Newsletter Title
RAI Spotlight
Sharon Vaughn RAI Coordinator 1 - 71 7 - 787- 18 1 6 Sharonqa- md s@ p a .g o v Vaughn RAI Coordinator 1 - 717- 7 8 7 - 1 8 1 6 Nursing Home Transition (NHT) Referral qa- m d s @ p a . g o v Process– New Coordination Entity
Volume , Issue This Office of Long-term Living Beginning immediately, NHT re- has introduced a new NHT coordi- ferrals for the non-managed long- May 2021 nation entity providing NHT ser- term care population should be vices to individuals who need NHT directed to Kepro at one of the Questions about the assistance but who are not enrolled following contacts: in the managed long-term care pro- RAI? grams, Living Independence for the Program phone number - Please submit them to Elderly (LIFE) or Community 888-204-8781 HealthChoices (CHC). This provid- [email protected] er, Keystone Peer Review Organiza- PANursingHomeTransi- tion (referred to as Kepro) will be [email protected] receiving NHT referrals statewide (Continued on Pg.3) for any individual not enrolled in managed long-term care, including referrals made as a result of the ad- ministration of Minimum Data Set (MDS) Section Q. For the purposes Inside this issue: of making referrals according to MDS Section Q guidelines, Kepro is Teleconference FAQs 2 to be considered the Local Contact Agency (LCA) for individuals not enrolled in managed long-term care. CMS Submission 2 Waiver
Nursing Home Tran- 3 sition Process
SecondaryRAI Story H eadline -Chapter 2: Teleconference PA - OBRA Changes 3 Date: July 8, 2021 This story can fit 75-125 words. Time: 1:30 – 2:30 pm EDT (Dial-in 10 minutes earlier) COVID-19 NHSN 4 YourTopic: headline is anReview important of partthe Basicsof the newsletter of the RAI and - should Chapter be considered 2 care- fully.Handouts: Power Point slides will be available about July 7th on In a few words, it should accuratelythe DOH represent Message the contentsBoard at:of the story and draw CMS On-line Train- 4 readers into the story.https://sais.health.pa.gov/commonpoc/Login/Login.aspx Develop the headline before you write the story. This way, the ing headline will help you keep the story focused. ExamplesCall in number: of possible headlines 1-888-694 include-4728 Product or 1 Wins-973 -Industry582-2745 Award, New Product CanConference Save You Time!, ID Number: Membership 4369065 Drive Exceeds Goals, and New Office Opens Near You. Company Name: Myers and Stauffer Presenter: Kerry Weaver
A recording of this conference will be available following the presentation at: https://nfrp.panfsubmit.com/ Page 2 Teleconference FAQs: PA-OBRA Assessment Changes-Effective July 1, 2021
On May 8, 2021 a training teleconference was provided on PA-OBRA Assessment Changes- Effective July 1, 2021. The following ques- tions were received.
Q. Can the primary diagnosis change from assessment to assessment when com- pleting item I20B on OBRA assess- A. The addition of PDPM items on the OBRA ments? assessment has no effect on the assess- ment schedule. You would continue to A. Yes. The primary diagnosis can change complete and submit the OBRA assess- from assessment to assessment. You ments per the required schedule as would code the primary diagnosis that before. As always, any assessments requires continued nursing facility care completed for managed care are not sub- at the time of the assessment. The diag- mitted and this would continue to be the nosis needs to be a current active di- case. agnois. Q. Did I understand that these stand-alone Q. When an OBRA assessment is combined OBRA changes begin with all assess- with a PPS 5-Day the section GG ments with the ARD beginning July 1st? assessment period is the first three (I thought I had read somewhere else days of the observation period, that it would be any submissions begin- correct? ning July 1st).
A. Yes. Any time an OBRA assessment is A. The OBRA assessment additions will be on combined with a PPS assessment assessments with ARD's of July 1, 2021 all of the coding instructions for and after. the PPS assessment are followed, therefore the Section GG assess- Q. Will there be a PA Section S: RAI Manual ment period would be the first 3 days (Resident Data Reporting Manual) up- date available? of. the Medicare stay. Q. Now that the PDPM MDS items will be A. There will no changes to the Resident Data Re- on the OBRA assessments, can I porting Manual related to additional combine an Adm./5-day assessment if OBRA MDS items at this time as these an insurance is using the PDPM mod changes do not affect the current CMI pro- el, or should I continue to do admis- cess and payment calculations used in re- sion and transmit, and do the 5 day imbursement. Updates to the manual will separate and not transmit? be released when PDPM is used for pay- ment purposes in PA. MDS Submission Waiver Ended
Several CMS waivers expired, May 10, 2021. Among these waivers were the MDS timeframe requirements. This allowed providers flexibility in completing and transmitting assessments. CMS now believes nursing homes should have developed practices for completing these assess- ments timely, which are critical for resident care planning. As a result, CMS expired the emer- gency blanket waiver for 42 CFR §483.20.
QSO-21-17-NH (cms.gov) Page 3
Nursing Home Transition (NHT) Referral Process– New Coordination Entity
(Continued from Pg.1) Please note that the process for referring in- dividuals who are enrolled in managed long- Please see contact information for the CHC- term care has not changed. LIFE participants MCOs below: must be referred to their LIFE Provider Or- AmeriHealth Keystone First PA Health UPMC ganization (PO) and CHC participants must Caritas (Southeast) & Well- be referred to their CHC Managed Care Or- (Southwest, ness ganization (MCO) for NHT assistance. For Northwest, (PHW) the purposes of making referrals according to Northeast, MDS Section Q guidelines, the CHC-MCO Lehigh/ or LIFE PO is to be considered the LCA for Capital) individuals who are enrolled in CHC or Provider: 1- Provider: 1-800 Provider: Provider: 800-521-6007 -521-6007 1-844-626- 1-844-860 LIFE, respectively. 6813 -9303 For all other questions regarding this notifi- cation, please contact the Office of Long- chcprovid- chcprovid- Infor- NHT@UP Term Living (OLTL) at RA- ers@ameriheal ers@keystonefir mation@pa MC.edu thcaritas.com stchc.com healthwelln [email protected] ess.com
Pennsylvania OBRA Changes: Effective July 1, 2021
As of October 1, 2020, the Centers for Medi- care & Medicaid Services (CMS) updated the July 1, 2021. These additional fields are located in Minimum Data Set Version 3.0 (MDS 3.0) Sections GG, I and J. This data collection is a nec- item sets (version 1.17.2) and related tech- essary step to begin evaluating the PDPM classifi- nical data specifications. The changes support cation system and its viability as an alternative for the calculation of Patient Driven Payment the RUG classification system that is used today as Model (PDPM) payment codes on Omnibus the basis for the case mix reimbursement system. Budget Reconciliation Act (OBRA) assess- A training was provided on April 8, 2021 as part of ments when not combined with a 5-day Pro- the Department of Health quarterly teleconfer- spective Payment System (PPS) assessment, ence to review this change for nursing facility staff. specifically the Nursing Home Comprehen- A recoding of this presentation is available on the sive (NC) and Nursing Home Quarterly (NQ) NFRP, under the MDS resources tab. https:// assessment item sets. This change allows nfrp.panfsubmit.com/ State Medicaid Agencies to collect PDPM Questions regarding this notification can be payment codes and compare the data to Re- emailed to Ruth Anne Barnard, Office of Long- source Utilization Group (RUG) III/IV and, Term Living, at [email protected]. thereby, determine any effects on future pay- ment models. Pennsylvania will require the completion and submission of specific MDS item set fields associated with PDPM on all OBRA NC and NQ MDS assessment submissions beginning Page 4 COVID-19 Vaccination and Therapeutics NHSN Reporting CMS Quality, Safety, & Oversight memo QSO- educated about and offered the COVID-19 vac- 21-19-NH, https://www.cms.gov/files/document/ cine, including samples of educational materials. qso-21-19-nh.pdf, includes new interpretive guid- Surveyors will request a list of residents and staff ance for surveyors for F887 (COVID-19 Immun- and their COVID-19 vaccination status. A sample ization), as well as updated investigative proce- of residents and staff will be selected to conduct a dures, potential tags for additional investigation, record review and conduct interviews to confirm and survey tools. The memo updates the guidance they were educated on and offered the COVID-19 at F884 (Reporting – National Healthcare Safety vaccine from which they will determine compli- Network (NHSN)). ance in accordance with the new requirements. In the case of noncompliance related to the re- On a weekly basis, the COVID-19 vaccination quirements for educating and offering COVID-19 status of residents and staff, total numbers of resi- vaccination to residents and staff will be cited at F dents and staff vaccinated, each dose of vaccine -tag 887 (COVID-19 Immunization). Noncompli- received, COVID-19 vaccination adverse events, ance related to COVID-19 vaccination reporting and therapeutics administered to residents for will be cited at F-tag 884 (Reporting – National treatment of COVID-19 through NHSN’s LTCF Healthcare Safety Network (NHSN)). COVID-19 Module. These requirements take ef- fect June 13, 2021. Additionally, Failure to meet reporting require- ments will also result in a CMP starting at $1,000 Compliance with F884 requires facilities to con- for the first occurrence of a failure to report. For tinue to report COVID-19 data through NHSN’s each subsequent week that the facility fails to sub- LTCF COVID-19 Module, and now, with finali- mit the required report, the noncompliance will zation of the new reporting requirements at, they result in an additional CMP imposed at an amount must begin reporting vaccination data for resi- increased by $500 and added to the previously dents and staff and the use of therapeutics for resi- imposed CMP amount for each subsequent occur- dents. CMS will begin reviewing for compli- rence. ance with the new vaccination reporting re- quirements Monday, June 14, 2021.
Surveyors will request a facility contact to pro- vide information on how residents and staff are Cognitive & Mood Assessment Four-Course Training
The Centers for Medicare & Medicaid Services Course 1: Approaches to Cognitive & Mood As- (CMS) is offering web-based training that pro- sessments for SNF Providers. vides an overview of the general and key clinical Course 2: Assessment of Cognitive Function for considerations important for conducting standard- SNF Providers (BIMS). ized cognitive and mood assessments. This four- Course 3: Assessing Delirium in the SNF Care course series is designed for providers in the Setting (CAM©). Skilled Nursing Facility (SNF) setting. The cours- Course 4: The Resident Mood Interview (PHQ- es contained within this training are: 9©) for SNF Providers.
These courses can be used on-demand anywhere you can access a browser. They include interac- tive exercises to test your knowledge related to cognitive and mood assessments. While it is in- tended that the courses be completed in sequential order, you may jump directly to any topic of inter- est.