Certified nursing facilities must complete the Long Term Care Facility Application for Medicare and Medicaid (CMS-671) at every annual resurvey. At the time of the annual resurvey, the survey team leader provides the administrator with the application and instructions for its completion. The application and instructions are also accessible at http://www.cms.hhs.gov/cmsforms/downloads/CMS671.pdf.
To avoid common errors when completing the application:
- Fill out the form completely and answer every question. Print all numbers and other information legibly.
- Facility staffing hours should only be reported for care provided in certified beds. If a facility is distinct part (not fully certified), then staffing hours for the non-certified beds should not be reported.
- Ensure all three boxes in each staffing category are completed under Column A, Services Provided. Enter a Y for Yes, or N for No.
- Do not enter any information in the gray boxes.
- If there are no staffing hours to report under Columns B, C and D leave the box blank – do not enter zeros in every blank box.
- Enter all hours in whole numbers. Do not use decimals or fractions.
- Staffing hours provided by hospice staff or private duty staff (not hired and paid for by the facility) should NOT be included.
- Report actual hours worked (reference timesheets, electronic time records or calendar notes).
- Salaried employees should report the actual hours they work.
- The form must be signed.
It is very important to report data accurately on the application. The Centers for Medicare & Medicaid Services (CMS) uses this data for calculation of staffing hours on Nursing Home Compare and the star ratings. This information is available on line, http://www.medicare.gov/nursinghomecompare/search.html.
This coming year, CMS will require Missouri to conduct Minimum Data Set (MDS) Focused Surveys that will be sampled to verify the staffing data self-reported by a nursing home during the most recent recertification survey.
If you have any questions regarding completing the Long Term Care Facility Application for Medicare and Medicaid (CMS-671), please speak to the survey team leader during the survey, or contact Tracy Niekamp in the Licensure and Certification Unit at email@example.com or 573-526-8522.
- Categorical Waiver: CMS has determined that the 2000 edition of the National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) contains provisions on the use of power strips in health care facilities that may result in unreasonable hardship for providers or suppliers. Further, an adequate alternative level of protection may be achieved by compliance with the 2012 edition of the LSC, which has extended allowances on the use of power strips in patient care areas.
- CMS is permitting a categorical waiver to allow for the use of power strips in existing and new health care facility patient care areas, if the provider/supplier is in compliance with all applicable 2012 LSC power strip requirements and with all other 2000 LSC electrical system and equipment provisions.
- Resident rooms in long-term care or other residential care facilities that do not use line-operated electrical appliances for diagnostic, therapeutic, or monitoring purposes are not subject to the more restrictive NFPA 99 requirements regarding the use of power strips in patient care areas/rooms. Resident rooms using line-operated patient-care-related electrical equipment in the patient care vicinity must comply with the NFPA 99 power strip requirement and may elect to utilize this categorical waiver.
- Individual waiver applications are not required: Providers and suppliers are expected to have written documentation that they have elected to use the waiver. A provider or supplier must notify the LSC survey team at the entrance conference that it has elected the use the waiver permitted under this guidance and that it meets the applicable waiver requirements. The survey team will review the information and confirm the facility meets the conditions for the waiver.
Please see the complete memo here or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-46.html?DLPage=1&DLFilter=14-46&DLSort=3&DLSortDir=ascending.
The complete set of RAI Manual v.1.12 pages and change tables and the Replacement Pages file, both in the Downloads section below, now contain revised versions of Chapter 2; pages A-8, A-10, and A-13 (Chapter 3 Section A); pages E-2 through E-8 (Chapter 3 Section E); page 6-12 (Chapter 6); the Appendix B, F, and H cover pages; and Appendix G. Files affected by this revision contain an R in the version number (“1.12R”) and pages affected include an “(R)” in the page footer.
This most recent version can be located at the following link: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html.
The complete manual can be found in the box labeled “downloads” at the bottom
of that page.
There is a company by the name of AKE with dealers in some states bordering Missouri selling unlisted fire extinguishers to businesses. If you get calls or questions about these “STOP-FYRE” fire extinguishers, or find them during an inspection, explain to the facility that 1998 NFPA 10, paragraph 1-4.3 require fire extinguishers to have a UL listing, or listing from another recognized testing laboratory such as ANSI, indicating they have been tested, and meet or exceed the performance standards for fire extinguishers. The website is www.AKE.com.
October 7 – 8, 2014: RAI Process from Start to Finish
November 12, 2014: Medicare from Start to Finish
Please visit the Missouri League for Nursing at www.mlnmonursing.org/MDS.
CMS has posted the updated version (v.1.12.0) of the Resident Assessment Instrument (RAI) User’s Manual, which goes into effect on October 1, 2014.
Go to https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, and then look under Downloads where you can view/print the entire manual or only the replacement pages. Change tables are also available which summarize the deleted and added wording.
You may also sign up for any of the following FREE webinars done by Carol Siem, MSN, RN, BC, GNP, Clinical Educator, QIPMO.
Monday, September 22, 2014: 2:00 p.m. – 4:00 p.m.
Tuesday, September 23, 2014: 10:00 a.m. – 12:00 noon
Tuesday, September 23, 2014: 1:00 p.m. – 3:00 p.m.
Thursday, September 25, 2014: 10:00 a.m. – 12:00 noon
Friday, September 26, 2014: 9:00 a.m. – 11:00 a.m.
Friday, September 26, 2014: 2:00 p.m. – 4:00 p.m.
To sign up go to: https://attendee.gotowebinar.com/rt/8072217808620282113. After registering, you will receive a confirmation email containing information about joining the webinar.
Along with the updated manual is a new version of the Minimum Data Set (MDS) Item Set (v.1.12.0). Software vendors should be making contact with providers to update/patch the MDS software. In order to successfully transmit the MDS on and after October 1, 2014, providers will need to use the new version Item Set with Assessment Reference Dates (ARDs) of October 1, 2014 and later.
Questions may be directed to the MDS unit at 573-751-6308 or 573-522-8421.
The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 1, Issue 4. Topics include Little Known Facts about the MDS, Interesting Websites, and features Dave Walker’s Questions from the Field. Please visit www.nursinghomehelp.org/qipmo.html.