DQA
Quarterly Information Update
October 2003
[PDF
Version of this month's Quarterly Update (PDF, 61
KB) - blue text indicates links
to other sections or to Internet pages]
Provider Directories on the Internet
We continue to add new provider types to the Wisconsin Health Care
Provider Directories page at www.DHS.state.wi.us/bqaconsumer/
HealthCare/directories.htm. Here are the latest additions:
- Ambulatory Surgical Centers
- Rural Health Clinics
- Swing Bed Hospitals (contain beds that can be converted to nursing
home status)
As with the other directories, we provide PDF versions in two
alphabetical versions: one by county (then by city) and one by facility
name. We also provide an Excel version for use in creating mailing labels.
A short-name field is included to provide a more convenient form of
individual providers’ names that might otherwise prove too long for
mailing labels.
We expect to prepare and post directories for hospitals and end-stage
renal disease/dialysis centers by November. We have already posted the
first quarterly replacements for the nursing home, FDD, hospice and home
health agency lists. If you have any questions, please contact Todd McCall
at (608) 267-3808 or by E-mail mccaltw@DHS.state.wi.us.
Caregiver Regulation Section Chief Retires
Donna Cochems, chief of the Caregiver Regulation & Investigation
Section (CRIS) retired from state service September 2, 2003. Donna was
hired to head the section when it was created in 1999 as a response to the
1998 Caregiver Law. She was responsible for overseeing the development and
staffing needed and also established the many systems and protocols needed
to assure the integrity of Wisconsin’s nurse aide registry, as well as
its implementation of the Caregiver Law.
We feel very fortunate to have had Donna’s expertise and enthusiasm
in leading this section over the course of its creation, and we wish her
well in her retirement.
Susan Larsen has been appointed as Interim Section Chief until the new
Section Chief is appointed.
Medicare: Final Rule on Hospital Responsibilities to Patients Seeking
Treatment for Emergency Conditions
The Centers for Medicare & Medicaid Services (CMS) issued a final
rule on August 29th, 2003 clarifying hospital obligations to
patients who request treatment for emergency medical conditions under the
Emergency Medical Treatment and Labor Act (EMTALA). The new rule expands
the definition of emergency department to mean any department or facility
of the hospital, whether situated on or off the main hospital campus,
that: (1) is licensed by the state as an emergency room or emergency
department; (2) is held out to the public as providing care for emergency
medical conditions without requiring an appointment; or (3) during its
previous calendar year, has provided at least one-third of all its
outpatient visits for the treatment of emergency medical conditions on an
urgent basis. The final rule will be published in the September 9, 2003 Federal
Register, and becomes effective November 10, 2003.
Other key provisions of the final rule include:
- Clarification of the circumstances in which physicians, particularly
specialty physicians, must serve on hospital medical staff
"on-call" lists. Under the revised regulations, hospitals
will have discretion to develop their on-call lists in a way that best
meets the needs of their communities. In keeping with traditional
practices of "community call," physicians will be permitted
to be on call simultaneously at more than one hospital, and to
schedule elective surgery or other medical procedures during on-call
times.
- Clarification that hospital-owned ambulances may comply with
citywide and local community protocols for responding to medical
emergencies and thus be used more efficiently for the benefit of their
communities.
- Permits hospital departments that are off-campus to provide the most
effective way of caring for emergency patients without requiring that
the patient be moved to the main campus when this would not be best
for the patient.
The final rule clarifies that EMTALA does not apply to individuals who
come to off-campus outpatient clinics that do not routinely provide
emergency services or to those who have begun to receive scheduled,
non-emergency outpatient services at the main campus – for example,
routine laboratory tests. Other regulations and state licensing laws
already cover the hospital's obligations to patients in such
circumstances.
In addition, the rule clarifies that EMTALA does not apply after a
patient has been seen, screened, and admitted for inpatient hospital
services, unless the admission is made in bad faith to avoid the EMTALA
requirements.
See the complete press release at www.cms.hhs.gov/media/press/release.asp?Counter=837
(exit DHS).
Final Rule for Rural Health Clinics
Per CMS, the Final Rule for Rural Health Clinics is expected soon. This
is the process to implement provisions of the Balanced Budget Act of 1997.
As soon as the Final Rule is available, BQA will post this information to
the Rural Health Clinic pages via www.DHS.state.wi.us/rl_DSL/RuralHealthClinics/RHCintro.htm.
New Rules: Feeding Assistants in Nursing Homes
The US Department of Health & Human Services announced new
regulations that allow for trained feeding assistants in nursing homes to
free up nurses and nurse aides for other duties. The final rule appears in
the September 26, 2003 issue of the Federal Register and becomes effective
October 27, 2003. The press release announcing this change is located at www.hhs.gov/news/press/2003pres/20030925.html
(exit DHS) and the Federal Register announcement can be found via www.archives.gov/federal_register/
(exit DHS).
BQA Numbered Memos August-September 2003
|
Memo |
Title |
Providers Affected |
|
03-012 |
Wisconsin
Nurse Aide Program Monitoring |
Nurse Aide Training Programs |
|
03-013 |
Informal Dispute Resolution (IDR) Update
(REPLACES BQA memo 02-013) [replaced by
08-008] |
Facilities for People with Developmental Disabilities, Nursing
Homes |
The following memo will be published in the near future:
"Insulin Medication Errors in Nursing Homes."
We obsoleted BQA memo 01-011, "BQA Best Practices Program for
Nursing Homes," as that program has been transferred to Metastar,
Wisconsin’s federal Quality Improvement Organization. Metastar has been
contracted by the Centers for Medicare and Medicaid Services to provide
best practices programs and technical assistance. Because Metastar
incorporates best practices into their programs, the decision was made to
merge the two programs into one and have Metastar move forward with
theirs. The Best Practices materials posted to the BQA Internet Pages have
been removed. We have also obsoleted BQA memos 00-074, 01-009 and 01-054
– please see article on "Reporting Deaths" below.
We have been asked to provide PDF versions of all BQA memos currently
posted only as browser-friendly files (HTML). Memos affected are those
from 1998 to the present. This work will proceed as time becomes available
over the next couple of months. Links to these PDF documents will be made
available in the memos’ HTML versions.
Access all BQA memos via www.DHS.state.wi.us/rl_DSL/Publications/
BQAnodMems.htm or from individual providers' publications pages via www.DHS.state.wi.us/rl_DSL/.
Plan Review: Permit to Start Form
The Permit
to Start, OQA 2457 (PDF, 23 KB), used by providers working with BQA’s Engineers,
is now available on the DHS Web. It was previously obtainable only as a
3-ply form by calling the Health Services Section office. Also available
is the updated Application
for Plan Review, OQA 2333 (PDF, 128 KB). Both forms are available via the
DHS Forms
Library at www.DHS.state.wi.us/forms/index.htm?nav=mo.
Revised Death Reporting Information Page
BQA’s reporting procedures for client or patient deaths attributable
to suicide, restraints or psychotropic medications have been reorganized
into a permanent Internet site at www.DHS.state.wi.us/rl_DSL/
Providers/ReportDeath.htm, along with information on pronouncement of
death, preserving death scenes, removal of bodies, and related issues.
This information was contained in BQA memos 00-074, 01-054 and 01-009,
which are now made obsolete. Providers responsible for reporting these
deaths to BQA include adult family homes, alcohol and other drug abuse
treatment programs, community based residential facilities, home health
agencies, hospices, hospitals, mental health treatment programs, nursing
homes and other long term care facilities, and residential care apartment
complexes.
The site contains a link to the revised Death
Reporting form OQA-2470 (PDF, 239 KB), which contains updated contact information
for faxing the form and any questions you may have about the process.
Watch for Upcoming ICF/MR Conference in 2004
A second annual ICF/MR Provider Conference is being planned for March
2004. No date or location has been set at this time. Watch for further
information. Facilities serving persons with developmental disabilities (FDDs)
should receive a training brochure in the mail. The brochure will also be
posted to the Internet at http://www.DHS.state.wi.us/
rl_DSL/Training/index.htm closer to the time of the
conference.
Upcoming Seminar/Training Opportunities
Brochures on upcoming training will be mailed to providers and posted
on the Internet. Check the BQA Provider Training page at www.DHS.state.wi.us/rl_DSL/Training/index.htm
or the Provider or What's Happening sections for individual
health/residential care providers via www.DHS.state.wi.us/rl_DSL.
For registration questions, contact the Bureau of Quality Assurance
Training Coordinator at (608) 267-1438.
|
Program(s) |
Locations and Dates |
| Beyond
Resident Assessment Instrument (RAI) Basics - Assessment and Care
Planning |
October 30, 2003 – Eau Claire, Park Inn
November 12, 2003 – Madison, Radisson |
| The
Power of Information – Using the Resident Assessment Instrument to
Improve the Quality of Nutrition and Hydration* |
November 4, 2003 – Tomah, Holiday Inn
November 20, 2003 – Fond du Lac, Holiday Inn |
|
*This program is planned for nutrition/dietetic
professionals and others who conduct nutritional assessments,
develop plans of care and evaluated nutritional outcomes for nursing
home residents. This program will focus on using the Resident
Assessment Instrument (RAI) in conducting nutritional assessments by
reviewing the RAI process and related regulatory requirements,
accurately coding the MDS, and using the assessment information in
developing plans of care. |
| OASIS
Items in Detail (see article below) |
November 13, 2003 – Eau Claire
November 19, 2003 – Madison |
Please note that the previously announced "Home Health 101"
presentation on the Centers for Medicare and Medicaid Services (CMS)
Conditions of Participation has been indefinitely postponed.
OASIS Training Opportunities
Items-in-Detail
BQA is conducting two half-day training sessions on OASIS
Items-in-Detail in November 2003. The workshop is intended to improve
clinician’s understanding of the OASIS data items, creating accuracy and
consistency in responding to the items.
Dates and locations:
November 13, 2003: Quality Inn, Eau Claire
November 19, 2003: Mendota Mental Health Conference Center, Madison
Brochure and registration form:
HHAs may obtain a detailed training brochure with registration form in
the following ways:
A brochure
with registration form was mailed to all Wisconsin HHAs in
September.
The brochure with registration form is available under Bulletins on the
State OASIS System Welcome Page.
Further information:
Contact Leann Graffin at (608) 267-1438 or graffl@DHS.state.wi.us
for registration information.
Interpreting and Using the New Outcome and Case Mix Reports
On October 2, 2003, BQA presented a WisLine Audio training on
"Interpreting and Using the New Outcome and Case Mix Reports."
BQA is making paper copies of this training available to home health
agencies. If you missed this training or would like to use it to train
your staff, you may access and print the following material from the State
OASIS System Welcome Page. Click on Bulletins and scroll down to
"Interpreting and Using the New Outcome and Case Mix Reports" to
obtain:
- Power point presentation with notes
- Sample reports
- Exercises
- Supplement to Outcome Based Quality Improvement Manual.
- OASIS resources
These are also available on the web via www.DHS.state.wi.us/rl_DSL/
HHAs/HHAprovds.htm.
If you have questions on the new reports, contact Andrea Henrich, OASIS
Education Coordinator, (608) 267-3807 or Chris Benesh, OASIS Automation
Coordinator, (608) 266-1718.
Home Health Quality Initiative (HHQI)
On October 3, 2003, CMS broadcast a two and ½ hour presentation via
satellite on HHQI and the home health quality measures that will be
displayed in the national launch of HHQI. Individuals can view the Webcast
of the program up to one year following October 3 at www.cms.internetstreaming.com
(exit DHS).
CMS Web-based OASIS Training
In mid-October, CMS will make an OASIS training program available on
the web. As more information becomes available, BQA will announce it on
the State OASIS System Welcome Page, under Bulletins.
Recent OASIS Changes
CMS announced changes to the OASIS data set as part of the reduced
burden OASIS. To accommodate these changes, CMS published a new version of
the data set and also new data submission specifications. The following
bullets summarize these changes and provide resources for further
information:
Data specifications: All assessment records with completion dates
(M0090) on or after October 1, 2003 must conform to the new version 1.40
data submission specifications. If the data specifications used for
submission do not meet this requirement, the assessment will receive a
fatal record error, causing the record to be rejected and the data will
not be stored in the state database. Resource: www.cms.hhs.gov/oasis/
datasubm.asp (exit DHS).
Diagnosis codes: To ensure that HHAs can report ICD-9-CM diagnosis
codes to be compliant with HIPAA, changes to reporting diagnosis codes in
M0230/240/245 are effective October 1, 2003. Resource: OASIS
Implementation Manual (December 2002).
Branch ID: CMS is in the process of assigning standardized branch
IDs to every existing branch belonging to a HHA or subunit. The CMS
Regional Office is in the process of mailing letters to parent HHAs with
their branch ID numbers. This process will be completed by the end of this
year.
Version 1.40 data specifications require that HHAs report these
standardized branch IDs in M0016 for all assessments with completion dates
(M0090) on or after January 1, 2004. At that time, the following responses
to M0016 are appropriate:
- If HHA has ‘no’ branches, respond "N".
- If HHA is the parent agency, respond "P".
- If HHA is the branch, enter entire assigned branch number.
Resource: www.cms.hhs.gov/oasis/datasubm.asp
(exit DHS).
Data set: The reduced burden OASIS data set is OASIS B-1 (12/2002).
HHAs may use either the OASIS B-1 (12/2002) or may continue to use the
previous version, OASIS B-1 (8/2002) data set for collection of OASIS
data, as long as the version 1.40 data submission requirements are met,
including changes to M0016, M0230, M0240 and the addition of M0245.
Non-required data items that are submitted will not be edited or stored on
the State database. Resource: www.cms.hhs.gov/oasis/
oasisdat.asp (exit DHS).
Life Safety Code – Questions / Answers:
Q: When does a hospital or nursing home facility have to submit
construction plans for a remodeling project?
A: Remodeling means to make over or rebuild any portion of a
building or structure and thereby modify its structural strength, fire
hazard character, exits, heating and ventilating systems, electrical
system or internal circulation, as previously approved by the Department.
Where exterior walls are in place but interior walls are not in place,
construction of interior walls shall be considered remodeling. Remodeling
does not include repairs necessary for the maintenance of a building or
structure. Hence all projects that meet the definition of remodeling shall
be submitted to the Department for review and approval prior to
construction.
Construction plan approval forms and instructions are available at
(608) 243-2088 or by connecting to www.DHS.state.wi.us/rl_DSL/
PlanReview/index.htm.
Q: When should a hospital or nursing home report a fire?
A: All fires within a hospital or nursing home should be reported to
the Department within 72 hours per HFS 132.82(6)(e) and HFS 124.36(11) by
faxing the report to (608) 267-7119 or by using a Fire Reporting Form
available at www.DHS.state.wi.us/forms/DDES/DDE2500.pdf
(PDF, 23 KB).
Latest CMS Survey & Certification Letters
Below is a list of the Survey and Certification Letters distributed by
the federal Centers for Medicare and Medicaid Services (CMS) during the
last quarter. These letters are posted as PDF files to the Internet via
www.cms.gov/medicaid/survey-cert/letters.asp [link not operable at this time]. Please be aware that some letters pertain only to state agency operations.
If you have questions about individual letters, contact Susan Hespen of
BQA at (608) 266-0582 or E-mail hespesj@DHS.state.wi.us.
|
Title |
Number |
Date |
|
State Survey Agency Performance Standards for Fiscal Year (FY)
2003 |
03-27 |
7/10/03 |
|
Automation of Surveyor Minimum Qualifications Test (SMQT) and
Clarification of Survey Activities |
03-28 |
7/10/03 |
|
Discontinuance of Forms HCFA-1513, "Ownership and Control
Interest Disclosure Statement" and HCFA-2572, "Statement
of Financial Solvency" |
03-29 |
8/14/03 |
|
Clinical Laboratory Improvement Amendments (CLIA) Policy Letters
for First Survey Cycle Following the Effective Date of CMS-2226-F |
03-30 |
8/14/03 |
|
Transfer of Data from the ASPEN Complaints/Incidents Tracking
System (ACTS) to State Systems - DECISION |
03-31 |
8/14/03 |
|
Pilot Program for Surveyor Technical Assistant for Renal Disease
(STAR) |
03-32 |
8/14/03 |
|
Correction Policy for Home Health Agency (HHA) Administrative
Data on the Home Health Compare Web Site |
03-33 |
9/11/03 |
Consumer Information Reports 2002
Visit www.DHS.state.wi.us/bqaconsumer/NursingHomes/CIRindex.htm
to view new reports for Wisconsin’s nursing homes and facilities for
people with developmental disabilities for 2002. According to our
established policy, the site contains two years’ worth of reports for
all facilities. Older reports can still be obtained on request from our
records center.
A change from previous practice will be the retention of reports for
closed facilities. They will continue to be listed (and the reports
available) with a note that the facility is no longer in operation.
Administrative Rules Update
HFS 124 – "Hospitals"
The Department modified provisions in Subchapter VI, "Critical
Access Hospitals" in HFS 124. The Department filed the final proposed
rules on August 15, 2003 and anticipates an effective date of October 1,
2003. You may view the final rule order on the DHS website at:
http://apps3.DHS.state.wi.us/admrules/public/Rmo?nRmoId=11
[Link no longer available]
Other Bureau of Quality Assurance (BQA) Rule Updates:
"Omnibus Rulemaking Order"
In the interest of keeping our administrative rules up to date, the
Department’s Rules Unit filed its first Department Omnibus Rule Order on
September 15, 2003. The omnibus package includes relatively minor
revisions to the following BQA rules: HFS 83, HFS 124, HFS 132, HFS 133,
and HFS 134. You may view the final "Omnibus Rule Order" on the DHS
website at http://apps3.DHS.state.wi.us/admrules/public/Rmo?nRmoId=33
[Link no longer available]
"BQA Long Term Care Rulemaking Order"
The Department is drafting a "Statement of Scope" that
proposes to revise two of its health facility-related administrative rules
through a single rulemaking order. The proposed revisions will cover
changes to the following rules administered by BQA: HFS 132 "Nursing
Homes" and HFS 134 "Facilities for the Developmentally
Disabled."
For questions about BQA-related rules, contact Cheryl Bell-Marek at
(608) 264-9896 or e-mail at bellmcj@DHS.state.wi.us [replaced by Pat
Benesh]
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