oltl updates panac june 2017 0617.pdf · –2016 hai surcharge, ma pass-through payments (for ma11...
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PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF LONG TERM LIVING
OLTL Updates
PANAC June 2017
Ruth Anne Barnard, BSN, RN
MDS/OBRA Coordinator for Nursing Facility Field Operations
Catharine B. Petko, BSN, RN
Senior Manager, Myers and Stauffer LC
June 2017 1
Agenda
• MDS Baseline Information
• Nursing Facility Report Portal
• New Section S Items
• CHC Updates
• OBRA Updates
• OLTL News
• Websites
June 2017 2
Baseline Results
June 2017 3
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Pe
rce
nta
ge
Year
RUG Elements Error Rates
Facility Error Rate
June 2017 4
0
100
200
300
400
500
600
# o
f F
ac
ilit
ies
Year
Facility Count by Baseline Error Percentage Rate
Top RUG Element Errors
MDS Item Definition Error %
H0200C Current toileting program/trial 13:17%
C1000 Decision making - staff 12.26%
O0500F Walking training 11.60%
O0500B ROM (active) 11.12%
O0700 Physician Orders (14) 10.70%
June 2017 5
June 2017 7
June 2017 8
Changing Passwords
June 2017 9
Changing Your Password
June 2017 10
1
2
3
Changing Your Password
• Requirements:
– Must be at least 8 characters
– Must not contain or resemble Username
– Must contain at least one letter and one number
– Must not contain dictionary words
– Must contain both upper- and lower-case letters
– Must contain at least one non-alphanumeric
character
– Must not match any of the previous 5 passwords
June 2017 11
PA-Specific MDS
• States may designate their own MDS 3.0 document
as long as it contains the minimum federally
required sections
– V. 1.15.0 for October 1, 2017 will contain Sections A – Q,
S, V, X and Z.
• Since 2010, PA has required completion of the
following Section S items:
– S0120 ZIP Code of Prior Primary Residence
– S0123 County Code of Prior Primary Residence
– S9080A-E Source of Payment
• In 2012, S8010H1 Picture Date Reporting
(Discharge conversion) was added
June 2017 12
Section S October 1, 2017
• No changes in current Section S items
– Instructions and completion requirements remain the same
– Will be integrated with new items according to their CMS
numerical designation
• New Section S Items
– S0113 Resident Living Situation Prior to Admission
– S0114 Support Person
– S0521 Primary Reason for Admission
– S9085 Community Health Choices Enrollment Details
• A. Is the resident enrolled in CHC?
• B. CHC Effective Date
• C. CHC Product/Provider Name
• D. CHC Member ID
June 2017 13
Completion Requirements
• Section S Forms and Instructions http://www.dhs.pa.gov/cs/groups/webcontent/documents/document
/c_261092.pdf
• Complete selected Section S items with
– All MDS 3.0 OBRA and PPS assessments
• A0310A Federal OBRA Reason For Assessment = 01 – 06
• A0310B PPS assessment = 01 – 05, 07
– Discharge assessments
• A0310F = 10, 11
– Tracking forms
• Entry record A0310F = 01
• Death in facility record A0310F = 12
June 2017 14
Section S Items Not Required
• Stand-alone Start or End of Therapy
assessment or Change of Therapy
assessment
– A0310A Federal OBRA Reason for Assessment
= 99; A0310B PPS Assessment = 7; A0310C
PPS OMRA = 1, 2, 3, 4
• Nursing Home Part A PPS Discharge (NPE)
assessment
– A0310A = 99; A0310B = 99; A0310C = 0;
A0310H = 1
– Complete required Section S items if NPE is
combined with a Discharge or other assessment
June 2017 15
S0113 Resident Living Situation Prior to Admission
June 2017 16
S0113 Resident Living Situation Prior to Admission
• Complete only on Admission assessment
(A0310A = 01); may not be skipped (^) or
dash (-) filled
• Enter the two digit code
• Possible responses:
– 01. Resident lived alone without services: No
other person shares the residence and no
services are received
– 02. Resident lived alone with services: No other
person shares the residence but resident
received services such as Home Health or Meals
on Wheels
June 2017 17
S0113 Resident Living Situation Prior to Admission
• Other possible responses
– 03. Resident lived with caregiver in the home
who is able to assist with daily medical and
custodial needs: Another person shares the
residence who is able to provide all needed
assistance
– 04. Resident lived in congregate situation:
Resident lived in assisted living, residential care
home, etc.
– 99. None of the above
June 2017 18
S0114 Support Person(s)
June 2017 19
S0114 Support Person(s)
• Resident has one or more support person(s) who
are positive towards discharge
– Support person(s) can be a spouse, one or more family
members, significant others, or friends
• Complete if A0310A = 1 – 6 or A0310F = 10 (NC,
NQ, ND)
• Code 0 No if there is no indication that the resident
has one or more support person(s) or the support
person(s) are unwilling or unable to support the
resident’s discharge
• Code 1 Yes if the resident has a support person(s)
who are positive towards discharge
June 2017 20
S0521 Primary Reason for Admission
June 2017 21
S0521 Primary Reason for Admission
• Enter a two digit code
• Complete only if A0310A = 01; may not be skipped
(^) or dash (-) filled
• Possible responses:
– 01. Significant change in functional status: Inability
to perform Activities of Daily Living at baseline level
– 02. Deterioration in cognitive status: Resident’s
cognitive status, skills, or abilities have deteriorated
as compared to baseline level
– 03. Change in the availability/status of primary
caregivers: Primary caregiver no longer willing or
able to provide services.
June 2017 22
S0521 Primary Reason for Admission
• Other possible responses
– 04. Difficulty arranging or paying for needed in-
home care or support: Costs of care exceed
resident’s personal resources or finances or no
provider is available
– 05. Failed to succeed in residential care home:
Current placement no longer appropriate for
resident’s community living option
– 06. Short term rehabilitation or skilled care:
Resident’s medical condition requires skilled
nursing or therapy services with an expectation
that s/he will be discharged within 100 days
– 99. None of the above
June 2017 23
Community HealthChoices (CHC)
• CHC is a new initiative that will increase
opportunities for older Pennsylvanians and
individuals with physical disabilities to remain in
their homes. CHC wll use managed care
organizations (MCOs) to coordinate physical health
care and long-term services and supports (LTSS)
• Developed for Pennsylvanians who are eligible for
Medicare and Medicaid, or eligible for Medicaid-
funded LTSS
• Is a managed care program by the departments of
Human Services (DHS) and Aging (PDA)
• Scheduled to begin in the southwest region in
January 2018
June 2017 24
S9085A Is the resident enrolled in CHC?
June 2017 25
S9085A Is the resident enrolled in CHC?
• The resident is considered to be participating in CHC if
they are enrolled with a CHC plan and have a
member card with a member ID and effective date
• Code 0 No if there is no indication that the resident is
enrolled with a CHC plan, and/or CHC is not active in
the nursing facility’s county. Skip 9085B, C and D
– Southwest counties January 1, 2018 (proposed)
– Southeast counties July 1. 2018
– Remainder of state January 1, 2019
– http://www.dhs.pa.gov/citizens/communityhealthchoices/#.Vs
YUumco6os
• Code 1 Yes if the resident has a CHC member card
indicating enrollment
June 2017 26
S9085A Is the resident enrolled in CHC?
• Complete with
– NC Comprehensive,
– NQ Quarterly,
– NP PPS,
– NT Tracker and
– ND Discharge
• Do not complete with NPE PPS discharge if
completed as a stand-alone assessment
– Complete if NPE is being combined with other
ISCs
June 2017 27
S9085B CHC Effective Date
June 2017 28
S9085B CHC Effective Date
• The CHC Effective Date is the first date that the
resident was enrolled with the current CHC plan
• Date is found on CHC member card.
• Enter 2-digit month, 2-digit day and 4-digit year
• If S9085A = 1 Yes, complete this item with
– NC Comprehensive,
– NQ Quarterly,
– NP PPS,
– NT Tracker and
– ND Discharge
• If resident is not enrolled in a CHC plan (S9085A =
0), skip this item (enter caret [^] marks)
June 2017 29
S9085C CHC Plan
June 2017 30
S9085C CHC Plan
• If S9085A = 1 Yes, complete this item with
– NC Comprehensive,
– NQ Quarterly,
– NP PPS,
– NT Tracker and
– ND Discharge
• If resident is not enrolled in a CHC plan (S9085A =
0), skip this item (enter caret [^] marks)
June 2017 31
S9085D CHC Member ID
June 2017 32
S9085D CHC Member ID
• If S9085A = 1 Yes, complete this item with
– NC Comprehensive,
– NQ Quarterly,
– NP PPS,
– NT Tracker and
– ND Discharge
• If resident is not enrolled in a CHC plan (S9085A =
0), skip this item (enter caret [^] marks)
June 2017 33
What is CHC?
COMMUNITY HEALTHCHOICES (CHC) Is a new
initiative that will increase opportunities for older
Pennsylvanians and individuals with physical
disabilities to remain in their homes. CHC will use
managed care organizations (MCOs) to coordinate
physical health care and long-term services and
supports (LTSS).
June 2017 34
What is MLTSS?
• Managed Long Term Services and Supports is the
delivery of long-term services and supports (LTSS)
through capitated Medicaid managed care
programs.
• It refers to an arrangement between Pennsylvania's
Medicaid programs and MCOs. The MCOs receive
capitated payments for LTSS and are accountable
for the health and welfare of participants through
the delivery of services and supports that meet
quality and other standards set in the agreements.
June 2017 35
What are the Goals of CHC?
• Enhance opportunities for community-based
services
• Strengthen health care and LTSS delivery systems
• Allow for new innovations
• Promote the health, safety, and well-being of
enrolled participants
• Ensure transparency, accountability, effectiveness,
and efficiency of the program
June 2017 36
Community Health Choices
June 2017 37
CHC Eligibility and Enrollment
You are eligible for CHC if you are over 21 years old and:
– are dually eligible for Medicare and Medicaid; OR
– qualify for Medicaid long-term services and supports (LTSS)
because need the level of care provided by a nursing facility.
You are not eligible for CHC if you:
– are an Act 150 program participant;
– are a person with intellectual or developmental disabilities
(ID/DD) who is eligible for services through DHS’ Office of
Developmental Programs; OR
– are a resident in a state-operated nursing facility, including the
state veterans’ homes.
– If you are eligible for, and select, the LIFE program, we will not
enroll you in CHC unless you specifically ask to be moved to
CHC.
June 2017 38
How to apply for CHC?
If you are eligible, our Independent enrollment broker
will talk to you about your CHC Managed Care
Organization (CHC-MCO) options and enroll you in
the program. You will have your choice of CHC-MCOs
(or LIFE program, where available) and will receive
counseling to help you to decide which CHC-MCO
best meets your needs. If you do not choose a CHC-
MCO, you will automatically be assigned to a plan
based on your needs.
June 2017 39
What services will be covered?
• CHC covers the same physical health benefits that
are currently available through the Medicaid Adult
Benefit Package.
• If you are eligible for LTSS, all services currently
available in the Office of Long-Term Living waivers
will be included in CHC. The following additional
services will also be available:
– pest eradication
– benefits counseling
– enhanced employment services
June 2017 40
MA for MA Case-Mix
• FFS rates for NFs will continue to be calculated
during the implementation of CHC and after
implementation.
• Since the rate methodology will essentially remain
the same, CMI reports, cost reports, etc. will
continue to be needed.
June 2017 41
Preadmission Screening and Resident Review
June 2017 42
Important websites
Community HealthChoices
http://www.dhs.pa.gov/citizens/communityhealthchoic
es/
Long Term Care Nursing Facility Providers website:
http://www.dhs.pa.gov/provider/longtermcarecasemixinfor
mation/index.htm
June 2017 43
• Average 5.12 CMI's in Pennsylvania
• Nursing Facility Field Operations Offices and Contact Information
• Healthcare-associated Infections
– 2016 HAI Surcharge, MA Pass-through Payments (for MA11 Cost
Reports with Acceptance Letters Mailed on or before March 6, 2017)
• Normalized Nursing Only CMIs - 2/1/2010 Latest MDS RUG-III v.
5.12 44 Group
• Nursing Facility Frequently Asked Questions About PROMISe
• Preventable Serious Adverse Events for Nursing Facilities
• Resident Data Reporting Manual (Updated 10/01/2016)
– Pennsylvania MDS Section S Form and Instructions (Updated
09/13/2012)
– Pennsylvania MDS Section S Form Effective 10/01/2017
– MA Nursing Facility CMI Report Calendar (06/29/2016)
• Supplemental Ventilator Care and Tracheostomy Care Payments
– SCTCP March 2017
Long Term Care Nursing Facility Providers website:
June 2017 44
Pennsylvania PASRR Process Website:
http://www.dhs.pa.gov/provider/longtermcarecasemixinformatio
n/obratrainingInformation/index.htm
Out of State Process for PASRR
http://www.dhs.pa.gov/provider/longtermcarecasemixinfor
mation/obratrainingInformation/nfcareprocess/index.htm
Order MA Forms:
http://www.dhs.pa.gov/dhsassets/maforms/index.htm
Important Websites
June 2017 45
PASRR Forms
• Level I PASRR Identification Form (MA 376)
• Level II PASRR Evaluation Form (MA 376.2)
Resources for PASRR:
• PASRR Clarifications, Questions and Answer Document
• PASRR Bulletins
• MA376
• MA376.2
• Handouts for Webinar Training
• PASRR Level I Tool Form Training Webinar
Who to contact for help with the Pennsylvania PASRR
process:
• Field Operations Offices
• Program Office Contacts
• State PASRR Coordinator at 717-214-3736
Pennsylvania PASRR Process Website
June 2017 46
Questions?
Ruth Anne Barnard, BSN, RN
PASRR/MDS/Field Operations Coordinator
◦ 717-214-3736
Cathy Petko, BSN, RN
Senior Manager, Myers and Stauffer LC
◦ 717-541-1203 (Office)
◦ 717-541 – 5809 (Helpdesk)
June 2017 47