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Category Archives: MDS 3.0

New PEPPER Release for Skilled Nursing Homes – May 2014

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled nursing homes.  PEPPERs will no longer be mailed to providers who previously received their PEPPERs by mail.  They will now be able to access them through a secure website portal,

Those providers who have been receiving their PEPPERs through QualityNet will continue to do so.  The Chief Executive Officer, President, or Administrator of the provider can obtain their PEPPER.  Information on accessing and downloading the PEPPER is available in the Secure PEPPER Access Guide.

Training and Resources are available on the website:

PEPPER Training Update (May 2014): is the official site for information, training and support.  If you have questions about the PEPPER reports, you may submit questions on this website through the Help/Contact Us tab.  Please do not contact your state QIO or state survey agency for assistance with PEPPER.

MDS Tips from the Section for Long-Term Care Regulation

Are you a new MDS Coordinator?  Are you unsure where to begin?  Print and save the helpful tips below from the Section for Long-Term Care Regulation:

MDS Coordinators Support Group Meetings

Support groups for Minimum Data Set (MDS) Coordinators meet monthly in each of Missouri’s seven regions.  These meetings provide an opportunity to discuss issues relating to MDS, PPS, and the RAI Process.  For more information, please visit the Quality Improvement Program for Missouri (QIPMO) at

Changing Antipsychotic Thinking (CAT) Tip #7

Cat Without a Tail

Do you see a TIGER in your percentages when you expect a KITTEN?  Are unexpected names on your Quality Measure (QM) Report for antipsychotic drug usage? Even the “appropriate” diagnosis of Schizophrenia will trigger the measure if not correctly reported. Schizophrenia, Tourette’s, and Huntington’s are the three accepted diagnoses for the use of an antipsychotic. Report these on the pre-printed section of the Minimum Data Set (MDS) Resident Assessment by checking I6000 for Schizophrenia, I5350 for Tourette’s Syndrome, and/or I5250 for Huntington’s Disease. In I8000 Additional active diagnoses, you may manually input “Schizophrenia with a tail.” One example is “Schizophrenia with Psychosis.” Please view CAT Tip #7 here: CAT_Tip_7.  View more tips at  The Missouri Local Area Network for Excellence (MOLANE) is the state coalition for Advancing Excellence.

MDS 3.0 Provider Updates – Training Videos

New Minimum Data Set (MDS) Sections I, G, M, and O provider training videos have been uploaded to YouTube.  To learn more and access these videos, please visit the Centers for Medicare and Medicaid Services at

MDS Section Q: Reminder for Social Workers and MDS Coordinators

Section Q:  Participation in Assessment and Goal Setting

The Section for Long-Term Care Regulation is posting this reminder to assist providers that may not understand all the requirements and procedures to follow regarding discharge planning within Section Q of the Minimum Data Set (MDS).

On May 1, 2014, the Missouri Department of Social Services issued Nursing Home Bulletin Vol. 26, No. 27 to assist providers with this requirement.  The bulletin contains specific instructions for completing the online referral.  Please view the bulletin here:  DSS Provider Bulletin 36-27 05-01-2014, or visit

Accurate completion of Section Q of the MDS is a requirement of the Centers for Medicare and Medicaid Services.  This section is designed to provide residents who do not have current active plans for discharge, with an opportunity to speak with an outside resource (Local Contact Agency or LCA).  The LCAs are contracted by the Division of Senior and Disability Services within the Missouri Department of Health and Senior Services.

Section Q is an interview process for all comprehensive MDS assessments and asks the following question in Q0500 of all residents who do not have current active discharge plans:  “Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community?”  If the resident wishes to speak to an options counselor about a potential discharge, no matter how feasible the care plan team thinks discharge may or may not be, the facility is expected to make a referral to the LCA, at  (If the resident answers “yes” to Q0500, also indicate “yes” on question Q0600 and make the referral).

Please remember that this is a Resident’s Rights issue and the facility cannot skip asking the question in Q0500 unless there is current active discharge planning already occurring.  The intent of Section Q is not to address residents who are already planning on discharge.  The intent is to capture all of the long-term care residents who do not have active discharge plans.  These are the residents who would be referred and benefit from speaking with an options counselor from the LCA.  The only time Q0500 would not be asked of the resident is if they have a guardian or invoked durable power of attorney.  In these cases, question Q0500 would be asked of the guardian/invoked durable power of attorney, rather than the resident.

If you have questions about Section Q of the MDS, you may contact Joan Brundick, State RAI Coordinator at 573-751-6308 or

Antipsychotic Drug use in Nursing Homes: Trend Update

CMS is tracking the progress of the Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported MDS quality measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington’s Disease or Tourette’s Syndrome.

Since the Partnership began in 2012, this data indicates Missouri’s percentage rates have dropped every quarter, with an overall decrease of 9.17 percent. This is encouraging and shows that Missouri is making improvements towards decreasing the use of antipsychotic medications for residents with dementia when their use is not indicated or appropriate. Please view the trend update here: CMS Trend Update – Antipsychotic Drug Use in Nursing Homes.