Volume #3-2019 | March 2019
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Cabinet for Health & Family Services
Office of Inspector General
Division of Health Care

Long Term Care Provider Newsletter
March 2019
PASRR Information

Over the last year DBH/DDID and Medicaid have worked to revamp the PASRR forms and manuals to have better clarification throughout all aspects of the process, and to ensure compliance with federal and state regulations. Remember to use the updated forms MAP 409 (Feb 2018) and MAP 4095 (July 2018). Both are located at https://chfs.ky.gov/agencies/dms/dpo/bpb/Pages/nursing-facilities.aspx, along with instruction sheets for each. The instruction sheets provide more detail on what each question is asking, and is a very useful tool in understanding the expectations.
It is highly recommended that all employees who are a part of the PASRR process complete the training webinar developed specifically for the Nursing Facility’s role in PASRR. This can also be found at https://chfs.ky.gov/agencies/dms/dpo/bpb/Pages/nursing-facilities.aspx. There is a PowerPoint for this training, as well as the webinar where we discuss details and examples from the PowerPoint. This provides you with the information needed to perform your role in the PASRR process.
Free Workshop - SAVE THE DATE!
Reducing Readmissions:
"Go to the Hospital or Stay Here?"
A Decision Guide

Readmissions are a fact of health care for the aged and chronically ill. However, CMS has identified that many transfers to the hospital are unnecessary and can potentially cause more harm than good for the resident. CMS is now imposing penalties on nursing homes for excess readmissions.

Timely education of residents and families about the care that can be provided in the facility early in the admission process and reinforced throughout the stay is a key component in reducing urgent transfers. To assist facilities in providing written information, Dr. Ruth Tappen and an interdisciplinary team at Florida Atlantic University produced a CMS Region IV and State of Kentucky approved Decision Guide, “Go to the Hospital or Stay Here?” ( www.decisionguide.org). The Guide provides facts and objective points for residents and families to consider when faced with a change in condition and possible readmission. The Guide has been piloted among select Skilled Nursing Facilities across eight states and now is being disseminated to all SNFs throughout CMS Region IV.

Several thousand Medicare-certified Skilled Nursing Facilities are being offered the unique opportunity to enhance their education to staff, residents and family on the options for going to the hospital or staying at the facility for care. Beginning in January there will be educational sessions offered in multiple locations across each state in Region IV. The dates for Kentucky will be April 10 th in Louisville and April 11 th at Kentucky Dam Village (Gilbertsville). During the session, participants will be provided with an overview of the Decision Guide content, learning videos and techniques to introduce the information to staff, residents and family. Best practices on how to hardwire “The Guide” into your organization’s admission process as well as highlights from the pilot project will be discussed.

Attached are the details for registering for this no-cost workshop. CEUs will be provided for nurses and administrators. Target audiences for the sessions should be any staff who provide education to residents and families during the admission process, as well as affiliate partners who support quality improvement such as QIOs, the State Survey Agency, Ombudsmen and LTC Professional Organizations.

The Guide was a perfect complement for our readmission reduction efforts. It validated everything we go over with our residents and families, but now we have “The Guide” to leave behind during the admission discussion.” - NC Pilot Facility.

Looking forward to seeing you there! 

Five-Star Quality Rating System

Changes were announced to the Five-Star Quality Rating System that will be implemented in April 2019. 

Improvements include:
• Ending the Freeze on Health Inspection Star Ratings In April 2019, the Centers for Medicare & Medicaid Services (CMS) will end the freeze on the health inspection domain of the Five Star Quality Rating System. We will resume the traditional method of calculating health inspection scores by using three cycles of inspections. Inspections occurring on or after November 28, 2017, will be included in each facility’s star rating.

• Quality Measure (QM) Domain Improvements – CMS is introducing separate ratings for short- and long-stay measures to reflect the level of quality provided for these two subpopulations in nursing homes. We are also revising the thresholds for ratings, adding a system for regular updates to thresholds every six months, and weighting and scoring individual QMs differently. Additionally, we are adding the long-stay hospitalization measure and a measure of long-stay emergency department (ED) transfers to the rating system. Two measures from the Skilled Nursing Facility Quality Reporting Program (QRP) will be adopted to replace duplicative existing measures.

• Staffing Domain Improvements – CMS is adjusting the thresholds for staffing ratings. Also, the threshold for the ‘number of days without a registered nurse (RN) onsite’ that triggers an automatic downgrade to one star will be reduced from seven to four days.
Refer to memorandum 19-08 NH for more detailed information.  
In the Downloads section of the Five-Star Quality Rating System website , the Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them.
Juniper VPN Network Client Upgrade

An upgrade is required to the Juniper VPN Network Client software (Network Connect Client) currently used by the QIES community to log into CMSNet for required submission and reporting. The upgrade for Nursing Home providers will occur on 06/30/2019. This will effect employees who use CMSNet for MDS, EPOC, and PBJ.

Upgrade Details
Users must have Administrator rights on their workstations or have an IT staff member with Administrator rights available to complete the upgrade. The upgrade will be initiated automatically when users launch the Juniper VPN Client beginning on 06/30/2019. Upon connection, the automated process will begin and users will be prompted to start the installation of the new Pulse Secure Desktop Client on their workstations.

For questions or assistance, please contact the CMSNet Help Desk at 888-238-2122.
SNF Provider Threshold Report

The new Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. This PTR is a user-requested, on-demand report, which enables users to obtain the status of their data submission completeness related to the compliance threshold required for the SNF Quality Reporting Program (QRP).

Currently, Fiscal Year (FY) 2020 and FY2021 are available for user selection for this report to assist providers in reviewing Calendar Year (CY) 2018 and CY2019 data submission. The SNF PTR will display an asterisk (*) for future dates (monthly and quarterly) when a measure is active, but data are not available yet.

This report is available in the “SNF Quality Reporting Program” category in the CASPER Reporting application. Please refer to Section 13-SNF Quality Reporting Program in the CASPER Reporting MDS Provider User’s Guide for additional information about this report.

The CASPER Reporting User’s Guide is available on the “Welcome to the CMS QIES Systems for Providers” web page and the Nursing Home (MDS)/Swing Bed Providers Reference & Manuals page on the QIES Technical Support Office (QTSO) website.
Patient-Driven Payment Model

Effective October 1, 2019, CMS will be using a new case-mix model for Medicare, the Patient-Driven Payment Model, which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment.

CMS has set up a website of resources available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html . As we prepare for this change, additional training opportunities will be made available later this year.
Informal Appeal of Survey Findings

Every Long Term Care provider has the right to both an informal and formal appeal process following receipt of a completed Form CMS-2567. There are two informal appeal processes: Informal Dispute Resolution (IDR) and  Independent IDR (IIDR) .
Interested in Serving on an IDR Panel?
Kentucky requires one member of the IDR panel to be "a person currently engaged in the provision of Long Term Care services who has no affiliation with the provider disputing a deficiency." Typically, a Long Term Care Administrator is on each IDR panel. There is no payment or travel reimbursement for an Administrator serving on a panel. Administrators will be rotated. If a Long Term Care Administrator is interested in serving on a panel, a confidentiality statement must be signed prior to the participation in the first IDR panel.
Please complete the  Confidentiality Agreement  and submit via email , fax, or mail to:
Chrystal Daugherty, IDR/IIDR Coordinator
Office of Inspector General
116 Commerce Ave.
London, KY 40744

Fax: (606) 330-2054
Improve Quality Measures for Pressure Ulcers and Other Wounds and Earn FREE CE Credits for LTC Nurses, Social Workers, Dietitians/Nutritionists

Access the newest AMDA Clinical Practice Guideline on Pressure Ulcers and Other Wounds as part of the Kentucky initiative to prevent pressure ulcers! Staff can earn FREE CE/CPE hours by completing the exam for nurses, social workers, and dietitians/nutritionists. Other staff can earn a Certificate of Completion! 

Access the other FREE training resources at the password-protected website www.cpgltc.org
with the CMS Region IV Quality Improvement Initiative, a 6-state CMS CMP program. 

  • 20 CE Exams with 1-3 contact hours – up to 42 total hours for LTC Nurses
  • 15 CE Exams with 1-3 contact hours – up to 29 NASW approved hours for LTC Social Work
  • 14 CE Exams with 1-3 contact hours – up to 20.5 hours for LTC Dietitians/Nutritionists from Becky Dorner Associates
  • CPG Implementation Series (Heart Failure, Pain Management, Urinary Incontinence) with accompanying training resources including narrated Power Points for nurses and nurse aides
  • 4-part Disease Awareness Video Series (COPD, Diabetes, Pain Management, Moderate Alzheimer’s)
  • Know-it-All™ Before You Call (for LTC staff) data collection tools for 70+ common health conditions
  • Know-it-All™ When You’re Called (for physicians and practitioners) data collection tools for 70+ common health conditions

LTC administrators receive facility-specific passwords and usernames. Please share with staff for access to FREE training materials at www.cpgltc.org. For facility username and password assistance, contact help@cpgltc.org
The next level of FREE Emergency Preparedness training conferences, EP 201, will be held on April 16-17 at the Crowne Plaza Hotel in Louisville, Kentucky. This conference is a “Deep Dive” into the elements of the CMS Final Rule on Evacuation, Transportation and Surge Planning. A preview of the new Electronic Hazard Identification mapping tool, created by Stantec, will be showcased at the conference. Learn how to conduct both Community and Tabletop Exercises. Bring your facility floor plans to create a Surge Plan specifically for your facility. Network with other facilities in your region.

All Leadership Teams such as Administrators, Assistant Administrators, Directors of Nursing, Maintenance/Plan/Facility Directors, Risk Managers and members of Safety/Emergency Preparedness Committees are invited to attend. There is no limit on the number of representatives from your facility who can attend.

Click here for a registration brochure. Please complete one registration form for each member attending the EP 201 conference and return by email to ltc2prep@louisville.edu or by fax to 502-852-5887.

This is the last of three EP 201 conferences to be offered, so don’t delay and register today!  

Questions? Contact Diana Jester at 502-852-3487 or diana.jester@louisville.edu.
A Message from Kentucky's QIN-QIO
OIG is pleased to provide information from the CMS funded QSource and atom Alliance, the Quality Innovation Network (QIN) - Quality Improvement Organizations (QIOs) for Kentucky. 
Click the link below to read a message from Kentucky's QIN-QIO:

Kentucky Annual Utilization Surveys

The Kentucky Annual Utilization Surveys were due on March 15, 2019. All licensed long term care facilities are required to report. To be in compliance with your license, an extension needs to be requested and data submitted. The reporting of this data is required by 902 KAR 20:008 and 900 KAR 5:020. 

Any request for an extension of the deadline must go through Elizabeth Tutt, Survey Administrator and Healthcare Data Analyst. You may contact her by  email  or by calling (502) 564-7940 x.3156.

CLICK HERE  for the website for the survey completion. The facility license number is the login and facilities should create their own password the first time they log in each year.
Kentucky's Top 10 Citations
for Nursing Homes

Chrystal Daugherty
MDS Assessment/Coding Issues
 606-330-2030 x.283 or  e-mail  
Rhonda Littleton-Roe  
Transmission or Technical
502-564-7963 x.3300 or   e-mail
ePOC Accounts
Is your certified nursing facility signed up for ePOC? If so, be diligent about keeping your account and password up to date.  Click here  for the CMS security rules.

If your facility is not signed up, see the  Account Setup  instructions.

Not sure if your facility has any ePOC accounts or have other questions?
E-mail  ePOC.Support@ky.gov .
Have you notified your residents?

Click the link below to download and/or print the contact list for various agencies.

to find an Ombudsman

Which Branch is Serving You? 
To provide the highest level of service, the Division of Health Care operates through four regional offices. Knowing the appropriate Branch to contact with questions and concerns will ensure you receive maximum service in minimum time. Review links below for detailed information.

CMS Survey and Certification memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.

Transfer/Discharge Hearing Appeals

Please submit your requests for transfer/discharge hearing appeals to Secretary Adam M. Meier, Cabinet for Health and Family Services, by emailing:

LTC Facility Self-Reported
Incidents & Complaints
New email addresses have been established for communications regarding LTC Facility Self-Reported Incidents and for use by residents and the general public to report possible violations of regulatory requirements.  Click Here  for the email addresses and additional contact information. 
ISTW: Integrated Surveyor Training Website

This CMS website provides training information to include the preceptor manual, the State Operations Manual and other documents. As always, the survey and certification process is a collaborative effort between CMS and providers. This website will allow providers the opportunity to take the same courses as surveyors.

Employment Opportunities  

To search and apply for positions within the Office of Inspector General, please visit the Kentucky Personnel Cabinet's web page by clicking below.

DHC Leadership Team:
Inspector General 

Deputy Inspector General 

Assistant Director
Assistant Director
Pharmacy Consultant
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