DQA Quarterly
Information Update
October 2008
PDF Version of this month's Quarterly Update (PDF,
117 KB)
NEW THIS ISSUE
REGULAR FEATURES
UPCOMING EVENTS
RAI / MDS Provider Training
The Division of Quality Assurance will be presenting two training
opportunities for nursing home staff who are involved with using Resident
Assessment Instrument (RAI) and completing Minimum Data Set (MDS)
assessments and/or are responsible for the transmission of MDS assessment
records to the CMS State MDS System. These programs will be held on
November 5th and 6th 2008, at the Holiday Inn in Fond du Lac.
The RAI Basics program will be held on November 5th and is intended for
nursing home staff that are new to using the RAI and completing MDS
assessments, and for staff that would like a refresher in the basic coding
of assessments.
MDS Automation training will be held on November 6th. This program will
review the process required to connect to the CMS State MDS System to
transmit MDS records, retrieving and interrupting validation reports, and
how to use the Certification and Survey Provider Enhanced Reporting (CASPER)
to retrieve Quality Measure/Indicator Reports and other MDS related reports.
These training programs are separate workshops and interested individuals
may register for either program or both programs. Training brochures and
registration forms have been mailed to all nursing homes. The training
brochure and online registration are also available on the DQA online
educational opportunity information website at http://www.dhs.wisconsin.gov/rl_DSL/Training/index.htm
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Adult Family Home Webcast - Opening a New AFH
Since 2004, the Bureau of Assisted Living has issued 584 AFH licenses,
many of these to first time license holders. Many of the Department of
Health Service initiatives to move more consumers from institutions to the
community has lead to this explosive growth.
In response to this growth, the Bureau of Assisted Living has developed a
webcast to help new providers understand the complexity of starting a
facility and the challenges they will face caring for some of Wisconsin's
most vulnerable citizens.
The webcast includes information about Wisconsin Administrative Code HFS
88 regulations for AFHs, as well as links to resources regarding public
funding, provider associations, emergency preparedness, Wisconsin Caregiver
Law, and others.
We hope this resource will help prepare new Adult Family Home providers
with the tools they will need to provide the best care possible to their
residents. A link to the webcast can be found at
http://www.dhs.wisconsin.gov/rl_dsl/Training/dqaWebcasts.htm
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Hospice Conditions of Participation
The new federal Conditions of Participation for hospices were published
on June 5, 2008 and will become effective December 2, 2008.
The CMS (Centers for Medicaid and Medicare Services) staff is currently
working on the interpretive guidelines which will give state agency and
hospice staff further guidance as to the intent of the new Conditions. The
guidelines have not yet been released.
As a result of the issuance of the federal Conditions of Participation, a
workgroup comprised of hospice provider representatives and DQA staff is
reviewing the current Wisconsin Administrative Code HFS 131 for needed
revisions.
The plan is to first identify areas of DHS 131 which may need to be
waived temporarily to be consistent with the new federal Conditions.
Secondly, the workgroup will re-write DHS 131 to better align it with the
federal regulations, keeping in mind that Wisconsin may choose to remain
more stringent than the federal regulations in some areas.
The re-write process of DHS 131 will likely take several months before it
is ready for submission to the legislature for action.
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Medication Management Initiative - Coming Soon to a
Computer Near You!
The Bureau of Assisted Living is very excited to announce that the
Assisted Living Medication Management Initiative (M2I) will soon be
available on our website. M2I is the product of our proactive response to
concerns about medication errors, medication administration, and the
increasing acuity of individuals residing in assisted living facilities.
The website will include information on a variety of medication related
topics and is intended to support the improvement of medication delivery
systems in assisted living facilities. Providers are encouraged to submit
materials such as best practice resources, and forms for inclusion on the
website.
Completion of the M2I website will be announced by DQA memo and is
expected to occur sometime in October 2008.
It is the Bureau of Assisted Living's intent that this website will serve
as a "living document" to which information will be added on an
on-going basis. We encourage all interested parties to submit materials for
possible inclusion on the website.
The Bureau's Quality Assurance Committee will review all submissions and
post as appropriate. If you would like to submit materials, please contact
the Assisted Living Regional Director in your region.
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MDS 3.0 is Coming!
The Centers for Medicare and Medicaid Services (CMS) has announced a
timeline for the implementation of MDS 3.0. The final implementation date
will be October of 2009. The purpose of the MDS 3.0 revisions is to improve
the clinical relevance and accuracy of MDS assessments, increase the voice
of residents in assessments, improve ease of use, and increase the
efficiency of MDS reports. The MDS 3.0 assessment has been tested in 71
community nursing homes in 8 states and 19 VA nursing homes; results were
very positive.
The Division of Quality Assurance will be providing training and updates
as CMS moves forward with implementation. Information about MDS 3.0
including the Implementation Timeline, Final Report, and MDS 3.0 vs. MDS 2.0
Crosswalk (draft) are available on the CMS MDS 3.0 website at
http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp.
Nursing facility staff may also contact DQA with specific questions:
Clinical
Margaret (Peg) Katz
RAI/MDS Education Coordinator
(715) 836-6748
margaret.katz@wisconsin.gov
Technical/Automation
Chris Benesh
MDS Automation Coordinator
(608) 266-1718
chris.benesh@wisconsin.gov
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MDS and OASIS Broadband Connection
In July, 2007, Wisconsin nursing homes and home health agencies were able
to convert from dial-up to broadband for MDS and OASIS assessment
submissions. Sometime in the near future CMS will no longer allow dial-up.
Providers will be required to use broadband to connect to the CMS State MDS
and OASIS System.
In order to use a broadband connection it is necessary to update the
AT&T's Global Network Client software. The most current version is
7.2.1. You can check the version of the AT&T Global Network Client you
have by launching the client, left mouse click "Help" on the top
menu bar, and select "About." The version number and date will be
displayed.
Providers can download the AT&T Global Network Client software by
logging onto https://www.qtso.com and
selecting the MDCN/AT&T Client Software Information link in the blue
outlined box on the right-hand side of the page. Installation instructions,
including network configurations, are also available on this website.
The use of broadband may involve some adjustments depending on your
particular computer environment. For example, if you are on a corporate wide
area network (WAN) or a local area network (LAN), your network administrator
will probably have to configure your network to allow access to the
network's broadband connection through the new client.
The 7.2.1 version and previous versions of the AT&T Network Client do
not support Network Address Translation (NAT) or using network printers. CMS
is working to resolve these issues and expects to have a new version of the
AT&T Network Client available soon that will correct these problems.
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New HHA OBQI Risk Models
New home health (HH) Outcome Based Quality Improvement (OBQI) risk models
have been developed and implemented into the HH Casper reports since the end
of July. Now all 41 of the outcome measures are risk-adjusted and are
included in the Risk Adjusted Outcome Report.
Seven of the outcome measures are not considered as strongly predictive
as the remaining 34 measures. These 7 measures can be identified on the OBQI
reports by a pound sign located immediately after the outcome measure
listing. Because all outcome measures are now risk adjusted, the Descriptive
Outcome report is no longer necessary and was removed.
An updated version of the CASPER Users Guide that includes how to obtain
OBQI reports, is available on the Welcome Page of the CMS State OASIS
System. Technical updates of Appendix A and B of the OBQI manual are
available on the Home Health Quality Initiative OASIS/OBQI page of the CMS
website at http://www.cms.hhs.gov/HomeHealthQualityInits/16_HHQIOASISOBQI.asp
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New OASIS Grouper
A new OASIS grouper version 2.03 was released in late
September to accommodate changes in ICD-9 codes effective October 1, 2008.
HHAs will need to update their OASIS software to incorporate the new
grouper. OASIS records submitted to the State OASIS System that do not
include the new version of the grouper will receive Warning Message -
257.
Additional information about the new grouper will be posted
on the QIES Technical Support Office (QTSO) website at https://www.qtso.com
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New HHA Quality Improvement Report
The Home Health Quality Improvement (HHQI) national campaign
which included Quality Improvement Organizations (QIO) involvement ran
through July 2008, which was focused on decreasing the percentage of HHA
patients requiring acute care hospitalization (ACH) while under the HHA's
care.
Through this campaign, a monthly report was generated and
distributed to all participating Medicare certified HHAs, to help them
improve their ACH rate. With the end of this campaign, the QIOs highly
recommended that CMS continue providing the monthly report to HHAs. Thus, a
new CASPER report titled HHA Trend Analysis Report became available the end
of September 2008.
The HHA Trend Analysis Report will include all 41 outcome
measures and will list the actual and risk-adjusted rates along with the
state and national percentile rankings. This new report will be available in
the OBQI Report category of CASPER.
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OASIS Clarification for M0150
Recently, with the expansion of Family Care in Wisconsin,
HHAs have had questions related to how to answer the OASIS item M0150 -
Current Payment Source for Home Care, for a patient who is being provided
with home health services under Family Care.
Family Care is a managed care program that is supported by
Medicaid funding under an approved Medicaid waiver. Most Family Care
participants are Medicaid eligible. OASIS applies to home health agency
skilled patients who are Family Care members and who are Medicaid eligible.
OASIS item M0150 should be answered 3 - Medicaid (traditional
fee-for-service) for these patients because response 3 includes patients
receiving services provided as part of a Medicaid waiver. Response 7 should
be coded for non-Medicaid eligible Family Care skilled patients. OASIS would
not apply for these patients unless the patient is also covered under
Medicare for their home health services, then M0150 response 1 or 2 would
also be coded.
Information about the coding of M0150 for Family Care
patients was initially addressed in a BQA (now DQA) Quarterly Newsletter
article in the May 2006 issue.
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New Construction Plan Review Status Report
As a result of collaboration with various stakeholders
regarding the status of construction plans submitted, the Division of
Quality Assurance staff has developed a report that will be posted weekly.
This report will provide the plan status of the previous week. The report
can be accessed at
http://www.dhs.wisconsin.gov/rl_dsl/PlanReview/index.htm
If you have any questions, please contact
Jan Heimbruch (608) 266-0371 or
Mark Andrews (608) 266-0269
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Office of Caregiver Quality (OCQ) Updates
Wisconsin Nurse Aide Verification
Recently, the Department has received a number of questions from
healthcare providers as to whether a nurse aide from another state can work
in Wisconsin before being listed on the Wisconsin Nurse Aide Registry.
Per Wisconsin State Statute 146.40, a person must be listed on the
Wisconsin Nurse Aide Registry, current, and in good standing in order to
work as a nurse aide in Wisconsin nursing homes, hospitals, ICF/MRs, home
health, and hospice agencies.
Some facilities felt that checking the nurse aide's status in the state
they were transferring from prior to employing them was sufficient. This is
not correct. Each state has its own statutes and/or rules for training,
testing, registry placement, and eligibility to work as a nurse aide in that
state. Some examples include:
- Some states allow an individual to take the test without having to
complete a training program; Wisconsin does not.
- Some states include individuals who completed less than the minimum 75
hours of training required by CFR 42, paragraph 483.152, listed on its
registry; Wisconsin does not.
- Some states do not track whether a nurse aide has performed nursing
related duties in the previous 24-month time period as required by CFR
42, paragraph 483.75; Wisconsin does track this requirement.
Wisconsin State Statute 146.40 states that individuals must successfully
complete a training program and competency evaluation program approved by
the Department of Health Services. The Department has reviewed the training
and testing programs for all states and approved only those state programs
that meet the requirements specified in Wisconsin State Statute 146.40 and
HFS 129, Wisconsin Administrative Code.
In other instances, some healthcare providers have allowed individuals
from another state to work in their facility based on CFR 42, paragraph
483.75, which applies only to nurse aide students employed in a federally
certified nursing home. A nurse aide student who is actively enrolled in a
nurse aide training program may be permitted to work for 120 calendar days
from the date of enrollment, if that person is employed full-time by a
federally certified nursing home.
This student may be allowed to provide direct nursing related duties for
which the student has been trained and found proficient by the primary
instructor. The employer must ensure that the student does not perform
services for which they have not been trained and found competent to
perform. Students who provide services to residents must be under the
general supervision of an RN or LPN.
By the 120th day, the individual must have successfully completed both
the written and skills portions of the competency evaluation examination
program and be listed on the state's registry in order to continue
performing nurse aide duties. However, a nurse aide transferring from
another state is not a nurse aide student and this exception does not apply
to nurse aide transfers.
If your facility is a nursing home, ICF/MR, home health agency, or
hospice, and the individual you are considering for employment as a nurse
aide is not listed on the Wisconsin Nurse Aide Registry, the person can not
be hired to perform nurse aide duties at your facility. You must verify that
the person is included on the Wisconsin Nurse Aide Registry prior to hiring
them as a nurse aide.
For additional information regarding the Wisconsin Nurse Aide Registry,
please see the Wisconsin Nurse Aide Training Program & Registry Manual
at http://www.dhs.wisconsin.gov/caregiver/publications/NATDMan.htm
DQA Wins National Award for Abuse Prevention Training
The Division's Office of Caregiver Quality (OCQ) is the winner of the
2008 Association of Health Facility Survey Agencies' Promising Practices
award in the education category. The Wisconsin submission was based on the
CMS-sponsored Caregiver Project, which developed and delivered statewide
abuse and neglect prevention training for direct caregivers in long-term
care settings.
Over 34 hours of multi-media training was developed during the project,
in which OCQ partnered with the UW-Oshkosh Center for Career Development and
Employability Training.
Training materials include eight reality-based scenarios of caregiver
misconduct in which participants take on the life of another character in
order to learn skills to prevent abuse and neglect. This training is
available as both a live training and on DVD.
Additional training topics include Keys to Professional Caregiving,
Supporting the Professional Caregiver, Conducting Internal Investigations of
Caregiver Misconduct, and Responding to Challenging Situations. All training
materials are available at http://www.dhs.wisconsin.gov/caregiver/training/trgIndex.htm
In order to sustain the training, DQA has offered train-the-trainer
sessions to facilities statewide. Between October 2007 and July 2008, 383
persons attended a variety of workshops. Participants estimated that they,
in turn, expected to train over 60,000 direct caregivers. Additional
workshops are scheduled this fall. To register or get more information, go
to http://www.caregiverproject.org
Questions? Contact:
DQA Office of Caregiver Quality
(608) 261-8319 Phone
(608) 264-6340 Fax
DHSCaregiverIntake@wisconsin.gov
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Federal Regulations Updates - F371 & F325
Recently, CMS has revised the federal regulations for F371 and F325.
Effective 9/1/08, F370 has merged with F371. F326 has merged with F325. The
regulatory language for F371 and F325 has not changed, but the interpretive
guidelines have. The revisions were made to provide definition, education,
clarification, and surveyor guidance.
F371 revised guidance includes, but is not limited to, references to
current standards of practice, clarification on "no bare hand"
contact with ready to eat foods, approved food sources, time and temperature
control systems, danger zone temperatures (above 41 degrees and below 135
degrees), the need for surveyors to increase their observation time spent in
the SNF kitchens, and examples of citations with severity clarification.
A collaborative effort with Public Health, CMS, and DQA has resulted in a
webcast, which can be viewed in the DQA Webcast Library under F371 Sanitary
Conditions at http://www.dhs.wisconsin.gov/rl_dsl/Training/dqaWebcasts.htm
F325 revised guidance includes, but is not limited to, acceptable
parameters of nutritional status, avoidable and unavoidable examples of
those parameters not being met, current standards of practice, dietary
supplements (vitamins, etc.), nutrition supplements (Ensure, food
supplements, etc.), insidious weight loss, and therapeutic diet now
including mechanically altered foods. It also includes the need for
surveyors to review all of Phase 1 sampled residents on the respective
parameters of nutritional status.
Previously, surveyors only reviewed residents that flagged on the matrix
for weight concerns. A webcast, for both surveyors and providers, concerning
the newly revised tag has been added to the DQA Webcast Library under F325
Nutrition at http://www.dhs.wisconsin.gov/rl_dsl/Training/dqaWebcasts.htm
The current MDS, Version 2.0, does not reflect the F325 changes on
mechanically altered diets. Continue to code the MDS, Version 2.0, as your
current practice, which states, "A mechanically altered diet should not
automatically be considered a therapeutic diet." The MDS is in the
process of being updated.
A Q & A document for F371 & F325 is in the process of being
developed. This document will be posted on the web. For further assistance
on these issues, contact:
Kitty Friend
414-227-4106
Katherine.Friend@wisconsin.gov
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September was National Preparedness Month
Check out the info at:
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2007 Wisconsin Act 108 Relating to Treatment Records and
Patient Health Care Records
Health information exchange (HIE) is necessary to improve the quality and
safety of health care. Variations in health information privacy law can
result in limitations on the development of HIE in Wisconsin. On March 17,
2008, Governor Jim Doyle signed 2007 Wisconsin Act 108 into law addressing
certain of these limitations.
The new law makes changes to Chapters 51.30 and 146, Wis. Stats.,
relating to the confidentiality of patient records and disclosure of health
information. All provisions of Act 108 are effective as of October 1, 2008.
For Department guidance regarding the provisions of Act 108, please refer
to the memo issued jointly by the Office of Policy Initiative and Budget,
Division of Mental Health and Substance Abuse Services and the Division of
Quality Assurance at http://wiredboard.wisconsin.gov
Please direct your questions or comments regarding the implementation of
Act 108 to the contacts identified on page four of the memo.
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REGULAR FEATURES
Changes in DQA Staff
Bureau of Assisted Living - SERO
Sharon Gries joined the Southeast Regional Office as a Nurse Consultant
assisted living surveyor on 9/15/08. Sharon has an excellent background in
nursing, including as a CNA trainer, Director of Health Services, and as a
RN Manager for a Residential Care Apartment Complex (RCAC).
Bureau of Assisted Living - NRO
With the vacancy of the Assisted Living Regional Director in the Northern
Region Office (NRO), Susan Murphy, Assisted Living Regional Director of the
Western Regional Office (WRO) has been appointed the interim director for
the NRO. Providers should still contact the NRO for any of their
correspondence.
Life Safety Code Engineer Assignment - Short Term Changes for the
Bureau of Nursing Home Resident Care and Bureau of Assisted Living
Effective October 1, 2008, DQA made short term assignment
adjustments of Life Safety Code surveys and plan reviews for assisted living
and nursing home facilities in the State. These reassignments are the result
of staff vacancies and are temporary. DQA is actively attempting to fill its
open positions and return assignments to the appropriate regional offices as
soon as possible.
Questions regarding these temporary assignments can be directed to the
regional offices:
NRO: Northern Regional Office - Rhinelander
NERO: Northeastern Regional Office - Green Bay
SRO: Southern Regional Office - Madison
SERO: Southeastern Regional Office - Milwaukee
WRO: Western Regional Office - Eau Claire
http://www.dhs.wisconsin.gov/rl_DSL/Contacts/reglmap.htm
Listed below are the counties affected by this temporary change.
-
The following counties will be temporarily
reassigned from NRO to WRO: Clark, Rusk, Taylor
-
The following counties will be temporarily
reassigned from NRO to SRO: Adams, Juneau
-
The following counties will be temporarily
reassigned from NERO to SRO: Green Lake, Marquette, Waushara
-
The following counties will be temporarily
reassigned from NERO to NRO: Door, Kewaunee, Marinette,
Menominee, Oconto, Shawano
-
The following counties will be temporarily
reassigned from NERO to SERO: Fond du Lac, Sheboygan
-
The following counties will be temporarily
reassigned from NERO to BHS (Bureau of Health Services): Brown,
Calumet, Manitowoc, Outagamie, Waupaca, Winnebago
CLIA Section Contact
If there are any questions regarding Clinical Labs or CLIA regulations,
please contact:
Barbara Saar, QAPS Senior
(608) 261-0653
Barbara.Saar@wisconsin.gov
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DQA Numbered Memos (July, August, September)
Access these memos via http://www.dhs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm
or from individual providers' publications pages via http://www.dhs.wisconsin.gov/rl_DSL/
|
Memo No. |
Title |
Summary |
Providers Affected |
|
08-022
|
Wisconsin Nurse Aide Certificate Update
|
The purpose of this memo is to provide clarification
regarding nurse aide requirements for employment eligibility in
healthcare provider settings in Wisconsin, and to explain the
rationale for removing the expiration date from the Nurse Aide Card.
|
Licensed Adult Family Homes, Community Based Residential Facilities,
Facilities Serving People with Developmental Disabilities, Home Health Agencies, Hospices,
Hospitals, Nurse Aide Training Programs, Nursing Homes, Residential Care Apartment Complexes
|
|
08-023
|
Electronic Video Monitoring and Filming in BAL
Regulated Facilities |
This memo provides guidance to providers on the
impact of electronic video monitoring and filming on residents and
tenants' right to privacy in facilities regulated by the Bureau of
Assisted Living (BAL). It describes the permissible circumstances and locations for
facility-initiated use of electronic video monitoring or filming
equipment under existing Wisconsin State Statutes and Administrative
Rules.
|
Adult Family Homes, Community Based Residential Facilities, Residential Care Apartment
Complexes
|
|
08-024
|
Assisted Living Management Initiative |
The purpose of this memo is to report on the outcome
of the Medication Management Workgroup Initiative workgroup's endeavor
and introduce the Assisted Living Medication Management Information
Website, which is the product of the initiative.
|
Adult Day Care Centers, Adult Family Homes Community
Based Residential Facilities, Residential Care Apartment Complexes
|
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HFS Administrative Rules Update
HFS 12 - Caregiver Background Checks
On May 15, 2008, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to revise Chapter HFS 12, Caregiver
Background Checks. 2007 Wisconsin Act 172 created section 50.065 (2m) (d) of
the Statutes, effective April 10, 2008. Section 50.065 (2m) (d) requires the
Department to promulgate rules to specify crimes for which an entity must
disclose to a client or the client's guardian, a conviction of a caregiver
who is assigned to provide personal care services to the client in the
client's personal residence, and to specify who is a "substitute
caregiver."
The Department asked representatives from advocacy organizations, trade
and professional associations, and other interested parties to review the
proposed rule and make recommendations for change. The Department revised
the proposed rule based upon comments received. For more information, you
may view the Statement of Scope on the Wisconsin Administrative Rules
website at https://health.wisconsin.gov/admrules/public/Home
HFS 83 - Community Based Residential Facilities
On October 18, 2007, the Wisconsin Administrative Register published the
Initial Proposed Rulemaking Order including a summary and text of the
proposed rule, Wisconsin Administrative Code Chapter DHS 83. The goal of the
proposed rule is to focus on resident outcomes and quality of life and
quality of care, improve readability and organization, eliminate excess and
prescriptive language, revise staff training standards establishing a more
cost effective system for providers, and promote the use of nationally
recognized standards of practice.
Public hearings were held in December 2007 in five locations: Eau Claire,
Milwaukee, Green Bay, Rhinelander, and Madison. The final proposed Rule
Order and Report to the Legislature were submitted to the legislature on
August 29. For more information, you may view the proposed rule on the
Wisconsin Administrative Rules website at https://health.wisconsin.gov/admrules/public/Home
HFS 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 Department
revised the proposed rule based upon comments from the Advisory Committee.
The proposed Rule Order is currently under review by the DHS Office of Legal
Counsel. For more information, you may view the Statement of Scope on the
Wisconsin Administrative Rules website at https://health.wisconsin.gov/admrules/public/Home
DHS 124 - Hospitals
On April 1, 2005, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter 124. The Department is
planning to update Chapter DHS 124 to eliminate overly prescriptive and
outdated regulations, clarify the Department's enforcement authority, and
make the rule more consistent with the federal Medicare requirements.
The Department asked representatives from a large number of trade and
professional associations, hospitals, and other interested parties, to
review proposed revisions to the rule and make recommendations for change.
The Department is reviewing their recommendations and preparing a revised
draft of Chapter DHS 124 for further review by stakeholders. For more
information, you may view the Statement of Scope on the Wisconsin
Administrative Rules website at https://health.wisconsin.gov/admrules/public/Home
DHS 129 - Certification Programs for Training and Testing Nurse
Assistants, Home Health Aides and Hospice Aides
On May 6, 2008, the Wisconsin Administrative Register published the
Initial Proposed Rulemaking Order including a summary and text of the
proposed rule, Wisconsin Administrative Code Chapter DHS 129. Through this
initiative, the Department proposes to make the rule more consistent with
federal regulations, to include the feeding assistant and medication aide
training and testing program requirements, and to reflect the Department's
decision to standardize administration and operation of nurse aide
competency evaluation by contracting for this service.
Public hearings were held in June 2008 in 4 locations: Milwaukee, Wausau,
Rice Lake and Madison. The final proposed Rule Order and Report to the
Legislature were sent to the legislature on August 25. For more information,
you may view the proposed rule on the Wisconsin Administrative Rules website
at https://health.wisconsin.gov/admrules/public/Home
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CMS Survey & Certification Letters (July, August,
September)
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 http://www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/list.asp
|
S&C No. |
Title |
Summary |
Providers Affected |
|
08-28 |
Issuance of Revised Nutrition and Sanitary Conditions
as Part of Appendix PP, SOM |
Revised guidance for long-term care surveyors
regarding Nutrition and Sanitary Conditions (Tags F325 and F371) will
be effective September 1, 2008. An advance copy of this guidance and
training slides are attached. A comprehensive training guide has been
sent to State and regional office training coordinators under separate
cover to assure that all surveyors who survey nursing homes are
trained in the revised guidance by the implementation date. |
Nursing Homes |
|
08-29 |
Revision of Publication 100-07, State Operations
Manual (SOM) - FQHCs |
Sections 2002, 2003A, 2005, and 2825-2826 of the SOM
are being revised to update general Medicare enrollment information,
as well as the process for enrolling FQHCs in Medicare, and for
handling complaints about FQHCs. A new Exhibit 179, Information on
Medicare Participation, FQHCs, is introduced and is to be made
available by Regional Offices (ROs) or State Agencies (SAs) to
potential FQHC applicants. |
Federally Qualified Health Centers |
|
08-30 |
2008 Physician Fee Schedule Changes Affecting Survey
and Certification |
On November 27, 2007, CMS published revisions to
payment policies under the Physician Fee Schedule. These changes
affected certain CMS Conditions of Participation. |
|
|
08-31 |
Draft Inperpretive Guidance for the Survey Process of
the New ESRD Conditions for Coverage |
We invite staff of State agencies, members of the
renal community, and our Federal colleagues to provide additional
input to CMS' revision of the surveyor Interpretive Guidance by way of
comment to the attached draft Interpretive Guidance for the new ESRD
regulation. The attached document includes the regulatory language
that was published as a Final Rule for the ESRD Program in the Federal
Register on April 15, 2008, as well as regulatory text that was
incorporated by reference in that Final Rule.
|
End Stage Renal Dialysis |
|
08-32 |
State Selection of SFFs for Technical Assistance by
QIOs - New 9th Scope of Work Item |
The 9th Scope of Work for QIOs directs each QIO to
provide technical assistance to a SFF nursing home in each State in
each of the three years of the contract
|
Nursing Homes |
|
08-33 |
Survey and Certification Issues Related to Hurricane
Gustav |
The President has declared a national emergency in
specified counties in the States of Louisiana, Texas, Mississippi, and
Alabama. In addition, Mike Leavitt, the Secretary of the U.S.
Department of Health and Human Services, has declared a public health
emergency in specified counties in these same States. CMS may waive or
modify, to the extent necessary, certain requirements or timetables if
providers, acting in good faith to provide needed forms and services,
are unable to comply with the requirements as a result of the effects
of the disaster. |
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08-34 |
Compliance With State Fire and Safety Code in Lieu of
Life Safety Code |
CMS has adopted the 2000 edition of the National Fire
Protection Association's (NFPA) Life Safety Code (LSC) as part of
Medicare health and safety standards for certified providers and
suppliers. It is permissible to use a State fire and safety code
(State Code) in lieu of the NFPA 2000 LSC, if CMS finds that the State
Code is imposed by State law and that it adequately protects residents
or patients. There are also financial implications for State Survey
Agencies (SAs).
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08-35 |
Drug or Alcohol Screening/Testing and CLIA
Certification |
This memorandum provides additional guidance
regarding the circumstances when laboratories performing drug or
alcohol screening and/or testing must be CLIA certified, and should be
considered an addendum to the attached February 05, 1993 memorandum
Guidance on the Applicability of the Clinical Laboratory Improvement
Amendments of 1988 (CLIA) to Substance Abuse Testing. We are restating
our ongoing policy that laboratories performing drug or alcohol
screening and/or testing followed by individual treatment must be CLIA-certified.
Facilities found to be performing such testing without CLIA
certification are in violation of CLIA.
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08-36 |
Survey and Certification Issues Related to Hurricane
Ike |
Mike Leavitt, the Health and Human Services
Secretary, has declared a public health emergency in affected counties
in Texas which invokes time-limited statutory authority under section
1135(b) of the Social Security Act (SSA) to permit CMS and its agents
to waive or modify certain requirements, or modify certain deadlines
and timetables for the performance of required activities.
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08-37 |
Impact of Nursing Shortage on Hospice |
This memorandum extends the period of time for
hospice agencies to qualify for an extraordinary circumstance"
exemption when they believe that the nursing shortage has affected
their ability to directly hire sufficient numbers of nurses.
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Hospice |
Content contact: Gina
Bertolini
Phone: (608) 266-6691
E-MAIL SUBSCRIPTION SERVICES
http://www.dhs.wisconsin.gov/dsl_info/signup.htm
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