MDS Mentor

The MDS Mentor is published four times a year — March, June, September and December.

MDS jRAVEN version 1.1.5 Available to Install

MDS jRAVEN version 1.1.5, released on May 4, 2012, is available at https://www.qtso.com/ravendownload.html 

Questions about jRAVEN should be directed to the QIES Technical Support Office (QTSO) help desk at 1-800-339-9313.

Clarification on Adjusting the ARD for a Scheduled Medicare MDS

Centers for Medicare and Medicaid Services (CMS) staff have clarified that when a resident on a Medicare Part A stay is discharged, the Assessment Reference Date (ARD) of a scheduled Medicare Prospective Payment System (PPS) assessment may be adjusted to the day the resident is discharged only when the ARD for the scheduled PPS assessment was set prior to the day of discharge. From page A-26 of the MDS 3.0 RAI Manual "When the resident dies or is discharged prior to the end of the look-back period for a required assessment, the ARD must be adjusted to equal the discharge date."

The ARD should be adjusted on the day of discharge or as soon thereafter as facility staff becomes aware the resident has been discharged. However, in all cases, the ARD must be adjusted no later than day 14 after discharge. As mandated on pages 2-44 and 2-45 of the MDS 3.0 RAI Manual and applicable to all required Medicare PPS MDS, "Must be completed (Item Z0500B) within 14 days after the ARD (ARD + 14 days)." Beyond 14 days after discharge, the scheduled PPS assessment becomes a missed assessment.

The following three scenarios illustrate this guidance:

• Scenario One: Facility staff set an ARD for day 8 for a PPS 5 day. On day 5, the resident was discharged. On the day of discharge or 1 to 14 days after discharge, staff can adjust the ARD to day 5, as long as the PPS MDS is completed no more than 14 days after the adjusted ARD.
• Scenario Two: Facility staff set an ARD for day 18 for a PPS 14 day. On day 17, the resident was discharged. Fifteen or more days after discharge, staff can NOT adjust the ARD to day 17.
• Scenario Three: Facility staff had a resident admitted for a Medicare Part A stay. Facility staff never set an ARD in the facility MDS software or on an MDS item set for a PPS 5-day. On day 3, the resident was discharged. Facility staff can NOT adjust the ARD to day 3 because there is no ARD to adjust. From page 2-72 of the MDS 3.0 RAI Manual: "If the SNF fails to set the ARD prior to the end of the last day of the ARD window, including grace days, and the resident was already discharged from Medicare Part A when this is discovered, the provider cannot complete an assessment for SNF PPS purposes and the days cannot be billed to Part A. An existing OBRA assessment (except a stand-alone discharge assessment) in the QIES ASAP system when specific circumstances are met may be used to bill for some Part A days. See chapter 6, Section 6.8 for greater detail."

MDS 3.0 New Resident Assessment Instrument Manual Errata

The Centers for Medicare & Medicaid Services (CMS) has posted a second errata document for the MDS 3.0 Resident Assessment Instrument (RAI) Manual (v1.08). The two PDF errata files are labeled:

1. MDS 3.0 RAI Manual (v1.08) Errata v3 with changed manual pages marked with footer "April 2012 (R2)" — the errata document that was previously posted
2. MDS 3.0 RAI Manual (v1.08) Errata v4 with changed manual pages marked with footer "April 2012 (R3)" — the newly posted errata document

Neither errata document is meant to replace the other. Both documents contain replacement pages for the MDS 3.0 RAI Manual (v1.08). Providers who download and print the full MDS 3.0 RAI Manual (v1.08) from the CMS website will need to download and print both errata documents. Each errata document begins with a table listing all identified corrections and the pages to which they have been applied. The documents provided after the table listing are the actual corrected replacement pages for insertion into the printed manual.

MDS 3.0 Quality Measure Preview Reports

The MDS 3.0 Facility and Resident Quality Measure Preview reports are available in each facility's shared folder in the CASPER Reporting application. These reports are similar to the MDS 2.0 Facility and Resident Quality Measure Preview reports, but have been updated to contain the new MDS 3.0 Quality Measures.

The reports contain Quality Measure data for the fourth quarter (Q4) of 2011. The publicly-reported short-stay measure data are based on a six-month time frame, from July 1, 2011 through December 31, 2011. The long-stay measure data are based on a three-month time frame, from October 1, 2011 through December 31, 2011.

MDS 3.0 Facility Preview Report
The MDS 3.0 Facility Preview report displays the quarterly numerator, denominator and percent values for each of the publicly-reported MDS 3.0 Quality Measures. The preview report allows facilities to see their measure percent values prior to being posted on the Nursing Home Compare website.

MDS 3.0 Resident Preview Report
The MDS 3.0 Resident Preview report displays the list of residents who triggered one or more of the publicly reported MDS 3.0 Quality Measures. For the Influenza or Pneumococcal vaccination measures, only residents who did not receive the vaccinations are listed. The information from this report is not publicly reported and is for use by the facility only.

Viewing Reports
To view the reports, log in to the CASPER Reporting application, select the 'Folders' button and locate the desired facility shared folder. The shared folders will be identified as 'st LTC facid', where 'st' is the 2-character postal code of the state in which the facility is located and 'facid' is the state-assigned Facility ID.

Additional Information
These reports are not the same as the Five Star Facility Preview reports. Any questions about the MDS 3.0 Facility and Resident Quality Measure Preview Reports should be directed to the QIES Help Desk at help@qtso.com or 1-888-477-7876.

Any questions regarding the Five Star reports should be emailed to BetterCare@cms.hhs.gov

MDS 3.0 Clarifications to March 2012 National Provider Conference Presentation

The Centers for Medicare & Medicaid Services (CMS) has posted the "Clarifications to March 2012 National Provider Conference presentation" on its website at: https://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp

IMPORTANT: There is a typing error in the last example in Clarification 5. The late COT ARD should be day 49, not 39. CMS plans to post a corrected copy in the near future.

It is crucial that you read this document in order to correctly complete MDS 3.0 assessments and bill for Medicare. The clarifications address issues from the March 2012 National Provider Conference presentation hosted by CMS and may be different from some of the information that CMS presented at the conference.

MDS jRaven version 1.1.4 is Available for Install

jRaven version 1.1.4, released on March 28, 2012, is available at https://www.qtso.com/ravendownload.html. This version of jRaven is updated for the April 1, 2012 implementation of the updated MDS 3.0 RAI Manual and technical specifications.

Questions about jRaven should be directed to the QIES Technical Support Office (QTSO) help desk at 1-800-339-9313.

MDS 3.0 RAI Manual (v1.08) Errata (Corrections to March 5, 2012 Version)

An MDS 3.0 Resident Assessment Instrument (RAI) Manual (v1.08) Errata document labeled "MDS 3.0 RAI Manual (v1.08) Errata_March_12_2012" has been posted in the Downloads section of the MDS 3.0 Training page. This is a correction of the March 5 version. The errata document describes and corrects issues that are present in the MDS 3.0 RAI Manual (v1.08) that will be effective April 1, 2012. The errata document also contains updated RAI manual pages that were affected by these corrections. The footer on each of the affected pages is appended with an "(R)" to reflect that it has been revised. The April 2012 RAI Manual will not be updated with corrections, so it is important to include the errata document as part of the MDS 3.0 RAI Manual (v1.08).

Click here for the updated information >>>

MDS 3.0 RAI Manual For April 2012 Available

The Centers for Medicare & Medicaid Services (CMS) posted the MDS 3.0 Resident Assessment Instrument (RAI) Manual that will become effective April 1, 2012. It is posted on the CMS MDS 3.0 Training web page. Click here >>>

Change tables are also provided on the MDS 3.0 Training page to identify changes to the MDS 3.0 RAI Manual. It is recommended that nursing home and swing bed facility staff become familiar with the changes to the RAI Manual before April.

MDS 3.0 Inactivation Procedure Clarification

The Centers for Medicare & Medicaid Services (CMS) has clarified the MDS 3.0 inactivation procedure to be used for MDS 3.0 Omnibus Budget Reconciliation Act (OBRA) and Prospective Payment System (PPS) records. An inactivation can only be completed after MDS 3.0 records have been accepted into the Quality Improvement Evaluation System (QIES) Assessment Submission and Processing (ASAP) system.

The MDS 3.0 Resident Assessment Instrument (RAI) Manual, page 5-12, offers the following information:

• An Inactivation (Item X0100 = 3) must be completed when any of the following items are inaccurate: Type of Provider (Item A0200), Type of Assessment (A0310), Entry Date (Item A1600) on an Entry tracking record, Discharge Date (Item A2000) on a Discharge/Death in Facility record, or Assessment Reference Date (A2300) on an OBRA or PPS assessment.
• When inactivating a record, the provider is required to submit an electronic Inactivation Request record. This record is an MDS record but only the Section X items are completed. This is sufficient information to locate the record in the QIES ASAP system, inactivate the record and document the reason for inactivation.
• For instances when the provider determines that an event date (ARD, entry date, and discharge date) or type of assessment item (A0310) is incorrect, the provider must inactivate the record in the QIES ASAP system, then complete and submit a new MDS 3.0 record with the correct event date or type of assessment, ensuring that the clinical information is accurate.

CMS Clarification: CMS staff clarified bullet number three to ensure that all facility staff understand that when an MDS is inactivated, the facility must complete and submit an entirely new MDS 3.0 record (X0100=1 Add New Record) with a correct event date or type of assessment. This is true whether the record is an assessment or an Entry or Death in Facility record.

If the MDS 3.0 record is an Entry or Death in Facility record:

• Facility staff must complete a new record with the correct event date or type of assessment, and
• Enter new completion dates in Section Z.

If the MDS 3.0 record is an assessment:

• Facility staff must set a new Assessment Reference Date (ARD) on a paper copy of the MDS Item Set or in the facility MDS software,
• Complete a new MDS assessment, coding all MDS items based on the new ARD and the appropriate look-back period, and
• Enter new completion dates in Section V (if active on that item set) and in Section Z.

Inactivation of assessments used for Medicare or Medicaid payment, and completion of new assessments, may result in payment consequences. If the resident has been discharged and is no longer in the facility, records with an MDS assessment type listed in A0310A cannot have an ARD set after the date of discharge. If the resident has been discharged from Medicare Part A, whether the resident remains in the facility or not, records with an MDS assessment type listed in A0310B and A0310C cannot have an ARD set after the date of Medicare discharge. Without an ARD set on or before the day of discharge, these OBRA and PPS assessments may not be completed or submitted.

There may be instances when a facility has already inactivated an MDS record and resent an edited version of the record instead of completing a new MDS record. Whether or not the facility inactivates the resent version of an inactivated MDS and completes a new MDS record to satisfy the CMS clarification is a determination made by facility management staff.

MDS 3.0 RAI Manual for April 2012 Available

The Centers for Medicare & Medicaid Services (CMS) posted the MDS 3.0 Resident Assessment Instrument (RAI) Manual that will become effective April 1, 2012. It is posted on the CMS MDS 3.0 Training web page. Click here >>>

Change tables are also provided on the MDS 3.0 Training page to identify changes to the MDS 3.0 RAI Manual. It is recommended that nursing home and swing bed facility staff become familiar with the changes to the RAI Manual before April.

MDS Account Update

Everyone with a Quality Improvement Evaluation System (QIES) account to submit MDS data or view CASPER reports should now update their account. Be sure all MDS Coordinators; Swing Bed Coordinators; and any other corporate and provider staff who have a QIES account follow this process to ensure they continue to receive critical Centers for Medicare & Medicaid Services (CMS) alerts. This will also make resetting passwords easier if the need arises. State staff will be sent separate instructions.

Users who run into any issues while following these instructions should refer to the QIES User Maintenance Application User's Guide located on the CMS MDS Welcome web page. If a solution cannot be found in the QIES User Maintenance Application User's Guide then call Andy Alegria at 512-438-2396 or email andy.alegria@dads.state.tx.us

1. Using the AT&T or Verizon secure connection, go to the CMS MDS Welcome web page (the web page with the links to submit MDS data and access CASPER).
2. Click on the "Unable to login? Click here to reset your MDS User ID / Password" link.
3. Log into the QIES User Maintenance Application (QUMA) with the same User ID and Password you use to submit MDS data or view CASPER reports. When you log in, a popup window might warn you that you have X days until your password expires. Click on the popup "OK" button if it appears. You do not have to change your password now but you may if you want, and you probably should change your password if you only have a few days left
4. Once you have successfully logged into the QUMA, click on the "User Profile" link.
5. Carefully check your name, phone number and email address - letter by letter and number by number - to ensure they are correct. If you make any changes, click on the "Save" button. This ensures the QIES Technical Support Office (QTSO) can contact you with important alerts and technical support.
6. Click on the "Security Questions" tab.
7. If you are not 100% sure what answers you previously set for each question shown, click the "Edit" checkbox on the right side and enter an answer you will remember. If you do not recall ever entering the answers to the security questions, edit ALL of them now. If you make any edits, click on the "Save" button. This will make it easier to unlock or reactivate your QIES account if it becomes necessary.
8. When you have finished updating your account, click on the "Logout" link and close the browser tab or browser window the QUMA opened.

MDS 3.0 Final Validation Report 60 Day Limit

Nursing Home and Swing Bed MDS 3.0 final validation reports (FVR) in CASPER only remain available in your facility's VR folder* for 60 days, after which they are removed from the VR folder. The CMS policy to remove FVRs older than 60 days has always been in place but a glitch in CASPER allowed older FVRs to remain in the VR folder since the start of MDS 3.0. That glitch was recently fixed.

To access FVRs in CASPER with a submission date older than 60 days:

1. Click on the Report function
2. Select the MDS 3.0 NH Final Validation report folder
3. Run the MDS 3.0 NH Final Validation report. Instructions for that report can be found in the CASPER Reporting Users Manual found on the MDS submission website.

There are two ways to store the FVRs so that a facility does not have to access them online. The first method is to save the FVR to your computer by right-clicking on the file name of the FVR in the VR folder and selecting Save file/target as... The second, less efficient and less economical method is to print the FVR on paper.

*The VR folder is listed in CASPER under the facility's Folders and has the format TX LTC/SB [facility id] VR.

MDS 3.0 Medicare Case Mix Index Set

The MDS 3.0 Medicare Case Mix Index Set changed on October 1, 2011. Facility MDS data entry software should have a Medicare Case Mix Index Set of E03 (rural) or E04 (urban) for any MDS with an Assessment Reference Date (ARD) on or after October 1, 2011 and a Medicare Case Mix Index Set of E01 (rural) or E02 (urban) for any MDS with an ARD before October 1, 2011.

Facilities must manually update the Medicare Case Mix Index Set in their MDS software if it was not updated automatically by their software vendor. Facilities who updated to jRaven version 1.1.3 from a previous version will have to update the Medicare Case Mix Index Set manually. Facilities must update their RUG configuration in their software if they are receiving validation report warning messages related to the recalculation of the Medicare RUG.

jRaven Instructions

1. Log into jRaven.
2. Click on Grouper and then click on Configuration for MDS 3.0.
3. Change the End Date of the E01/E02 RUG configuration to 09/30/2011.
4. Click on the Update RUG Options button to save.
5. Select the new Case Mix Index Set of E03/04.
6. Change the Start Date to 10/01/2011.
7. Change the End Date to 10/01/9999.
8. Click on the Add button to create the new Grouper configuration.
9. Click the X on the Grouper tab to finish.

MDS 3.0 Medicare Assessment Calculator

An MDS 3.0 Prospective Payment System (PPS) Assessment Calculator is posted on the Texas Department of Aging and Disability Services MDS website in the Document Library at:
    http://www.dads.state.tx.us/providers/MDS/library/

The PPS Assessment Calculator is an interactive Microsoft Excel spreadsheet that calculates when MDS 3.0 Medicare PPS assessments are due. It is intended for nursing homes and swing bed providers. At a minimum, a provider can enter the date of admission or reentry to find the initial windows (sets of days) when the scheduled PPS assessments are due.

If the provider enters key information for all scheduled and unscheduled PPS assessments, as well as any non-billed Medicare days due to Leave of Absence, then the calculator will adjust scheduled PPS assessment due dates appropriately and identify the due dates for Change of Therapy evaluations.

Calculator features include therapy minutes tracking, 2-page formatting for easy printing, optional color coding of scheduled PPS assessments, and detailed instructions.

MDS 3.0 October 6, 2011 Updates

The Centers for Medicare & Medicaid Services (CMS) posted two recent updates that affect MDS 3.0.

The "August 23, 2011 National Provider Call Follow-Up and Clarifications" has been updated in the past couple of days without notification. "Clarification regarding the effect of Leave of Absence (LOA) days on scheduled and unscheduled PPS assessments" has been added to page 2 of the clarifications document. The addition addresses several issues including how LOAs affect End of Therapy and Change of Therapy assessments. Download the newest version of the clarifications document at:
    https://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp

Changes were made to the DRAFT QM User's Manual and CMS announced that future changes will be made. The newest information can be found at:
    http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp

MDS 3.0 Version 1.07 Errata and Registered Users

The Centers for Medicare & Medicaid Services (CMS) posted the MDS 3.0 version 1.07 errata – corrections to Chapters 2, 3 (Section O), and 6 of the Resident Assessment Instrument (RAI) Manual, version 1.07. While chapters 2, 3 (Section O), and 6 were just published in September 2011, the errata document was published on October 6, 2011. However, be aware that the corrections in the errata are effective retroactive to October 1, 2011. The MDS 3.0 RAI Manual available on the CMS website will not be updated to reflect the errata changes until the April 2012 RAI Manual update.

The "MDS3 0_V1 07_Errata" may be found on the CMS website at:
    http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp

CMS has posted a list of providers who only have a single user registered with a personal login ID. CMS encourages providers to have more than one user registered per provider. Visit https://www.qtso.com/providernh.html for more information and for the list of Texas nursing home providers with a single user registered.

Clarification of CMS Revised Leave of Absence (LOA) Definition

Effective October 1, 2011, the Centers for Medicare & Medicaid Services (CMS) revised the definition of a LOA, on page 2-12 of the MDS 3.0 Resident Assessment Instrument (RAI) User's Manual:

"Leave of Absence (LOA), which does not require completion of either a discharge assessment or an entry tracking record, occurs when a resident has a:

• Temporary home visit of at least one night;or
• Therapeutic leave of at least one night; or
• Hospital observation stay less than 24 hours and the hospital does not admit the patient.

Providers should refer to Chapter 6 and their State LOA policy for further information, if applicable.

Upon return, providers should make appropriate documentation in the medical record regarding any changes in the resident."

The May 2011 version of the RAI User's Manual, Chapter 2, notes that a discharge is not required for a resident who has a temporary home visit or therapeutic leave of one night. The October 2011 version changes the wording to at least one night. With the revision and inclusion of "at least" prior to "one night", CMS clarifies that a LOA can be more than one night.

In addition, because it was not specified in the new LOA definition, CMS staff recently clarified that a LOA also includes temporary home visits or therapeutic leaves of less than one night. Therefore, no discharge assessment is required when residents are out LOA for minutes or hours but less than one night, as long as all LOAs are authorized by the physician and allowed by the payment rules for the resident's payment source.

For resident's whose payment source is Medicare, consult your Medicare Manuals, Medicare experts or your Medicare Administrative Contractor . For residents whose payment source is Medicaid, contact DADS Provider Claims Services staff with any questions, but only after you have reviewed Texas Administrative Code (TAC) 19.2603 found at
    http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=40&pt=1&ch=19&rl=2603

If you have any questions, please contact the Texas MDS staff at
    http://www.dads.state.tx.us/providers/MDS/contact.html

MDS 3.0 jRAVEN October 2011 Update

jRAVEN version 1.1.3 is posted at https://www.qtso.com/ravendownload.html on the QIES Technical Support Office website. Providers using jRaven should immediately download and install the new version in order for their MDS and Medicare RUGS to be correct starting October 1, 2011.

New Assessment Reference Date (ARD) Setting Procedures

Effective October 1, 2011, the Centers for Medicare & Medicaid Services (CMS) has new requirements for setting the ARD on all Minimum Data Set (MDS) assessments. The Texas MDS staff has emphasized the new requirements by underlining them in the ARD definition below. From page 2-8 of the MDS 3.0 Resident Assessment Instrument User's Manual:

"Assessment Reference Date (ARD) refers to the last day of the observation (or "look back") period that the assessment covers for the resident. Since a day begins at 12:00 a.m. and ends at 11:59 p.m., the ARD must also cover this time period. The facility is required to set the ARD on the MDS form itself or in the facility software within the appropriate timeframe of the assessment type being completed. This concept of setting the ARD is used for all assessment types (OBRA and Medicare-required PPS) and varies by assessment type and facility determination."

It is extremely important to ensure that the ARD is set according to CMS rules, not only to avoid inaccurate assessments but also to avoid potential payment consequences.

If you have any questions, please contact the Texas MDS staff at
    http://www.dads.state.tx.us/providers/MDS/contact.html

MDS 3.0 Medicare Assessment Clarifications

The Centers for Medicare & Medicaid Services (CMS) have posted clarifications to the MDS 3.0 Prospective Payment System (PPS) assessments that will be in effect on October 1, 2011. The Texas MDS staff highly recommends that providers read and understand the clarifications that can be found by clicking on the link titled "August 23, 2011 National Provider Call Follow-Up and Clarifications" located on the CMS website at:
    https://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp

Activating the link will bring up the document titled "Follow-up information from August 23 provider training call and September 1 Open Door Forum".

If you have any questions, please contact the Texas MDS staff at
    http://www.dads.state.tx.us/providers/MDS/contact.html

MDS 3.0 Fiscal Year 2012 RUG Tips

The "MDS 3.0 October 2011 Medicare Transition" alert posted September 15, 2011 describes the fiscal year (FY) 2012 Resource Utilization Group (RUG) warnings. If a provider has already submitted a Prospective Payment System (PPS) assessment before the FY 2012 RUG warning was turned on and the PPS assessment has billed days in October 2011 requiring an FY 2012 RUG; then modify and submit the assessment.

1. You do not have to modify and submit ALL assessments which do not have a FY 2012 RUG. You only need to modify and submit any PPS assessment submitted in FY 2011, which has billed days in FY 2012 and for which there is not a FY 2012 RUG.
   • Example 1: A 5-day PPS assessment with an Assessment Reference Date (ARD) on September 10, 2011, does not need to be modified and submitted since it does not have a billed day in October 2011. 
   • Example 2: A 30-day PPS assessment with an ARD on September 10, 2011, needs to be modified and submitted since it does have billed days in October 2011.
2. When you modify a PPS assessment to obtain a FY 2012 RUG, the appropriate reason for modification in item X0900 is "Z. Other error requiring modification." Unless there are other errors in the PPS assessment requiring correction, only item Z under item X0900 needs to be checked. In this situation, Section X is the only section that needs to be modified.
3. In September 2011, the final validation report warning "-3616b" regarding Medicare RUG version numbers 1.0066 and 1.0166 may be ignored. However, no later than October 1, 2011, it will be important that MDS data entry software is updated to version 1.0166, along with the new values from the new set of Case Mix Indexes (CMIs).
4. The QIES Help Desk informed Texas MDS staff that the FY 2012 RUGs in the final validation report warnings are based on Group Minutes divided by four (4), even for MDS with an ARD (A2300) before October 1, 2011.

MDS 3.0 RAI Manual changes for October 2011

On September 20, 2011, the Centers for Medicare & Medicaid Services (CMS) posted an updated MDS 3.0 Resident Assessment Instrument (RAI) Manual for October 2011. Chapter 2, Chapter 3 Section O, and Chapter 6 were updated with changes. The newest RAI Manual can be downloaded from:
    http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp

CMS did not provide a list of the most recent changes separate from the other October 2011 changes made since May 2011, so the Texas Department of Aging and Disability Services MDS staff created documents which identify the most recent changes made on 9/15/2011 in the MDS 3.0 RAI Manual for October 2011. You can find the MDS 3.0 RAI Manual for October 2011: September 15 changes in the DADS MDS website Document Library at:
    http://www.dads.state.tx.us/providers/MDS/library/

CMS will soon be updating Appendix H with the most recent Item Subsets, so keep an eye on the CMS MDS 3.0 Training Materials for the update. Providers should always ensure that they have the newest version of the MDS 3.0 RAI Manual for October 2011 for reference.

MDS 3.0 OBRA Assessment Scheduling Form Now Available

An MDS 3.0 OBRA Assessment Scheduling Form has been posted on the DADS MDS website in the Document Library. It is an optional form that providers can use to track past, pending, and upcoming OBRA-required MDS for a resident. The Adobe version is provided for anyone who does not have Microsoft (MS) Word. The MS Word version is provided for anyone who wants to change the form to suit their needs. Download the form at:
    http://www.dads.state.tx.us/providers/MDS/library/

For comments or suggestions regarding the DADS MDS website and its contents, please contact:

    Andy Alegria, Texas MDS Automation Coordinator
    Phone 512-438-2396 or
    E-mail andy.alegria@dads.state.tx.us

MDS 3.0 October 2011 Medicare Transition

On October 1, 2011, the updated MDS 3.0 Resident Assessment Instrument (RAI) Manual and new Resource Utilization Group IV (RUG-IV) rates go into effect. Unlike the October 2010 implementation of MDS 3.0, providers will NOT need to complete and submit "repeat" scheduled Medicare MDS in October 2011 to avoid default RUG payments. For example, if a facility completes a Medicare 5-day PPS MDS at the end of September 2011, there is NO need to complete another 5-day PPS MDS on or after October 1, 2011 to avoid default RUG payments for the days that are in October.

Instead, the Final Validation Report (FVR) in CASPER will list the fiscal year (FY) 2012 RUG for assessments with an Assessment Reference Date prior to October 1, 2011 and will list the FY 2011 RUG for assessments with an Assessment Reference Date on or after October 1, 2011. The FY2012 RUG will be listed on the FVR as warning 1059 and the FY2011 RUG will be listed on the FVR as warning 1060. Providers may use the RUGs submitted in Section Z, as well as the alternate fiscal year RUGs listed on the Final Validation Report, to bill Medicare for RUGs where the billing period spans both fiscal years.

Download the October 2011 MDS 3.0 RAI manual at:
    http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp

Download the FY 2012 SNF PPS Transition Policy and related provider call at:
    https://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp

Download the October 2011RUG-IV CMIs in "RUG III Files & RUG IV Files" at:
    http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp

For questions regarding MDS 3.0, please contact:

    Andy Alegria, Texas MDS Automation Coordinator
    RAI Manual Chapter 2, Chapter 3 Sections A & X, Chapter 5 & 6,
    CASPER reports including validation reports and QM reports

    Cheryl Shiffer, BSN, RN, RAC-CT Texas MDS Clinical Coordinator
    RAI Manual Chapter 1, Chapter 3 Sections B - Z, Chapter 4

    Contact info: http://www.dads.state.tx.us/providers/MDS/contact.html

MDS — The Missing Assessment Report

CMS has announced that the MDS 3.0 Missing Assessment report is working correctly. The enhanced version of the report is available in the CASPER Reporting application under the MDS 3.0 NH Provider Report category. An updated description of the report is available in the CASPER Reporting User's Guide - a link to that guide can be found on the CMS MDS Welcome page where providers go to submit their data.

Most importantly, a detailed description of how to read the Missing Assessment report and handle missing assessments can be found on the Texas Department of Aging and Disability Services MDS website at:
    http://www.dads.state.tx.us/providers/MDS/introduction/step5.html#providerreports

The MDS 3.0 Missing OBRA Assessment report is one of several methods for finding MDS errors that must be corrected. Using the Missing Assessment report can help you avoid survey tags, payment issues, and incorrect reports (including the future QM report). There should be no residents listed on your Missing Assessment report and the missing or incorrect assessments of any residents who are listed should be addressed in a timely fashion.

Questions about the Missing Assessment report can be directed to:

    Andy Alegria, Texas MDS Automation Coordinator
    Phone (512) 438-2396 or
    E-mail andy.alegria@dads.state.tx.us

MDS 3.0 RAI Manual for October 2011 available

The new MDS 3.0 RAI Manual that will take effect starting October 1, 2011 is now available on the CMS MDS website at http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp in the Downloads section, called "MDS 3.0 RAI Manual (V1.07) [ZIP 23 MB]".

The Fiscal Year 2012 Skilled Nursing Facility Prospective Payment System changes, referred to as the FY 2012 SNF PPS Policies, are discussed in National Provider Call Slides and Audio Transcript that can be found at http://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp under Downloads.

After thoroughly reading the Oct 2011 RAI Manual and reviewing the FY 2012 SNF PPS Policies Slides, if you have any questions please contact one of the following:

    Cheryl Shiffer, BSN, RN, RAC-CT, Texas MDS Clinical Coordinator
    RAI Manual Chapter 1, Chapter 3 Sections B - Z, Chapter 4

    Andy Alegria, Texas MDS Automation Coordinator
    RAI Manual Chapter 2, Chapter 3 Sections A & X, Chapters 5 & 6,
    CASPER reports including validation reports and QM reports

MDS Transition for Implementation of FY 2012 SNF PPS Policies

The SNF PPS FY2012 Final Rule (76 FR 48486) outlined several policy changes in the SNF PPS effective for FY 2012. The memo which describes the transition guidelines for these policies can be found on the new "FY 2012 RUG-IV Education & Training" page of the CMS website at the following address:
    https://www.cms.gov/SNFPPS/03_RUGIVEdu12.asp

Policy changes include: A revised MDS assessment schedule, the Change of Therapy (COT) Other Medicare Required Assessment (OMRA), a resumption of therapy option for the End-of-Therapy OMRA, the allocation of group therapy time, and a revised student supervision policy.

The SNF PPS FY2012 Final Rule (76 FR 48486) can be found at:
    http://www.gpo.gov/fdsys/search/pagedetails.action?granuleId=2011-19544&packageId=FR-2011-08-08&acCode=FR

MDS State Website Update

The Texas Department of Aging and Disability Services MDS website at http://www.dads.state.tx.us/providers/mds/ has been updated:

Step 6: Correct your data on the left menu has been updated with tips on correcting MDS 3.0 records.

MDS 3.0 Look-Back Periods has been added to the Document library. This document is a reference table of look-back periods for all MDS 3.0 items.

For questions or comments concerning the DADS MDS website, please contact:

MDS jRaven Version 1.1.2 is Available for Install

jRaven version 1.1.2, released on August 2, 2011, is available at https://www.qtso.com/ravendownload.html. According to QTSO, the main reason for this upgrade is so that providers can import, store, and update MDS 2.0 records in jRaven. This affects all Raven and Raven Swing Bed users.

Questions about jRaven should be directed to QTSO at 1-800-339-9313.

Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule Published

On 7/29/11, the Centers for Medicare & Medicaid Services (CMS) posted the final SNF PPS rule for FY 2012 in the Federal Register at: http://www.ofr.gov/OFRUpload/OFRData/2011-19544_PI.pdf

Along with recalibrating and updating the SNF PPS payment rates for FY 2012 - reducing Medicare payments in FY 2012 by $3.87 billion, or 11.1 percent lower than payments for FY 2011 - this final rule makes a number of additional revisions aimed at enhancing SNF PPS accuracy and integrity. The rule modifies the patient assessment windows and grace days to minimize duplication and overlap in observation periods between assessments. The final rule also:

• Clarifies circumstances when SNFs must report breaks of three or more days of therapy.
• Eliminates the distinction between facilities regularly furnishing therapy services on a 5- or 7-day basis for purposes of setting the date for the End of Therapy (EOT) Other Medicare Required Assessment (OMRA).
• Streamlines procedures for documenting situations involving a brief interruption in therapy, where therapy resumes without any change in the patient's RUG-IV classification level.
• Introduces a new Change of Therapy (COT) OMRA to capture those changes in a patient's therapy status that would be sufficient to affect the patient's RUG-IV classification and payment, even though they may not increase to the level of a significant change in clinical status.
• Provides for the allocation of a therapist's time for group therapy (defined in the rule as a single therapist leading four patients in a common activity) to ensure that Medicare payments better reflect resource utilization and cost for these services, and specifically that the therapist's time is being appropriately counted and reimbursed.
• Discusses the impact of certain provisions of the Affordable Care Act, and announces that proposed provisions regarding ownership disclosure requirements set forth in the Affordable Care Act will be finalized at a later date.

Your Texas state Resident Assessment Instrument (RAI) Minimum Data Set (MDS) staff strongly encourage you to read and become familiar with the new rules.