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DQA Quarterly
Information Update

April 2011

PDF Version of this month's Quarterly Update (PDF, 127 KB)




  • MDS Automation Training


Update on DQA's Annual FOCUS Conference
Bureau of Technology, Licensing an Education

The Department of Health Services has determined that planning for the annual joint provider/surveyor conference should be turned over to a non-state entity. Therefore, DQA will not be proceeding with plans for a conference in 2011. Your support and attendance at previous conferences has been greatly appreciated.

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OASIS Updates
Bureau of Technology, Licensing and Education

OASIS-C Guidance Manual and Errata Sheets

CMS released the third OASIS 'errata sheet' dated December 2010, which contains a listing of changes incorporated into the December 2010 revision of the OASIS-C Guidance Manual. The errata sheet lists all the revisions included in the 12/2010 version of the Guidance Manual for your convenience, as well as other refinements and clarifications on data collection. Both the errata sheet and the guidance manual were originally posted by CMS on January 5, 2011 but, due to a significant typographical error, both were reposted on January 13, 2011. Make certain that you have the latter version. The errata sheet and revised Guidance Manual can be obtained by scrolling to the bottom of this webpage:

You will see a "zip file" dated January 2011. However, when you download the manual, the pages are actually dated December 2010.

CMS plans to republish the entire Guidance Manual (on-line) only once per year, but will publish errata sheets several times per year that summarize changes/corrections to the Guidance Manual as they occur. The errata revisions are effective immediately upon publication and will be incorporated into the next republication of the entire Manual.

New Quarterly OASIS Q&As and Revised Q&As

In January 2011, the newest quarterly OASIS Q&As were released by the Centers for Medicare and Medicaid (CMS) and the OASIS Certificate and Competency Board (OCCB). These two groups collaborate to release new Q&As each quarter. The next release is scheduled for April 21st. Q&As that are directly related to OASIS-C items begin with the October 2009 set.

The quarterly Q&A sets are posted to the OCCB website, which was revised a few months ago and has a whole new look. The overhauled website may be difficult to maneuver initially, but you can get to the Q&As by going to the "Resources" tab at the top right of the home page:

CMS has also begun revising the long list of OASIS Q&As that have been published since the inception of OASIS. CMS had previously published the Q&As grouped into twelve categories of similar/like items; e.g., OASIS Applicability, Comprehensive Assessment, Dataset Items, etc. They have now started revising these Q&A categories, making each answer appropriate for the current OASIS-C dataset. The first four categories were revised and posted in January. To obtain the revised Q&A's, go to this webpage and select categories 1- 4, dated 1/10/11: 

Casper Reports

CMS updated the CASPER User's Manual; the manual walks you through using the CASPER system to obtain/read your HHA's reports derived from OASIS data. Chapter 2 is particularly useful for understanding the details of how to obtain your HHA's reports; this chapter was updated in February 2011. The revised manual is available for download on the state's OASIS Welcome page, which is the same website utilized for transmitting OASIS data to the state.

The CASPER system support staff discovered that the "Tally Report" has a limitation: you cannot obtain a report that covers a time period containing more than 5,000 patient episodes of care. So, it's a matter of the "report size" that's at issue. If you experience problems obtaining a "Tally Agency Patient-Characteristics Report" or receive a warning message that the report is over 5,000 episodes, change your "date parameters" to a smaller time frame in order to obtain a report with fewer episodes.

CMS has released a new transition timeline defining the projected availability of OASIS-C Casper reports. As you may recall, not all of the OASIS-C reports were going to be available at the same time; different reports were being made available (transitioned) as sufficient information was gathered to create reliable reports. CMS projects that all of the Casper reports should be available by May/June of this year. To see the new transition timeline, scroll to the "downloads" section of this webpage: 

CMS-Sponsored OASIS Video Training

CMS released four web-based YouTube trainings for OASIS, as promised. The first release was "Understanding PBQI" (Process-based Quality Improvement). Later, three additional videos were released that targeted specific M-questions: M1910, M2250, and M2400. You can find these training videos here:

NOTE: If these links do not work for you, go to the YouTube website and do a search for "CMS+OASIS;" all four selections should appear (along with other items) as a result of your search.

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New DQA Construction Listserv Available for Subscription
Office of Plan Review and Inspection

The Division of Quality Assurance is pleased to announce that a new listserv (e-mail distribution list) is now open for subscription on the Division's website. This listserv, called "DQA Construction," will provide subscribers with notice of DQA physical plant memos, CMS Life Safety program letters, questions and answers, and interpretations. Subscribers to the listserv will receive e-mail messages announcing the availability of such publications along with links to the actual memos and letters.

To subscribe to the DQA Construction listserv, go to the Division's E-Mail Subscription Service webpage at:

You will need to enter the e-mail address at which you wish to receive listserv messages. Upon submitting your subscription request, you will receive an e-mail (at the address you supplied) asking you to confirm your subscription. After doing so, you will receive confirmation. Details on the subscription process for this and other DQA listservs are on the Division website.

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Effect of Change from AT&T to Verizon on Nursing Homes and Home Health Agencies
Bureau of Technology, Licensing and Education

CMS is changing vendors for connecting nursing homes and home health agencies to the QIES MDS and OASIS Systems. AT&T is the current vendor, but CMS hopes to transition to Verizon by June 30, 2011. Providers currently have to install and use the AT&T Global Client software to connect to the QIES MDS and OASIS Systems to submit records. Verizon will be providing a clientless web-based access solution that does not require installing software. CMS will be releasing additional information in the coming months. Providers should watch for alert messages on the MDS and OASIS welcomes pages and also periodically check for information on the QIES Technical Support Office website at:

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MDS News
Bureau of Technology, Licensing and Education

Change in MDS Correction Policy

Effective with submissions on April 1, 2011, CMS will no longer allow facilities to modify the MDS 3.0 reason for assessment items, assessment reference date (ARD), discharge date, and entry date. If a modification record is submitted attempting to change any of these items, the record will be rejected. These MDS items must be corrected by inactivating the old record and submitting a new record. Chapter 5 of the RAI manual will be revised to reflect this change.

Only OBRA and Medicare PPS Assessments Allowed to be Submitted

On the January, 2011, SNF Open Door Forum conference call, CMS explained only MDS 3.0 assessments that are OBRA assessments or Medicare Part A PPS assessments should be submitted to the QIES ASAP MDS System. Assessments completed for Medicare Advantage Plans or for other insurance purposes should not be submitted. CMS acknowledged this is a change from MDS 2.0, which allowed submission of all MDS assessments.

MDS 3.0 Training Videos

March 1, 2011, CMS posted the following three additional MDS 3.0 training videos on YouTube:

  • Section M: Skin Conditions
  • Evening Experts Panel Discussion
  • Dr. Deb Saliba's Introduction

Links to these videos and other MDS 3.0 training videos are available on the following CMS MDS 3.0 Training Materials web page:

Nursing Home Five-Star Quality Rating System

CMS created a Five-Star Quality Rating System to help consumers, their families, and caregivers to compare nursing homes. The Nursing Home Compare website provides a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to be of a quality much above average; nursing homes with 1 star are considered to be much below.

The Five-Star Quality Rating System is based on facility performance in the areas of survey inspection results, staffing information, and quality measures. Starting in April, 2011, the quality measures domain will not be included in the calculation of the 5-Star Quality Rating and only the domains of inspections and staffing will be used. The MDS 3.0 quality measures are not expected to be available until 2012, at which time they will be added back into the calculation. The CMS Nursing Home Compare website is located at:

MDS 3.0 Automation Nursing Home Training

The Division of Quality Assurance will be presenting a training opportunity for nursing home staff who are involved with the transmission of MDS 3.0 assessment records to the CMS QIES MDS System. This program will be held on May 24, 2011, at the Holiday Inn - Convention Center in Stevens Point.

This training program will review the process required for nursing homes to connect to the CMS QIES ASAP MDS System and the Certification and Survey Provider Enhanced Reporting (CASPER) System to transmit MDS records, retrieve validation reports, and access other MDS related reports.

Training brochures, including registration information, have been mailed to all nursing homes. The training brochure and online registration are available on the Division of Quality Assurance online educational opportunity information website at:

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Changes in DQA Staff

Claudette Bradley, RN
Nurse Consultant / Bureau of Health Services

Great News! We have filled the vacant Nurse Consultant position in Milwaukee. Claudette Bradley will be surveying Hospitals and ESRDs.

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DQA Numbered Memos (January, February, March)

Access these memos via 
or via individual providers' publications pages at

Memo No.



Providers Affected


Revisions to Chapters DHS 83 Community Based Residential Facilities and DHS 88 Licensed Adult Family Homes - Effective January 1, 2011

The DQA Omnibus Rule, amending provisions in DHS 83 and DHS 88, takes effect 01/01/2011. Administrative rules were amended to correct cross references, links, and charts, and to make other minor changes.

Adult Family Homes, Community Based Residential Facilities


Office of Plan Review and Inspection

In July 2010, it was announced that the Wisconsin Department of Administration had approved the DHS request to reorganize the DQA. The reorganization created the Office of Plan Review and Inspection (OPRI) and moved DQA's Civil Engineer Advanced and support staff positions from the Bureaus of Health Services and Nursing Home Resident Care to OPRI.

Ambulatory Surgery Centers, Community Based Residential Facilities, End Stage Renal Dialysis Units, Hospices, Hospitals, Nursing Homes, Relationship Enhancement Committee, Design Professionals


Carbon Monoxide Alarms New Requirements Expand Coverage to Most Residential Buildings
Effective February 1, 2011

On February 1, 2011, new requirements in 2009 Wisconsin Act 158 and Chapters Comm 21 and 28, relating to Carbon Monoxide Alarms, will go into effect.

Adult Family Homes, Community Based Residential Facilities, Residential Care Apartment Complexes


Respiratory Therapy Orders in Hospitals

The purpose of this memo is to inform hospitals regulated by the DQA about a statewide variance of DHS 124 related to respiratory therapy orders.



Listing of Mental Health Practitioners Using Individual Provider Status Confirmation Letters

The DHS, DQA, Behavioral Health Certification Section and the Bureau of Prevention, Treatment and Recovery have participated in a series of meetings with the Joint Board of Marriage and Family Therapy, Professional Counseling and Social Work, and the Dept of Regulation and Licensing regarding credentialing options for mental health practitioners currently providing psychotherapy, following confirmation of their training and clinical experience via the Individual Provider Status Application process.

Certified Outpatient Mental Health Clinics


Employment Requirements for "Nurse Technicians" and Student Nurses Working as Nurse Aides

This memo provides information regarding the role and responsibilities of "nurse technicians," and student nurses. This memo (1) clarifies that "nurse technicians" are nurse aides and must comply with the training and testing requirements for nurse aides who work in health care facilities; (2) explains employment requirements for student nurses who work as nurse aides in health care facilities; and (3) clarifies charge nurse and staffing requirements.

Nurse Aide Training Programs, Nursing Homes


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.

Federally-certified Nursing Home Administrators, ADRC Directors, Area Agencies on Aging Executive Directors, Board on Aging and Long Term Care Executive Director, County DHS Directors, County DSS Directors, County DCP Directors, County/Tribal Aging Unit Directors, Disability Rights Wisconsin Executive Director, MCO CEOs


Notice of State Only Re-Visit Fee

Act 205 became effective 06/29/09 and created new language for Nursing Homes authorizing a $200 fee for onsite re-visits resulting from State administrative code violations. This memorandum outlines the nursing home re-visit fee process that DQA implemented on December 1, 2009.

Nursing Homes, Facilities for the Developmentally Disabled


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CMS Survey & Certification Letters (January, February, March)

Listed below are Survey and Certification (S&C) Letters distributed by the Centers for Medicare & Medicaid Services (CMS) during the last quarter. Please note that the CMS Internet site for reviewing all S&C memos is:

S&C No.



Providers Affected


Hospital and Critical Access Hospital (CAH) Facility Life Safety Code (LSC) Occupancy Classification

Hospital and CAH component facilities may be classified as new or existing Health Care, Ambulatory Health Care, Business, or other occupancies, as allowed by provisions of the LSC.

Hospitals, Critical Access Hospitals


Clinical Laboratory Improvement Amendments of 1988 (CLIA)

This memo provides guidance on the applicability of CLIA regulations to testing associated with blood, cells/tissue, and organs for transfusion, implantation, infusion, or transplantation.

Clinical Laboratories


Approval of Deeming Authority of Det Norske Veritas Healthcare (DNVHC) for Critical Access Hospitals

CMS has approved DNVHC as a national accreditation program for CAHs seeking to participate in the Medicare or Medicaid programs.

Critical Access Hospitals


Revised Hospital Anesthesia Services Interpretive Guidelines - State Operations Manual Appendix

Revisions to Recently Updated Interpretive Guidelines for Anesthesia Services



Revised Home Health Survey Protocols

CMS is issuing revisions to the existing HHA survey process. New State Operations Manual Appendix B is provided.

Home Health Agencies


Relationship Between Civil Money Penalty Funds Paid by Nursing Homes and the Money Follows the Person Rebalancing (MFP) Demonstration grant program.

This letter explains the relationship between civil money penalty funds collected from nursing homes that have been out of compliance with Federal requirements and programs designed to provide alternatives to nursing homes, such as the MFP Demonstration grant program.

Nursing Homes


Update of End Stage Renal Disease (ESRD)

CMS wants to promote common understanding about the regulatory process and the specific rules that guide the CMS S&C process in order to promote consistency of standards and expectations regarding the ESRD CfCs,

End State Renal Dialysis Centers


Clarification of Self-Administration of Medications

It has been the expectation of ICF/MR surveyors, pursuant to previous CMS interpretations of 483.460(k)(4), that every client residing in an ICF/MR must participate at some level in a formal, self-administration program for medications.

Intermediate Care Facilities for the Mentally Retarded


Clarification of Reporting Mistreatment, Neglect, Abuse, and Injuries of Unknown Source

Both State and Federal surveyors have requested further clarification regarding the parameters surrounding what constitutes "injuries of unknown source," the definition of "immediate," and to whom such allegations/injuries must be reported.

Intermediate Care Facilities for the Mentally Retarded


Publication of Final Rule Civil Money Penalties for Nursing Homes

The final rule "Civil Money Penalties for Nursing Homes," was published in the Federal Register on March 18, 2011.

Nursing Homes


April and July 2011 Changes to Nursing Home Compare

This memo describes changes that CMS will make to the Nursing Home Compare website on April 23, 2011 and on July 21, 2011. CMS is soliciting comments about these website changes. CMS will be evaluating the website in a systematic way, including seeking comments from stakeholders and visitors to the site.

Nursing Homes


Publication Contact: Gina Bertolini
Phone:  (608) 266-6691


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Last Updated: June 18, 2013