DQA Quarterly
Information Update

October 2010

PDF Version of this month's Quarterly Update (PDF, 126 KB)

NEW THIS ISSUE

• Employment of Youth in the Health Care Industry
• MDS Updates
• OASIS Basics' Training Scheduled
• CBRF Department-Approved Training:  First Quarter
  Reports and Survey Results
• OASIS Updates
• Foreign Language Services
• E-mail Encryption:  What You Need to Know & Do
• DQA to Create Provider Portal and to Post
  Statements of Deficiency for Nursing Homes

REGULAR FEATURES

• Changes in DQA Staff

• DQA Numbered Memos

• DHS Administrative Rules Update

• CMS Survey & Certification Letters

UPCOMING EVENTS

• FOCUS 2010 Conference

NEW THIS ISSUE

U.S. Department of Labor - Employment of Youth
 in the Health Care Industry
Office of Caregiver Quality

On July 19, 2010, the U.S. Department of Labor, Wage and Hour Division (DOL WHD) issued a restriction on the use of hoists and hoisting apparatuses. Hazardous Order No. 7 prohibits minors under the age of 18 from operating or assisting in the operation of most power-driven hoists, including those designed to lift and move patients.

Per U.S. DOL directive, employees under the age of 18 are prohibited from operating or assisting with the operation of patient lifts, even with the supervision of an employee who is 18 or older. For more information, see the U.S. DOL "Fact Sheet No. 52 - The Employment of Youth in the Health Care Industry" at: http://www.dol.gov/whd/regs/compliance/whdfs52.pdf

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MDS Updates
Bureau of Technology, Licensing and Education

RAI/MDS 3.0 Information

New information and links have been added to the DQA RAI/MDS Information web page located at: http://www.dhs.wisconsin.gov/rl_DSL/NHs/MDS30.htm  Nursing homes are encouraged to routinely review this web page for updates.

The MDS 3.0 RAI Manual was updated in September and on September 23, 2010 CMS also released an Errata Document to correct formatting of Chapter 3, Section O, Page O-17. The DQA RAI/MDS 3.0 web page includes a link to the CMS MDS Training Material web page that contains the most current RAI Manual information located at: http://www.cms.gov/NursingHomeQualityInits/
45_NHQIMDS30TrainingMaterials.asp

MDS 3.0 Submissions

There is a MDS 3.0 Submission link on the MDS Welcome Page for nursing homes and swing bed providers, not located in critical access hospitals, to use to submit MDS 3.0 assessment records. MDS 3.0 assessment records will be submitted to the Assessment Submission And Processing (ASAP) system located on a CMS national server. The MDS 2.0 Submission link will also continue to be available and the process for submitting these records will not be changing.

MDS 3.0 submission files are required to be compressed files ending with a .zip extension. After a file is submitted to ASAP, a confirmation message will appear on the web page indicating that the submission has been received. There will not be an Initial Feedback report. A Final Validation Report will be automatically generated and placed in CASPER under Folders. Users will be required to log into CASPER to obtain Final Validation Reports.

The MDS 3.0 Provider User's Guide provides detailed information on the submission process. This guide is available on the QTSO website under the MDS 3.0 link at: https://www.qtso.com/mds30.html

MDS 3.0 Missing Assessment Report

The Missing Assessment Report is currently automatically generated on the fifth day of each month and placed in the same location as MDS validation reports on the MDS System. The MDS 3.0 Missing Assessment Report will be available in CASPER for nursing homes to generate and will not be automatically generated.

The Missing Assessment Report lists residents in a facility for whom the effective date of the most recent assessment is more than 138 days in the past and is not a discharge record. This report is a good tool for nursing homes to use to help ensure all required MDS assessments are completed and successfully submitted to the MDS System. Nursing homes are encouraged to generate the Missing Assessment Report once a month and to follow up on all residents that are listed on this report. If you have questions about this report, contact Chris Benesh at (608) 266-1718.

Medicaid Reimbursement

Effective October 1, 2010, nursing home providers will begin using the MDS 3.0/RUGS IV-48 classification system for Medicaid residents. The new system does not affect Medicaid Fee for Service billing or rates in the current rate period of July 1, 2010 - June 30, 2011. The first picture date that will reflect this change will be December 31, 2010, and the first fee for service rates based on RUGS IV-48 will be July 1, 2011. MDS 3.0 Section Z items Z0200 and Z0250 are not required to be coded and may be left blank.

Nursing Home and Home Health Agency New System Security Requirements

Effective November 15, 2010, CMS is requiring providers that access the CASPER reporting system and/or the Assessment Submission and Processing (ASAP) system, used for submitting MDS 3.0 records, to activate the Transport Layer Security (TLS) 1.0 in Internet Explorer. The MDS and OASIS Welcome pages also include an alert message about this new system security requirement. Use the following steps to make this change:

1. Open the Internet Explorer browser.
2. Select "Tools" from the Menu bar.
3. Click on "Internet Options."
4. Select the "Advanced" tab.
5. Under "Security," ensure that the box next to "Use TLS 1.0" is checked. (This should be located near the bottom of the list.)
6. Click "Apply."
7. Click "Ok."

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OASIS Basics' Training Scheduled
Bureau of Technology, Licensing and Education

The Division of Quality Assurance is pleased to offer an 'OASIS Basics' training, to be held December 2, 2010 in Fond du Lac at the Holiday Inn. The full day of training is targeting individuals fairly new to OASIS, who have responsibility for completing OASIS assessments, or administrative and supervisory staff whose responsibilities include oversight of OASIS assessments. This training also serves as an in-depth OASIS-C refresher course for clinicians who desire greater accuracy in answering the OASIS questions and is appropriate for home health agencies that wish to learn about OASIS in order to obtain their Medicare certification.

A brochure detailing the offering can be obtained on the DQA's Provider Training webpage at: http://www.dhs.wisconsin.gov/rl_DSL/Training/dqaProvTrng.htm

The program trainer is Mary Jo Sutton, Wisconsin's OASIS Education Coordinator. E-mail any questions related to program content to: MaryJo.Sutton@wi.gov

The program/fee includes training materials, certificate of attendance, continental breakfast, lunch, and an afternoon refreshment break. The conference begins at 8:30 a.m. and concludes at 4:00 p.m. for the day.

The registration deadline is November 22, 2010. Online registration is required at: https://charge.wisc.edu/quality/oasis2010

If you have difficulty registering online, send an e-mail to Leann.Graffin@wi.gov or call Leann Graffin directly at 608-267-1438.

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CBRF Department-Approved Training: First Quarter Reports
 and Survey Results
Bureau of Assisted Living

As part of the DHS inter-agency agreement with UW Oshkosh, quarterly reports are produced showing the number of approved instructors on the registry, number of students on the registry, number of classes conducted, and scatter maps of instructor locations. In addition, the Bureau of Assisted Living conducted a survey regarding the program. A PowerPoint and maps summarizing this information can be found at the following link --- Assisted Living Forum Archive, September 13, 2010: http://www.dhs.wisconsin.gov/rl_dsl/Providers/asstdLvgForum.htm

Kevin Coughlin, Director of the Bureau of Assisted Living, stated, "We are very pleased with the numbers we are seeing in the reports. They greatly surpassed our projections. Also, despite only the first quarter rollout of a very complex and comprehensive program, the satisfaction rates are very high from the survey conducted. We will be analyzing all this information from the reports and survey and will be working toward continuous quality improvement. We also hope the "market place" will take this information and help fill in the gaps where we need more instructors and for more Train the Trainer (TtT) programs."

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OASIS Updates
Bureau of Technology, Licensing and Education

OASIS Quarterly Q&As and the OCCB Website

In July 2010, the 26 newest OASIS Q&As were released by the Centers for Medicare and Medicaid Services (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 mid-October. 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 has recently been revised 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 of the home page on the revised website at: www.oasiscertificate.org.

OASIS-C Guidance Manual and Errata Sheets

CMS released a second OASIS "Errata sheet," dated June 2010, which contains changes to the OASIS-C Guidance Manual. 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. The Errata revisions are effective immediately upon publication, and will be incorporated into the next republication of the entire Manual. The June Errata sheet can be found by scrolling to the bottom of the following webpage:
http://www.cms.gov/HomeHealthQualityInits/14_
HHQIOASISUserManual.asp

CMS published the first Errata sheet early in December 2009 and, because there were so many revisions/corrections at that time, they did re-publish the entire Guidance Manual with revisions to chapters 1, 3, 5, and several Appendices.

NOTE: The Guidance Manual was republished to the above website on 12/23/09, after the first Errata sheet was released and, though the Manual is still dated September 2009, all the items from the first Errata sheet have been incorporated into the revised Manual. Each HHA will want to make sure they have the revised Manual, since much of the clinical guidance has been revised/updated from the initial version used in training for OASIS-C.

OBQM Manual and Reports

CMS has announced the release of the revised Outcome Based Quality Monitoring (OBQM) Manual and Appendix A, which has been re-written for OASIS-C.

The OBQM Manual describes the OASIS-based OBQM reports that are available, as well as instructions for using these reports for quality monitoring. It is designed to help HHAs make use of their reports for monitoring and improving quality of care to their patients.

Appendix A: Guidelines for Reviewing Potentially Avoidable Event and Agency Patient-Related Characteristics Reports includes descriptions, definitions, and "How to Read" instructions for the Potentially Avoidable Event and Agency Patient-Related Characteristics reports. Obtain the new OBQM Manual by scrolling to the bottom of this webpage: http://www.cms.gov/HomeHealthQualityInits/18_
HHQIOASISOBQM.asp

The OBQM reports for HHAs to use to monitor conditions within their agency include the "Potentially Avoidable Event" report and the "Patient-Related Characteristics" report. Both reports allow each HHA to compare their agency's results to national data and to their own data in a prior period.

The "Potentially Avoidable Events" report (formerly the Adverse Event report) displays incidence rates for 12 untoward events. These potentially avoidable events serve as markers for potential problems in care delivery because of their negative nature. Whether an individual patient situation results from inadequate care can only be determined through internal investigation. Measures are presented in graphical and tabular forms, along with a listing of patients for whom the event occurred. This allows the HHA to investigate individual, potentially avoidable events to determine if changes in care practices are indicated.

The "Agency Patient-Related Characteristics Report" (formerly the Case Mix Report) presents a "snapshot" of HHA patient characteristics at the start or resumption of care and includes length of stay and emergency or hospital care information. Characteristics of an agency's patients can impact many decisions about patient care delivery, staffing, resource allocation, strategic planning, and program development.

Of particular interest is what CMS has to say about OBQM: "The reports and the related investigation of care processes can be used to assist agencies to move beyond 'hunches' in understanding the characteristics of the patients that they care for and evaluating quality of patient care. The reports support agency efforts to continually monitor outcomes and focus efforts on specific quality indicators. Agencies are strongly encouraged to take advantage of the information presented in the reports to provide direction for their continuous quality monitoring activities."

OBQI Manual

CMS has announced the release of the revised Outcome Based Quality Improvement (OBQI) Manual and Appendices A and B, which also have been re-written for OASIS-C. The Manual focuses on the use of the OBQI Reports for quality/performance improvement. It provides background information on OBQI (and OASIS) and then discusses the steps/activities of outcome enhancement, including interpretation of the OBQI Reports, selecting target outcome(s), activities involved in the investigation-of-care processes, developing and implementing a written plan of action to modify care delivery, and internal agency processes for successful implementation. The manual includes a summary of strategies for establishing an effective OBQI system. Appendix A includes "How-to Read" guidelines for the OBQI reports and, in Appendix B, key terms related to OBQI are defined. You can obtain a copy of the new OBQI Manual by scrolling to the "Downloads" area at the bottom of this webpage: http://www.cms.gov/HomeHealthQualityInits/16_
HHQIOASISOBQI.asp

OASIS-C Process Measure Reports

The OASIS-C Process Measure reports are now available in CASPER, as of September 1, 2010. Each HHA can access their reports through a link on the state's OASIS Welcome Page, the same webpage HHAs use for transmitting OASIS submissions. A User's Guide is also available on the Welcome Page. The reports will only have six months of data available as of September 13th, but will be expanded as more data is available. CMS has created a training video on the Process Based Quality Improvement (PBQI) process, which is available on YouTube at: http://www.youtube.com/watch?v=hNno1GIVAPA

In October, the Home Health Compare website, which is being redesigned, will be updated to display a select set of the Process measures. The OASIS-B1 OBQM/OBQI reports will remain available to HHAs in CASPER but, to avoid confusion, will be identified under the OASIS-B1 report category.

OASIS HHRG Grouper Software Version 3210 and HAVEN

Version 3010 of the OASIS HHRG Grouper becomes effective for OASIS Assessments with a Reason for Assessment (RFA) at M0100 with a value (answer) of 01, 03, 04, or 05 and a Completion Date at M0090 of 10/1/10 or later. This version was posted to the CMS website at: http://www.cms.gov/HOmeHealthPPS/05_
CaseMixGrouperSoftware.asp and https://www.qtso.com/hhadownload.html (on the QTSO website)

Haven 10.2 will be available on September 20, 2010, also on the QTSO website noted above. Those HHAs using HAVEN, whose software has not been updated by October 1, will find that a HIPPS Code is not generated for OASIS assessments with a M0090 date of 10/1/10, or later, and will receive a warning message. Along with the warning message, the Final Validation Report will display the HIPPS Code and Version returned by the state submission system. HHAs whose vendors (other than HAVEN) have not been able to update their software by October 1st can download and use HAVEN 10.2 until their software has been updated.

OASIS 2011 Follow-Up Scheduling Calendar

The 2011 OASIS Follow-up Scheduling Calendar is now available to HHAs and can be accessed on the QTSO website at: https://www.qtso.com/hhadownload.html

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Foreign Language Services
Bureau of Technology, Licensing and Education

DHS made significant changes in its phone system in the spring of 2010. In a response to budgetary concerns and the need for a more sophisticated approach to a heavy and widely diverse call load, DHS instituted an automated phone system to better serve the residents of Wisconsin. One of the benefits of the new system is the creation of Spanish and Hmong phone menus and voicemail options.

Menu and Voicemail Options

When a caller dials the main number for DHS --- 608-266-1865 --- the caller is immediately given a choice of language options --- English, Spanish, or Hmong. If a caller chooses Spanish or Hmong, he/she hears a DHS phone menu in that language and is given an option to leave a voicemail message with a Division. Each day, each Division checks its foreign language voicemail boxes for messages and, if needed, arranges a return call with the assistance of an interpreter.

Although there are only two foreign language menus and voicemail boxes at this time, the long-range plan is to create over 30.

Translation Services

DQA has contracted with Certified Languages International (CLI) to provide translation services for the Division and now has access to interpreters for more than 175 languages. Besides providing extensive services, CLI is HIPAA compliant, Safe Harbor Certified, and Section 508 compliant.

CLI interpreters live in the U.S. and work and interact with the same language population, enabling more accurate interpretations for everyone involved in a phone call. Interpreters are certified and specially trained in the terminology of various areas --- medicine, insurance, finance, law, and government. They are also bound by confidentiality and non-disclosure agreements, and an enforced Code of Ethics.

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Email Encryption-What You Need to Know and Do
Bureau of Technology, Licensing and Education

On September 15, 2010, the Department of Health Services implemented new software designed to protect external e-mails (those going outside the state e-mail network). This software will "encrypt" e-mails or e-mail attachments containing confidential data such as Social Security Numbers or terms which may indicate the presence of sensitive information, i.e., personal health information protected under the HIPAA privacy rules. Whether a particular e-mail message is encrypted depends upon which specific terms are used and how many times the terms occur.

If an e-mail from DQA to a provider or other external recipient is encrypted, the incoming message will include the following subject line (or something similar): You have received a secure message. Read your secure message by opening the attachment, securedoc.html. When the e-mail is opened, additional guidance on how to read it is provided. Briefly, before providers or partners will be able to read an encrypted e-mail, they must first register with Cisco Registered E-mail Service. This involves creating a user ID and password, which is then used whenever opening an encrypted e-mail from DQA. Registration only needs to occur the first time an encrypted e-mail is received. When opening any subsequent encrypted e-mails, the recipient will only need to enter his or her password.

The Department of Health Services has created an online tutorial explaining e-mail encryption and the process external recipients will need to follow in order to read encrypted e-mails. A link to this tutorial is located at: https://connect.wisconsin.gov/dhspartencrypttrain

DQA is also pursuing the creation of special secure accounts that will enable providers to receive e-mails from Division staff free of encryption. More information on the process for establishing these accounts will be provided soon via DQA numbered memo. In the meantime, if you receive an encrypted e-mail from the Division, follow the procedures outlined in the online tutorial.

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DQA to Create Provider Portal and to Post Statements of 
Deficiency for Nursing Facilities
Bureau of Technology, Licensing and Education

DQA is partnering with HP Enterprise Services to create a web-based "provider portal" which will give external customers the ability to query the Division's databases for information about regulated facilities and other providers. This portal, which will be integrated with the existing Forward Health system that is already accessible on the Department of Health Services website at http://www.dhs.wisconsin.gov/forwardhealth/, will feature a search function enabling consumers to find information about specific providers based on several criteria, including provider type, geographic location, and services offered. The portal will also utilize mapping software to display the location of providers meeting the search criteria and enable users to retrieve driving directions. By linking to a particular provider, consumers will be able to view basic information such as contact names, telephone numbers, and licensure status.

Also, in response to language in section 6103 of the Patient Protection and Affordable Care Act of 2010 (ACA), the portal will be used to provide access to copies of Form 2567 inspection reports (Statements of Deficiency or SODs) and Provider Plans of Correction (POCs) for nursing facilities. The ACA directed the Centers for Medicare and Medicaid Services (CMS) to make this and other information available "in a manner that is prominent, updated on a timely basis, easily accessible, readily understandable to consumers of long-term care services, and searchable." 

CMS has stated that state survey agencies will need to begin posting SODs and POCs for nursing facilities on their own websites no later than March of 2012; DQA's development plan for the provider portal anticipates having this information available by April 2011. A second development phase will expand the availability of SODs and POCs to include other provider types regulated by DQA.

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UPCOMING EVENTS

FOCUS 2010
Bureau of Technology, Licensing and Education

Conference:  Striving for Excellence in Challenging Times November 18, 2010

Special Session: The Art and Science of Infection PREVENTION and Control November 17, 2010

Registration Deadline: Wednesday, November 3, 2010

Online Registration:  https://charge.wisc.edu/quality/focus2010.asp  (Payment may be made with a Check, Master Card, or VISA.)

The Wisconsin Department of Health Services, Division of Quality Assurance (DQA), is pleased to announce the 10th annual conference for health care providers and DQA staff. The Focus 2010 Conference is developed in collaboration with health care providers and associations. At FOCUS 2010 you will have access to leading experts in the field, the chance to network with others, and an opportunity to visit the numerous exhibit booths. Visit the FOCUS 2010 website for detailed information about the conference at: http://www.dhs.wisconsin.gov/rl_dsl/Training/focus10.htm

Online registration will be required this year. Since this is a first-come-first-served registration process, this ensures accuracy and that all registrants have the opportunity to reserve a seat at the conference. Register online with a Check, Master Card or VISA at: https://charge.wisc.edu/quality/focus2010.asp  Conference registrations are flowing in, so don't delay!

The conference is being held at the Kalahari Convention Center, Wisconsin Dells, WI. To make a hotel room reservation, call (608) 254-5466. Blocks of rooms are reserved under FOCUS 2010. When making room reservations, you must indicate it is for FOCUS 2010 to receive a special room rate.

FOCUS 2010 is once again GOING GREEN! A CD with presenter handouts will be given to each attendee at registration the day of the conference. If you would like to print them prior to the conference, they are available at: http://www.dhs.wisconsin.gov/rl_dsl/Training/focus10.htm  Thank you for helping in the effort to preserve Wisconsin resources.

NOTE: Breakout Session No. 602, Essentials of Assisted Living Enforcement - An Introduction and Discussion. In this session, Assisted Living staff will address the objectives of the enforcement process, violations that are targeted for enforcement, the sanctions available, and how they are determined. If you are planning to attend this breakout session, submit your questions to an online survey at: https://doa.wi.gov/DHSSurveys/TakeSurvey.aspx?SurveyID=86ML3o5M

See you at the FOCUS 2010 Conference!

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REGULAR FEATURES

Changes in DQA Staff
Office of Caregiver Quality

Jessica Link joined the Office of Caregiver Quality as the Human Services Program Coordinator for nurse aide training and testing and registry issues on September 7, 2010. Jessica can be reached at (608) 261-8334 or at: Jessica.Link@wisconsin.gov

Tom Wilczewski started with the Office of Caregiver Quality on September 13, 2010 as the Office Operations Associate for the intake of caregiver misconduct complaints. Tom can be reached at (608) 264-6720 or at: DHSCaregiverIntake@wisconsin.gov

Bureau of Health Services

Ann Hansen is the new Quality Assurance Program Specialist-Senior in BHS. Her role is that of complaint intake; data analysis, reporting, and trending; and special projects. Ann comes to BHS with a B.A. in Philosophy and has experience with federal and state regulations, complaint intake, policy/tool development, training, data analysis and trending, and effective communication. Ann's first day in DQA was August 2, 2010. She is located at the Central Office.

Deb Sobczak was hired in June as one of our two new Personal Care Agency Nurse Surveyors. Prior to State employment, Deb worked as a Case Manager/Utilization Review Nurse for a Wisconsin Managed Care Organization. Deb's new duties will take her throughout the State conducting surveys of personal care agencies.

Maura McNamee was also hired in June as a Personal Care Agency Nurse Surveyor. Maura came to DHS from the Department of Corrections and her previous work includes employment with a HHA. She too will travel throughout Wisconsin conducting PCA surveys.

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DQA Numbered Memos (July, August, September 2010)
Administrator's Office

Listed below are DQA Numbered Memos distributed during the last quarter. You can view these memos on the internet at: http://www.dhs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm and http://dhs.wisconsin.gov/rl_DSL/

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DHS Administrative Rules Update
Administrator's Office

DQA Omnibus Rule (located within DHS 12)
DHS 12 - Caregiver Background Checks
DHS 83 - Community-Based Residential Facilities
DHS 88 - Adult Family Homes
DHS 124 - Hospitals
DHS 127 - Rural Medical Centers
DHS 148 - Laboratory Certification
DHS 148 - Cancer and Chronic Disease Drug Repository Program

The Department proposed to make a number of changes, primarily of a minor and technical nature, to the above identified rules to update, correct, or remove outdated rule provisions and cross-references. The Final Proposed Rulemaking Order was filed on August 30, 2010 and can be viewed on the Wisconsin 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, Hospitals. 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. A revised Statement of Scope was posted on the Wisconsin Administrative Rules website and can be viewed at the following link: https://health.wisconsin.gov/admrules/public/Home

DHS 131 - Hospices

On October 1, 2010, Wisconsin Administrative Code, Chapter DHS 131, Hospices, went into effect. DHS 131 was revised to align the rule with recently revised federal Medicare regulations, eliminate outdated regulations, and reflect current professional standards of practice. The Department worked with the Hospice Organization and Palliative Experts (HOPE) of Wisconsin, hospices, and hospice consumers to revise ch. DHS 131. The revised rule is available at: http://www.legis.state.wi.us/rsb/code/dhs/dhs131.pdf

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CMS Survey & Certification Letters (July, August, September 2010)

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

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

MAIL SUBSCRIPTION SERVICES

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

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Last Updated: June 18, 2013