealthQualityInits/
14_HHQIOASISUserManual.asp#

Also, a helpful comparative "Crosswalk from B1-to-C" can be found in Appendix G of the new Guidance Manual.

In addition, several personnel from and contractors to CMS (who were responsible for the development and testing of OASIS-C) gave presentations on OASIS-C in October at the National Association of Home Care and Hospice's (NAHC) convention. The four presentations have been made available to the public and slides are available for viewing at: http://www.dcprovidersonline.com/nahc/?event_id=NAHC102

The new July 2009 version of "OASIS Considerations for Medicare PPS Patients" was posted in November at:  https://www.qtso.com/hhadownload.html 

The new "2010 OASIS Follow-up Assessment Scheduling Calendar" is also available at this site.

In October, CMS and the OASIS Certificate and Competency Board (OCCB) released 45 new Q&A's related to the use of the OASIS-C dataset that HHAs will want to view at: http://oasiscertificate.org/main/

CMS also plans to release new Wound, Ostomy, and Continence Nurses' (WOCN) guidance related to the new OASIS-C wound questions, when it becomes available. Revised OBQI and OBQM manuals and a new Process Measure Manual will also be available in the future.

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New Home Health Quality Measures
Bureau of Technology, Licensing and Education

OASIS-C is the first major update to the OASIS dataset since its introduction. There are significant revisions to existing elements, elimination of some data elements, and the addition of new elements that are capable of capturing new process and outcome measures. Some of the new process elements will collect data on processes of care that HHAs might use in caring for their patients, which will enable calculation of the HHA's use of "best practices." 

Previously, home health quality measures focused only on patient outcomes. The new process data items will allow the measurement of processes of care that are under the agency's control and will be used to "give credit" to HHAs that are incorporating evidence-based practices into their patients' care.

CMS does not plan to merge OASIS-B and OASIS-C quality measures in the OBQM and OBQI reports. B1 Casper reports will be available for HHAs and on Home Care Compare until all reports that utilize data through 12/31/09 have been published. Following, there will be a "blackout period" where no new reports will be available because (1) publishing quality reports with too little data carries risks that reports could be inaccurate or misleading and (2) risk-adjustment models have not yet been developed for OASIS-C.

Taking 'report lag time' into consideration, the first OBQM Casper reports will be available in May or June 2010 and will be renamed "Potentially Avoidable Events." New process measure reports and Home Care Compare reports may be available in September or October 2010, and Outcome Casper reports are expected to reflect OASIS-C measures by approximately May 2011.

Descriptions of the revised quality measures and draft report formats will be posted on the CMS OASIS-C website at: www.cms.gov/

Questions regarding any OASIS-related information can be directed to either of the following:

Mary Jo Sutton, OASIS Education Coordinator
MaryJo.Sutton@wi.gov
920-983-3188

Chris Benesh, OASIS Automation Coordinator
Chris.Benesh@wi.gov
608-266-1718

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OASIS E-mail Group
Bureau of Technology, Licensing and Education

In August 2008, DQA sent a questionnaire to Home Health Agencies (HHAs) in Wisconsin, asking for provider input on DQA plans for future OASIS trainings. One questionnaire item asked whether the HHA was interested in joining an OASIS communications e-mail group (listserv) that could be used to send OASIS-related information to HHAs. The overwhelming response to this question was "Yes!"

Since that time, it was determined that creation of a listserv limited to HHAs could not be undertaken for multiple reasons. DQA is still interested in creating an e-mail group not hosted by the state listserv system for dissemination of OASIS information. 

However, in order to join such a group, HHAs would need to have (or be able to create) a non-personal e-mail box to which messages could be sent. Such mailboxes might take the form "oasis@hhaname.com" or "oasis@hhaname.org."

If your agency is interested in joining such an e-mail group and has or can establish this type of "oasis@" mailbox, please e-mail your name, title, and the mailbox address for your HHA to:  MaryJo.Sutton@wi.gov

DQA will then tabulate responses and determine the feasibility of establishing this program. If you have questions, please contact Mary Jo Sutton, OASIS Education Coordinator, at the above e-mail address or by telephone at 920-983-3188.

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MDS 3.0 Implementation
Bureau of Technology, Licensing and Education

The Minimum Data Set (MDS) 3.0 is scheduled for implementation on October 1, 2010. MDS 3.0 includes many improvements that will have profound implications for nursing home and swing-bed care and public policy. One of the areas that has changed replaces Resident Assessment Protocols (RAPs) with Care Area Triggers (CATs). Nursing home and swing-bed facilities should be planning for this implementation by familiarizing staff with the MDS 3.0. CMS posts MDS 3.0 materials at:  www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

The website currently includes the following information:

  • RAI Manual Chapters 1, 3, and 5 and many of the Appendices. (Chapters 2, 4, and 6 and Appendix C are scheduled for posting in December.)
  • Item Subsets (V1.00) - data items required for each assessment type.
  • Item Matrix (V1.00) identifies data items used for CATs, Quality Measures, Quality Indicators, RUG-IV, and RUG-III.
  • Technical information including detailed data submission specifications, logic for calculation of RUG-IV and RUG-III classifications, and triggering logic for the CATs.

On December 17, the CMS sponsored a live satellite broadcast and webcast entitled "MDS 3.0: Part I - An Introduction." This program is the first of a three-part series focused on providing information about MDS 3.0. This webcast can be viewed up to a year after December 17, 2009. Nursing home providers can view the archived broadcast by clicking on "Satellite Broadcast" or "Archived Webcast" at: http://surveyortraining.cms.hhs.gov

Non-surveyors do not need to register. For complete details regarding this broadcast, see the "Bulletins" area of the State MDS Welcome page.

The Division of Quality Assurance will be offering provider training on the MDS 3.0 in spring/summer of 2010.

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MDS 2.0 State Specified Quarterly Assessments
Bureau of Technology, Licensing and Education

The State specified, two-page MDS Quarterly Assessment form has been changed to a larger MDS MPAF Quarterly Assessment form. Nursing homes were given a transition period to update their software programs with this change. Starting in January 2010, the State MDS System will reject MDS Quarterly Assessment records that do not include MPAF data items. 

Nursing homes must complete and submit MDS MPAF Quarterly assessments to meet the Quarterly Review and Automated Data Processing federal requirements.

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REGULAR FEATURES

Changes in DQA Staff

Lydia Reitman
Long time DQA Nursing Consultant, Lydia Reitman, passed away on October 10, 2009.

Tina Lubick
Bureau of Nursing Home Resident Care (SRO) - Transfer to Bureau of Assisted Living 12/05/09

Martha Janeice Armes
Bureau of Nursing Home Resident Care (SRO) - Retired 08/01/09

Helen Brewster
Bureau of Health Services (CO) - Retired 12/11/09

Linda Szfranski
Bureau of Nursing Home Resident Care (SERO) - Retired 12/17/09

Diane Caruso
Bureau of Assisted Living (SERO) - Retired 12/30/09

Kitty Friend
Bureau of Technology, Licensing and Education (SERO) - Retired 12/30/09

Peggy Ramer
Bureau of Nursing Home Resident Care (SRO) - Retired 01/06/10

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DQA Numbered Memos (October, November, December)

Access these memos via http://www.dhs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm or via individual providers' publications pages at  http://www.dhs.wisconsin.gov/rl_DSL/

DQA Memos

Memo No.

Title

Summary

Providers Affected
09-040

For All Facilities Performing Tests on Human Specimens: CLIA Requirements

Under the authority of Section 353 of the Public Health Service Act, the Clinical Laboratory Improvement Amendments of 1988 (CLIA) require all facilities performing tests on human specimens to be certified to perform these tests. The regulations that implemented CLIA became effective September 1, 1992.

Ambulatory Surgery Centers
Adult Day Care Centers
Adult Family Homes
Certified Mental Health and AODA
CLIA
Community Based Residential Facilities
End Stage Renal Dialysis Units
Facilities for the Developmentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehabilitation Facilities
Residential Care Apartment Complexes
Rural Health Clinics

09-041

Emergency Preparedness Resource Inventory Registration System Now Online

This memo announces the availability of online registration for the CMS Emergency Preparedness Resource Inventory (EPRI) system.

Ambulatory Surgery Centers
Adult Day Care Centers
Adult Family Homes
Certified Mental Health and AODA
CLIA
Community Based Residential Facilities
End Stage Renal Dialysis Units
Facilities for the Developmentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehabilitation Facilities
Residential Care Apartment Complexes
Rural Health Clinics

09-042

Palliative Care

The purpose of this memorandum is to provide information and guidance on the meaning of palliative care and expectations for palliative and supportive care programs.

Home Health Agencies
Hospitals
Nursing Homes

09-043

Notice of Implementation of Revisit Fee

This memorandum outlines the implementation of an inspection (revisit) fee assessment for Community Based Residential Facilities (CBRFs), Adult Family Homes (AFHs), Residential Care Apartment Complexes (RCACs), and Adult Day Cares (ADCs), consistent with the enactment of the state budget bill, Wisconsin Act 28, which became effective June 29, 2009.

Adult Day Care Centers
Adult Family Homes
Community Based
Residential Facilities
Residential Care Apartment
Complexes

09-044

Invitation to Nursing Home Stakeholders to Apply for Grants for Use of Civil Money Penalty (CMP) Funds

The purpose of this memo is to announce the availability of grant funding from the civil money penalty (CMP) program that can be used to benefit Wisconsin nursing home residents. 

These grants are available for projects or programs that are provided through various interested nursing home stakeholders; e.g., facilities, consumer groups, professional nursing home associations, ombudsmen program, quality improvement organizations, etc.

Nursing Homes

09-045

Notice of Department Designee for CBRF Department-Approved Training

On April 1, 2009, the Department implemented the revised Wis. Admin. Code, ch. DHS 83, licensing standards and regulations for CBRFs. 

Minimum training requirements for CBRF personnel changed substantially with a delayed implementation date of April 1, 2010 for all current department approved CBRF training plans and approved trainers.

Community Based
Residential Facilities

09-046

Department-Approved Assisted Living Administrator's Training Course

On April 1, 2009, the revised Wis. Admin. Code, Chapter DHS 83 for CBRFs was implemented, establishing new qualification requirements for CBRF administrators.

The department has developed curriculum criteria and trainer requirements that will be utilized in the department review and approval process

Community-Based Residential Facilities

09-047

Changes in 2010 to WI Clean Indoor Air Act and Its Effect on Nursing Home Smoking Policies

Effective July 5, 2010, the Wisconsin Clean Indoor Air Act will prohibit smoking in all inpatient health care facilities, including nursing homes, within the state of Wisconsin.

This memo updates and replaces DDES-BQA-05-008, which was issued June 15, 2005. This memo is being sent at this time so that staff and residents can prepare for any changes that will need to be implemented by July 5, 2010.

Nursing Homes

09-048

Notice of Change in Certification Fees for Mental Health and Substance Abuse Services Providers

This memo announces changes in the annual certification fees for mental health and community substance abuse programs and services.

Certified Mental Health and Substance Abuse Services Providers

09-049

Notice of Change in Certification Fees for Mental Health and Substance Abuse Services Providers to take effect on Counties in 2011

This memo announces changes in annual certification fees for county mental health and community substance abuse programs and services.

Wisconsin County Departments of Human Services
Community Services

09-050

Staffing of Facilities and Programs During a Pandemic

This memo expands upon information previously provided in DQA Memos 09-018, 09-020, and 09-030 regarding Novel Influenza A (H1N1) / 2009 (Swine Flu).

The purpose of this memo is to identify planning resources for staffing shortages when a pandemic is occurring.

Ambulatory Surgery Centers
Adult Day Care Centers
Adult Family Homes
Certified Mental Health and AODA
CLIA
Community Based Residential Facilities
End Stage Renal Dialysis Units
Facilities for the Developmentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehabilitation Facilities
Residential Care Apartment Complexes
Rural Health Clinics

09-051

Domestic Partnership - Chapter 50 Information Update

This document summarizes the rights of domestic partners in health care settings relating to accompaniment or visitation, resident rights, and consent to admission to certain facilities.

Adult Family Homes
Community Based Residential Facilities
Hospitals
Hospices
Nursing Homes
Residential Care Apartment Complexes

09-052

Plans of Correction Via Attestation for Assisted Living Facilities

This memo announces that, in specified situations, the Bureau of Assisted Living will accept an attestation of compliance as a facility's plan of correction.

Adult Day Care Centers
Adult Family Homes
Community Based Residential Facilities
Residential Care Apartment Complexes

09-053

Webcast Presentation
F441: Infection Control - Guidance to Surveyors

On July 20, 2009, CMS issued revisions to Appendix PP - Interpretive Guidelines for Long Term Care Facilities for F-tag 441. These updated guidelines became effective September 30, 2009.
DQA is making this webcast available to enable viewers to (1) identify and describe the revisions to the interpretive guidelines for infection control; (2) demonstrate knowledge of the contents of the revised guidance to surveyors for F441; (3) appropriately and accurately utilize the revised guidance and investigative protocol during the survey process.

Nursing Homes

09-054

Cleaning and Disinfecting Glucose Meters Shared Between Residents

This memo provides information and guidance regarding the cleaning and disinfecting of glucose meters that are shared between residents in the facility and notifies  that, effective immediately, the revised guidance at F441, issued by the Centers for Medicare and Medicaid Services (CMS) on 11/30/09, directs surveyors to cite at the level of immediate jeopardy the deficient practice of failing to clean and disinfect the shared glucose meter between residents.

Nursing Homes

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DHS Administrative Rules Update
Administrator's Office

DHS 85 - Non-Profit Corporation as Guardian

On September 19, 2006, the Wisconsin Administrative Register published a Statement of Scope of proposed rules to amend Chapter DHS 85, Non-profit Corporation as Guardian. Through this initiative, the Department proposes to make the rule reflect current standards of practice, recognizing the increase in the number of adults in need of guardianship and the increase in the complexity of their needs.

An Advisory Committee, including advocates, providers, registers in probate, and County adult protective services staff, met and reviewed proposed rule language and made recommendations for change. The proposed rule was filed with the Clearinghouse and Legislative Reference Bureau on August 12, 2009. Public hearings on the proposed rule were held on October 8 in Waukesha and on October 14 in La Crosse.

The Rule Order and Fiscal Estimate for Chapter DHS 85, Private Non-profit Corporations and Unincorporated Associations as Guardians, has been posted on the Department's Administrative Rules website at the following link: https://health.wisconsin.gov/admrules/public/Home

DHS 124 - Hospitals

During the early part of 2008 the Department of Health Services began working with hospitals, professional associations, advocates, and trade associations to revise Wisconsin Administrative Code, Chapter DHS 124. The Department is planning to update the code to eliminate overly prescriptive and outdated regulations, clarify the Department's enforcement authority, and make the rule more consistent with the federal Medicare requirements.

While we are continuing to work on this extensive revision to the rule, new legislation makes it necessary for the Department to move forward with a limited number of revisions to ch. DHS 124 at this time. To that end, the Department amended the Statement of Scope for ch. DHS 124, dividing the revision of the rule into two separate processes.

The Rule Order and Fiscal Estimate for Chapter DHS 124, Hospitals, relating to forfeitures, anatomical gifts, and automated external defibrillator (AED) training, was posted on the Department's Administrative Rules website on October 23, 2009. A public hearing on the proposed rule was held on December 14, 2009 in Madison. For more information, you may view the Rule Order and Fiscal Estimate on the Wisconsin Administrative Rules website at: https://health.wisconsin.gov/admrules/public/Home

DHS 131 - Hospices

On December 15, 2008, the Wisconsin Administrative Rules website published a Statement of Scope of proposed rules to revise Chapter DHS 131, Hospices. The Department proposes to revise ch. DHS 131 to align the rule with revised federal Medicare regulations, to eliminate outdated regulations, and to reflect current professional standards of practice.

The Department has asked the Hospice Organization and Palliative Experts (HOPE) of Wisconsin, hospices, and hospice consumers to participate in revising ch. DHS 131. For more information, you may view the Statement of Scope on the Wisconsin Administrative Rules website at: https://health.wisconsin.gov/admrules/public/Home

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CMS Survey & Certification Letters (October, November, December)

Listed below are Survey and Certification (S&C) Letters distributed by CMS during the last quarter. Please note that the CMS Internet site for reviewing all S&C memos is: http://www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/list.asp

S&C Memos

S&C No.

Title

Summary

Providers Affected

10-01

Treatment of Subpoenas Duces Tecum for Federal and Joint Federal/State Documents

This memo provides guidance for handling of subpoenas duces tecum that seek disclosure of records in the possession of the State Survey Agency (SA) as a result of the SA's implementation of its Agreement with the Secretary, Health and Human Services, under Section 1864 of the Social Security Act (1864 Agreement). Guidance contained herein is based upon 45 C.F.R. Part 2, as amended by 73 FR 53148, dated September 15, 2008. It is effective immediately and supersedes previous instructions related to subpoenas for records treated as Freedom of Information requests.

State Survey Agency Directors

10-02

H1N1 Flu Vaccinations or Other Emergency Activities

This memo provides information that CMS will work with the SAs on a case-by-case basis to adjust work schedules and other survey and certification actions if State emergency response authorities determine that they must deploy surveyors to administer vaccinations and the State has determined no alternative strategies are available.

State Survey Agency Directors

10-03

Approval of State and National Certification Programs for Dialysis Technicians Under New ESRD CFCs

The new ESRD Conditions for Coverage requires dialysis patient care technicians (PCTs), who have been employed since October 14, 2008, to be certified by either a State or National PCT certification program by April 15, 2010. PCTs hired after October 14, 2008 must be certified within 18 months of their date of hire.

State Survey Agency Directors

10-04

Waiver to Allow Hospitals to Use the NFPA 6-Year Damper Testing Interval

This memo permits hospitals to apply the NFPA 6-year testing interval for fire and smoke dampers in hospital heating and ventilating systems, so long as the hospital's testing system conforms to the testing requirements under the 2007 edition of NFPA 80 and NFPA 105.

State Survey Agency Directors

10-05

EMTALA Regulation Changes and H1N1 Pandemic Flu and EMTALA Waivers

The Fiscal Year (FY) 2010 Inpatient Prospective Payment System (IPPS) Final Rule included technical revisions concerning the non-applicability of EMTALA sanctions under Section 1135(b)(3) of the Social Security Act (the Act).  During a public health emergency, waivers under section 1135(b)(3) can provide exceptions to penalties for the otherwise impermissible redirection or relocation of individuals for a medical screening examination (MSE) and for inappropriate transfers. In this memo we describe the waiver process for these EMTALA-specific waivers

State Survey Agency Directors

10-06

Presidential Emergency Declaration and HHS Section 1135 Waiver Authorization

Secretary Sebelius exercised her waiver authority under section 1135 of the Social Security Act, effective October 23, 2009. The Secretary has delegated to the CMS the determination for a waiver for each case justified by necessity and extent [other than for the Health Insurance Portability and Accountability Act (HIPAA) waivers permitted under section 1135]. H1N1 Tracking Tool for State Agency (SA) Staffing: Attachment 1 contains a tracking tool to assist States in reporting any H1N1 influenza impact to their survey and certification activities.

State Survey Agency Directors

10-07

Consolidation of Personnel Policies for Individuals Directing or Performing Non-waived Tests

Presently, CLIA-related personnel policies and procedures are dispersed throughout the regulations, State Operations Manual, Interpretive Guidelines, training presentations, and in other less formal venues. This memo attempts to consolidate and clarify them for the surveyor's use and understanding.

State Survey Agency Directors

10-08

Phasing Implementation of Life Safety Code Surveys in ESRD Facilities for CY 2010

LSC surveys are being phased into the ESRD survey program in two phases. Phase I includes the implementation of initial surveys for new facilities, relocation surveys for existing facilities which move to a new location, and complaint surveys that include allegations related to LSC requirements. LSC surveys for existing ESRD facilities will be implemented following the development of Interpretive Guidance specific to those surveys, an ESRD LSC Survey Protocol, and a specific Training Module for ESRD LSC.

State Survey Agency Directors

10-09

Revised Hospital Anesthesia Services Interpretive Guidelines SOM Appendix A

CMS is clarifying the interpretive guidelines concerning the provision of anesthesia services in a hospital.

State Survey Agency Directors

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Content contact: Gina Bertolini
E-Mail: Gina.Bertolini@dhs.wisconsin.gov
Phone:  (608) 266-6691

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http://www.dhs.wisconsin.gov/rl_DSL/Listserv/signup.HTM

 

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Last Updated: May 28, 2013