DQA Quarterly Information Update
July 2009
PDF Version of this month's Quarterly Update (PDF,
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NEW THIS ISSUE
REGULAR FEATURES
UPCOMING EVENTS
NEW THIS ISSUE
FOCUS 2009 Conference
Bureau of Technology, Licensing and Education / Education Services
Section
Wednesday, October 21 - Special Sessions
Thursday, October 22 - FOCUS 2009
The Wisconsin Department of Health Services, Division of Quality
Assurance (DQA), is pleased to announce its 9th annual conference for health
care providers and DQA staff on October 21st and 22nd, 2009. The FOCUS 2009
Conference, being developed in collaboration with health care providers and
associations, is themed "Furthering Our Commitment to Ultimate
Service". This year's conference has an all-star lineup of presenters
to help improve your day-to-day work and bring the best service possible to
the consumer.
A FOCUS 2009 "Save the Date" postcard was mailed out this
spring. In early August the brochure will be mailed and posted on the DQA
website. At that time registration for the conference will begin.
This year the conference will be held at:
Kalahari Convention Center
1305 Kalahari Drive
Wisconsin Dells, WI
For lodging information, contact the Kalahari Convention Center at 1-877-525-2427.
Be sure to mention the FOCUS 2009 Conference for the special room rate.
On October 21st, two special sessions will be offered. Attendees
will have the option of attending "The Art and Science of Pressure
Ulcer Prevention and Treatment" or "ServSafe® Essentials."
"The Art and Science of Pressure Ulcer Prevention and Treatment"
will feature pressure ulcer expert Joyce Black, Ph.D., former president of
the National Pressure Ulcer Advisory Panel.
This conference will have break out sessions featuring many experts in
the field. The ServSafe® course will be taught by Certified ServSafe®
Instructor, Rich Daehn. He will explain food safety and the critical
importance of its role. Upon successful completion of the ServSafe®
Essentials course, participants will be given the opportunity to take an
approved exam to become ServSafe® Certified.
On October 22nd, the FOCUS 2009 Conference will feature two
keynote speakers. Dr. Gregory Poland will kick off the conference with a
presentation entitled, "Influenza Immunization of Health Care
Workers." Dr. Poland is an international expert in the field of
vaccinology and clinical research and is the director of Mayo Clinic's
Vaccine Research Group.
In the afternoon, the keynote speaker will be Clint Maun. The title of
Clint's presentation is, "Yes We Can!" Clint is a nationally
recognized leader in healthcare consulting, speaking, and research.
The agenda for this conference is loaded with great presenters and
current topics that are of importance to consumers. More information will be
included on DQA's conference website as plans are finalized. For additional
information, please visit the website at: http://dhs.wisconsin.gov/rl_dsl/training/focus09.htm
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Recall: Biosite Brand Triage Cardiac Panel
Bureau of Health Services / Clinical Laboratory Section
DQA is alerting emergency care managers, hospital risk managers, and
laboratory services managers of the Class 1 recall of the Biosite brand
Triage Cardiac Panel, a test used by health professionals as an aid in the
diagnosis of a heart attack (myocardial infarction).
Use of the affected lot may lead to false negative results with patient
samples containing troponin I at very low levels, with CK-MB, and with
myoglobin --- possibly resulting in missed or incorrect diagnosis. A false
negative test result would indicate that a person did not have a heart
attack or heart muscle injury when, in fact, they had.
Lot #W44467B, shipped as 25 individually pouched devices per kit box, was
distributed from January 24, 2009 through February 17, 2009. On April 27,
2009, the company issued an urgent recall notice to customers who were
instructed to immediately discontinue all use of and to discard all affected
products.
Read the complete MedWatch 2009 Safety summary, including a link to the
FDA recall notice, at: http://www.fda.gov/medwatch/safety/2009/safety09.htm#Panel
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Non-LTC Providers - Recent Survey Trends
Bureau of Health Services / Acute Care Compliance Section
The Bureau of Health Services has seen an increase in the number of
serious level deficiencies identified during surveys of non-long term care
providers. Acknowledged is the fact that most non-long term providers are
operating under new Medicare Conditions of Participation or Conditions for
Coverage.
Recent communications from the Centers for Medicare and Medicaid Services
(CMS) may assist you in evaluating whether you have thoroughly investigated
and implemented corrective actions to ensure ongoing compliance with
regulatory requirements. These are guidelines CMS shares with surveyors who
may be asked to determine a provider's compliance.
Surveyors use a variety of tools during a survey which may include review
of provider records and documentation, staff and patient/client interviews,
observations, and tours. Following are some of the inquiries that might be
made:
Tell me what you did in response to this problem.
What analysis of the underlying cause(s) was done?
When did you address it?
Were policies written or revised? If so, what were they?
Was training conducted?
What corrective action(s) was implemented?
What follow-up monitoring of these actions is being done and who is
doing the monitoring?
Has the problem been entered into the facility's quality assurance
performance improvement program?
Or, have you discussed the problem with your Governing Body? If not,
why?
Please show me documentation of committee minutes where the problem was
discussed or minutes of your governing body committee meetings where the
problem was discussed.
Citations for non compliance may be issued if the problem is still
occurring. If mechanisms put into place to address the original problem are
not monitored and tracked to ensure sustainability, the problem may likely
recur.
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Coming Soon! DHS 83 Q & A
Bureau of Assisted Living
Bureau of Assisted Living (BAL) staff are compiling a question and answer
document regarding the implementation of Wisconsin Administrative Code DHS
83 for Community-Based Residential Facilities. Since the new requirements
went into affect April 1, 2009, BAL staff have received a number of
questions regarding the department's interpretation of the regulation. We
hope the Q & A document will help clarify the regulation and assure
consistent application of the requirements.
The Q & A document is expected to be posted to the department's web
site sometime in July. When posted, an announcement will be sent via the DQA
LISTSERV with the web site link.
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New Outpatient Mental Health Clinic Rule
Bureau of Health Services / Behavioral Health Certification Section
On June 1, 2009 a new administrative code, DHS 35, for Outpatient Mental
Health Clinics took effect. This rule replaced HFS 61.91 with modern
standards for psychotherapeutic care, oversight, and consultation.
Outpatient mental heath has advanced as new treatment modalities and
knowledge were gained, technologies improved, specialties defined, and
business models adapted.
The rule was authored by the Division of Mental Health and Substance
Abuse Services (DMHSAS) and incorporates improvements, public comment, and
addresses variances issued in past years. DHS 35 affects approximately 840
service providers. The new rule is available on-line at: http://www.legis.state.wi.us/rsb/code/dhs/dhs035.pdf
The DMHSAS and DQA are committed to assisting clinics in achieving full
compliance with program standards within one-year's time. Because there have
been so many changes to DHS 35, clinics have until January 1, 2012 to meet
the new standards for minimum staffing combinations. Questions regarding
legislative intent and interpretation may be directed to:
Dan Zimmerman
DMHSAS / Bureau of Prevention, Treatment and Recovery
(608) 266-7072
Daniel.Zimmerman@dhs.wisconsin.gov
The DQA Behavioral Health Certification Section (BHCS) monitors all
mental health providers, including outpatient clinics. Support may be
received through the provider's regional Health Service Specialists with
application questions directed to:
BHCS Central Office
(608) 261-0657
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Telehealth for Behavioral Health Service Providers
Bureau of Health Services / Behavioral Health Certification Section
Since 2004, the Division of Quality Assurance has accepted "telehealth"
applications to certify behavioral health services delivered via streaming
media. Telehealth was first addressed via numbered memo series,
DDES-2004-014, now located at: http://dhs.wisconsin.gov/dsl_info/NumberedMemos/DDES/CY_2004/NMemo2004-14-DDES.htm
Telemedicine is conducted in many spheres of primary medicine. The
effectiveness of telemedicine is evidenced in research and, once tried, is
generally approved of by patients and providers alike. For the program
director, telehealth services are found to be an effective means of
extending the access to services which otherwise may be delayed or not be
available at all. The business manager, insurance payer, and patient will
also find that telehealth is efficient, providing a savings in the total
cost of service delivery.
Many behavioral health services are eligible to be delivered via
telehealth. While most certified telehealth services have been in mental
health and substance abuse outpatient treatment programs, some program
directors have discerned the usefulness of this modality within day
treatment, crisis and emergency care, community support programs, and even a
prevention service. Applications may be made to the Behavioral Health
Certification Section and are available on-line at: http://dhs.wisconsin.gov/forms1/F6/F62589.pdf
Questions regarding telehealth may be directed to (608) 261-0657.
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Effective August 1, 2009:
Iron, Price, and Sawyer Counties to Have Managed Care
Administrator's Office
On June 19, 2009, the Division of Quality Assurance issued DQA memos
09-023 (CBRFs), 09-024 (RCACs), and 09-025 (Nursing Homes) outlining the
Preadmission Consultation (PAC) requirements for providers, effective July
1, 2009. The memoranda are available at:
http://dhs.wisconsin.gov/rl_dsl/Publications/09-023.htm
http://dhs.wisconsin.gov/rl_dsl/Publications/09-024.htm
http://dhs.wisconsin.gov/rl_dsl/Publications/09-025.htm
The memoranda identify certain information dissemination and referral
responsibilities that affect facilities in counties with Managed Care/IRIS
(self-directed supports waiver) and in counties where Medicaid Waiver
programs are available. Currently, managed care is not available in all
counties. When managed care is made available in a county, new PAC
requirements take effect. DQA will continue to publish the Managed Care
Organization (MCO) start dates in the DQA Quarterly Information Update to
inform providers when the new PAC requirements go into effect.
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Quality of Life and Environment Changes
Bureau of Nursing Home Resident Care
CMS introduced new guidance on specific Quality of Life and Environment
tags which became effective on June 17, 2009. Although the regulations have
not changed, the interpretative guidance to surveyors has expanded to
include culture change and person-directed care concepts.
The word "homelike" stresses the concept of a setting as close
to home as possible. A homelike environment can be achieved in a nursing
home once residents have a sense of feeling at home. As we move away from an
institutional feeling toward a more natural sense of home, the new
guidelines provide a balance between person-directed care and regulatory
requirements. Although not all of the guidance is new, Federal tags that
have been expanded include the following:
F172 - Access and Visitation Rights. Access to visitors at
times convenient for those living in the nursing home is part of creating an
environment like that of one's home. The facility's right to reasonable
restrictions does not include limiting visiting hours.
F241 - Dignity. Staff should both encourage and assist
residents to dress in their own night clothing rather than hospital type
gowns. Encouragement plays a role in this new guidance since some persons
living in an institutional setting may have become accustomed to this type
of facility practice.
When staff are assisting residents or providing cares, the guidance
mentions that staff should be interacting and conversing with the residents
rather than only with each other. It is a violation of dignity for staff to
ignore residents and to talk only to each other as if the resident is not
present.
Language has also been added to this tag that staff should avoid use of
undignified labeling of residents. This includes descriptive words such as
"wanderer," "eloper," or "feeder." The
movement is toward the use of first person language and away from
institutional language. A wheelchair-bound resident is more appropriately
referred to as "a person who uses a wheelchair."
Another homelike concept that has been added as an option (not a
requirement) relates to bodily privacy in the bath and shower. One method of
ensuring privacy is to take persons to bathing areas in their clothing and
to change them there rather than escorting them in a hospital gown with an
opening in the back.
F242 - Self-Determination and Participation. The guidance
at this tag enhances choices regarding bathing, including the timing and day
of the week as well as a choice of bathing method. In 2002 CMS introduced
the "bathing without a battle" method of in-bed cleansing, which
is now considered an option for those living in the nursing home.
Language has also been added to the guidance regarding the right to
choose a room with a person of the resident's choice. This is not limited to
a husband and wife, but includes anyone residing in the nursing home (as
long as both residents agree), including family members or two friends of
the same or opposite gender.
F246 - Accomodation of Needs. The new guidance at this tag
focuses on the physical environment and goes beyond the resident's bedroom
and bathroom. The language stresses the concept of the facility attempting
to add some individualization to the environment in common areas. This is
not a regulatory requirement, but it is a homelike option that is
encouraged.
When discussing accommodation of needs the concept of reasonableness is
to be determined on a case-by-case basis.
F247 - Room/Roommate Change. Guidance has been added to
provide specificity and to encourage the nursing home to be sensitive to
resident needs when moving to a new room or when getting a new roommate. In
the case of the death of a resident, the roommate may be experiencing a
loss. It is encouraged that the resident be given some time to begin their
adjustment and to grieve prior to introducing a new roommate.
F252 - Environment. The main focus of this tag consists of
two issues:
1. general comfortableness of the environment; and
2. homelike environment.
Examples of institutional practices that a facility should strive to
eliminate include:
- overhead paging
- meals served on trays in the dining room
- institutional signage that label rooms
- medication carts
- widespread use of audible seat and bed alarms
- mass purchased furniture
- nurse's stations
Guidance indicates that most homes cannot make these changes right away
but should strive toward them. It is not considered a deficiency if these
practices remain.
F256 - Lighting. Guidance for adequate lighting addresses
several issues for both the resident and facility staff. Adequate lighting
design must:
- be sufficient
- produce minimal glare
- provide even lighting in common areas
- provide as much daylight as possible
- eliminate glare from shiny floors and unshielded windows
Daylight is excellent for resident health and should be encouraged when
possible.
In addition to lighting, guidance has been added to cue homes about the
use of contrasting coloring to enhance a resident's ability to distinguish
surfaces from each other. Areas of concern are baseboards that are the same
color as the floor, bathroom fixtures that are the same color as the walls,
and dinnerware that is the same color as the tablecloths.
F371 - Sanitary Conditions. The new guidance at this tag
makes it clear that any resident has the right to accept food that is
brought in by any visitors.
F461 - Resident Rooms. This tag was updated to include the
LSC 2000 edition which replaced the outdated reference. Wording from the LSC
was added to clarify that the height of the window sills in resident rooms
must not exceed 36 inches. Language also clarified that the floor of the
bedroom must be at or above the surrounding exterior ground level.
F461 and F255 - Two tags both addressed closet spaces. The
two requirements were moved together and F255 has been deleted. The guidance
makes it clear that the clothes racks and shelves (if any) need to be
accessible to the resident, meaning that the resident can get to and reach
their clothing. Closets also include free standing furniture such as a
wardrobe. If a facility uses a wardrobe, the racks and shelves need to be
accessible to the residents.
F463 - Call System. Language has been added to address
homes that do not have nursing stations and homes that use wireless systems.
The guidance for this tag adds language that, to be in compliance, the
system must not only be merely functional but that it must actually be in
use. That is, that calls must be answered. The system is in compliance if it
is effectively functional, functioning, and if staff are actually responding
to calls.
A complete presentation on the new guidance for Quality of Life and
Environment Federal tags can be found at:
http://media1.wi.gov/DHFS/Viewer/?peid=2ce814ff-df05-4ebd-b352-71e908598bcf
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Requirements for Laboratory Director - CLIA Certified
Laboratory
Bureau of Health Services / Clinical Laboratory Section
The Clinical Laboratory Section frequently receives calls regarding the
requirements for a Laboratory Director of a CLIA certified laboratory. The
requirements depend both on the type of CLIA certificate required and the
complexity of testing performed. The types of certificates and complexity of
testing are:
- Certificate of Waiver - allows only waived laboratory testing to be
performed
- Certificate of Provider Performed Microscopy (PPM) - allows providers
to read simple microscopic procedures and perform waived testing
- Certificate of Compliance/Accreditation for a Moderately Complex
Laboratory
- Certificate of Compliance/Accreditation for a Highly Complex
Laboratory
These requirements can be found on the web at:
http://www.cms.hhs.gov/CLIA/downloads/apcsubm.pdf
For additional information, please contact the Clinical Laboratory
Section at (608) 261-0653.
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CLIA CONTACT INFORMATION
Bureau of Health Services / Clinical Laboratory Section
The Clinical Laboratory Section may be contacted regarding CLIA
certification --- application for CLIA certification, questions pertaining
to current certificate status, renewal, and requests for certificate
changes.
DHS / Division of Quality Assurance
BHS / Clinical Laboratory Section
P.O. Box 2969
Madison, WI 53701-2969
Telephone: (608) 261-0653
FAX: (608) 264-9847
Requests for changes in certificate information are now required to be
made in writing. Requests may be submitted by mail, FAX, or e-mail to:
Barbara Saar, QAPS
Telephone: (608) 261-0653
FAX: (608) 264-9847
Barbara.Saar@dhs.wisconsin.gov
or
Cherie Williams
Telephone: (608) 261-0654
FAX: (608) 264-9847
Cherie.Williams@dhs.wiconsin.gov
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OASIS-C UPDATE: OASIS-C Not Yet Finalized
Bureau of Technology, Licensing and Education / Technology Services
Section
Current Status
CMS submitted the current draft of OASIS-C, version 12.2, on March 9 for
approval from the Office of Management and Budget (OMB). OMB's intent in
reviewing the data collection instrument is to focus on the burden posed to
Home Health Agencies, as compared with the current OASIS-B1. A second public
comment period ended April 8 and resulting comments were submitted only to
the OMB for use in their analysis.
As of June 16, a CMS spokesperson reported that OMB had neither granted
clearance nor submitted comments/questions back to them. Once this occurs,
there may need to be an additional revision of the dataset, though CMS and
the Home Health industry is expecting this to be minimal. The dataset will
also go through a Notice of Proposed Rulemaking (NPRM) process.
To obtain a copy of the current OASIS-C version 12.2, go to the Home
Health Quality Improvement website at:
http://www.cms.hhs.gov/HomeHealthQualityInits/06_OASISC.asp
Next Steps
CMS remains on task for the anticipated final version of OASIS-C to
become effective January 1, 2010, unless unforeseen circumstances intervene.
CMS is planning Open Door Forums, National Provider Calls, Listserv notices,
and software "Vendor Calls" this summer after publication of the
final version of the dataset.
CMS has also announced plans to develop a free, 4-hour Medicare Learning
Network training program to be used by Home Health Agencies, as well as a
re-write of related portions of the OASIS Implementation Manual, including
the Item-by-Item Tips in Chapter 8.
State OASIS Education Coordinators (OECs) will tentatively receive
CMS-sponsored training on OASIS-C mid-September and will then conduct
subsequent state-sponsored training sessions within their respective states.
Wisconsin is planning to hold multiple OASIS-C training sessions for HHAs
around early November, if the anticipated timeline remains unaltered. These
training dates/locations will be posted to the DQA training page when
finalized at:
http://dhs.wisconsin.gov/rl_dsl/Training/dqaProvTrng.htm
The new OASIS-C data items include new structure, process, and outcome
elements that are capable of capturing new process reports, outcome-based
quality monitoring (OBQM), and outcome-based quality improvement (OBQI)
reports, as well as for publication on Home Care Compare. OASIS-C includes
clinically relevant measures that can be used to reflect the agency's use of
evidence-based best practices, such as influenza vaccination rates.
The National Quality Forum (NQF) has been working to "globally
harmonize" reporting measures across all post-acute health care
settings and has endorsed 20 new homecare quality measures toward this
effort, with 4 more pending. CMS anticipates public reporting on the new
measures to begin in Spring 2011.
To view the NQF press release and the 20 endorsed quality measures, go to
the NQF website at:
http://www.qualityforum.org/Press_Releases.aspx
Preparation
There are several things an agency can do now to prepare for OASIS-C,
prior to the publication of the final dataset. Some suggestions are:
- First, obtain a copy of version 12.2, as outlined above. Examine each
of the data questions. Some of the questions are best answered using
standardized industry-accepted assessment tools, e.g., pain assessment.
If your agency doesn't have these, you will want to do some research and
obtain them, then put them into practice.
- Many of the questions require "look back" information, such
as care given or symptoms experienced during the previous certification
period. This information will be difficult to retrieve if the clinician
who needs to collect OASIS is not the primary clinician who has been
caring for the patient, unless your agency has a standardized location
to document and retrieve this information. This could significantly
affect the amount of time it takes to complete an OASIS/comprehensive
assessment. Identify which questions require this "look back"
and start discussions with your clinicians to recommend where to
document these items for quick/easy retrieval.
- Whether your agency uses software or paper documentation, contact your
vendor now to obtain drafts of their proposed documentation, so you can
be somewhat prepared for what your agency will be using. Be sure to
obtain each assessment (e.g., SOC, recertification), since the OASIS
questions make up only a portion of each of these comprehensive
assessments. This will also help you decide where to document "look
back" information for easy retrieval.
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CMS and DQA to Implement Emergency Preparedness
Response System --- E-mail Addresses Requested
Bureau of Technology, Licensing and Education / Technology Services
Section
Later this year, DQA expects to begin implementing a new information
system being developed by the Centers for Medicare and Medicaid Services
(CMS). This system, tentatively known as the Emergency Preparedness Resource
Inventory, or EPRI, is designed to track the status of regulated health care
facilities during emergencies, such as those created by severe flooding or
other natural disasters, chemical spills, and similar situations.
EPRI will enable CMS and Wisconsin to send broadcast or targeted e-mail
messages to DQA-regulated providers notifying them of emergency conditions
and requesting information on their operational status, such as the number
of beds available in a hospital or nursing facility, availability of
electrical power, etc. Providers receiving emergency alerts and requests for
status information will use an Internet connection to EPRI to update their
status and provide other requested information.
In preparation for the rollout of EPRI, DQA will need to collect e-mail
addresses for most of the health care providers regulated by the Division.
An online survey will be created that providers will use to enter one or
more contact e-mail addresses (typically those of the administrator and a
designated back-up), an assigned facility identifier (such as the federal
certification number or state license number), the name of the respondent,
and a contact phone number.
The provider identifier will be cross-referenced with the detailed
facility records housed in DQA's licensing and certification databases to
create the information that will be stored in the EPRI database. Providers
can then be notified using their supplied e-mail addresses of the need for
an EPRI status update.
Providers should look for and, in the near future, find a DQA memo
announcing the availability of this online survey and a link to it on the
main DQA webpage at:
http://dhs.wisconsin.gov/rl_DSL/bqa.htm
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Wisconsin Nurse Aide Training Programs
Office of Caregiver Quality
All nurse aide training programs that were approved prior to the December
1, 2008 implementation date of Chapter DHS 129, Wisconsin Administrative
Code, were terminated effective June 30, 2009.
Graduating Students
Students who completed one of these previously approved nurse aide
training programs have one year from the date of training completion to
successfully complete both parts of the Wisconsin nurse aide examination. If
they do not successfully pass both parts of the examination in that time
period, they will have to successfully complete a nurse aide training
program that meets the revised nurse aide training requirements of ch. DHS
129.
New Program Requirements
Entities wishing to conduct nurse aide training after July 1, 2009 were
required to submit a new application and meet all requirements of ch. DHS
129, dated December 1, 2008. These requirements include:
- The training program length must be a minimum of 120 hours.
- Of the120-hour training, 32 hours must be hands-on experience in a
clinical setting.
- Instruction must be increased in the following areas:
- Commonly used alternatives to restraints in accordance with current
professional standards [129.07(b) 17, Wisconsin Administrative Code]
- Recognizing the general effects of prescribed routine medications
[129.07(b) 26, Wisconsin Administrative Code]
- Recognizing the therapeutic interventions and specialized
non-pharmacological pain control interventions [129.07(b) 27,
Wisconsin Administrative Code]
- Transferring clients safely and according to principles of patient
care ergonomics and with proficiency in use of available equipment
that is used to transfer clients. This requirement includes, but is
not limited to: mechanical lifts, friction reducing devices,
wheelchairs and gait belts [129.07(d) 3, Wisconsin Administrative
Code]
- Possible causes of dementia-related symptomatic behavior changes,
specifically focusing on understanding behavior as an attempt to
communicate unmet needs and, then, how to address the unmet need,
including an understanding of how pain impacts behavior [129.07(f) 5,
Wisconsin Administrative Code]
- Ways to help a person with dementia continue meaningful involvement
in his or her day, the importance of structure and routine, and the
incorporation of the person's life story and past interests, routines,
tastes, values, and background [129.07(f) 6, Wisconsin Administrative
Code]
- The stress involved for a client, family, and nurse aide in caring
for a client with dementia and the techniques for coping with this
stress; ways to address the person with dementia's core needs of
having self-esteem boosted, being useful, giving and receiving love,
and caring for self and others [129.07(f) 7, Wisconsin Administrative
Code]
In addition to revising course syllabi and calendars, programs were
required to revise course quizzes and course examinations to include
questions relating to the additional topics listed in ch. DHS 129.
The Department placed increased emphasis on student attendance and required
programs to submit policies that reflect that a minimum of 120 hours of
class attendance is mandatory. Programs that allowed absences without
establishing provisions to ensure completion of the mandatory minimum 120
hours of training were not approved. In addition to the above curriculum
requirements, all training programs were encouraged to review and update
their present policies and procedures as they relate to dress code, cell
phone, camera phone usage, etc.
Questions? Contact the DQA Office of Caregiver Quality:
Telephone: (608) 261-8319
FAX: (608) 264-6340
E-mail: DHSCaregiverIntake@wisconsin.gov
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REGULAR FEATURES
DQA Numbered Memos (April, May, June 2009)
Access these memos via
http://dhs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm
or from individual providers' publications pages via
http://dhs.wisconsin.gov/rl_DSL/
|
Memo No.
|
Title
|
Summary
|
Providers Affected
|
|
09-011
|
Bureau of Assisted Living Restructuring to Four (4)
Regions |
As a result of the challenging financial future,
effective April 1, 2009, the Bureau of Assisted Living will cease
operations in the Northern Regional Office located in Rhinelander.
Facilities previously assigned to the NRO will be reassigned to the
WRO in Eau Claire, the NERO in De Pere, and the SRO in Madison. |
Adult Day Care Centers
Adult Family Homes
Community-Based
Residential Facilities
Residential Care
Apartment Complexes |
|
09-012
|
Carbon Monoxide Alarms New Requirements
|
2007 Wisconsin Act 205, created section 101.149 of
the Wis. Stats., requiring installation of carbon monoxide alarms in
most residential buildings that have fuel burning appliances. DHS/DQA
is sending this information to effected facilities, requesting that
all administrators, designated service managers, and licensees inform
their staff of these new requirements.
|
Adult Family Homes
Community-Based Residential Facilities
Residential Care Apartment Complexes
Hospices
|
|
09-013
|
Supervision of Licensed Practical Nurses in Methadone
Treatment Programs |
This memo provides clarification regarding the role
of the supervising physician or registered nurse when a licensed
practical nurse (LPN) administers methadone in basic and complex
nursing situations in Certified Narcotic Treatment Service.
|
Area Administrators / Asst. Administrators
Bureau Directors
County DHS Directors
County Mental Health Coordinators
Tribal Chairpersons / HS Coordinators
Certified Mental Health and AODA
Community Substance Abuse Providers
Certified Outpatient Mental Health Clinics
|
|
09-014
|
Medication Cart Storage in Hospitals: Secured and
Locked |
In November 2006, hospital regulations related to
medication security received updates that relaxed the requirements for
all medications to be locked at all times. The regulations now require
medications to be kept in a secure area and locked when appropriate. In February of 2008, CMS issued guidance related to locking and
securing medications. The attached regulations and associated guidance
include the provisions for locking and securing medications in
hospitals and critical access hospitals.
|
Hospitals
|
|
09-015
|
Antipsychotic Medication Use for Individuals with
Dementia |
This memo addresses the current federal Food and Drug
Administration (FDA) Public Health Advisories on antipsychotic
medication use for the treatment of behavioral disorders in elderly
individuals with Alzheimer's disease, dementia, or other organic brain
syndrome.
|
Nursing Homes
|
|
09-016
|
Wisconsin Statutes, Section 50.36(5) Instructions and
Proficiency in the Use of Automated External Defibrillators |
2007 Wisconsin Act 104 was signed into law on March
14, 2008, establish-ing requirements for certain individuals to
complete instruction and have current proficiency in the use of an
automated external defibrillator (AED). This new law created section
50.36(5),Wis. Stats., effective September 1, 2008, establishing
standards for the use of AEDs in hospitals.
|
Hospitals
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|
09-017 |
Survey and Certification Issues Related to Swine Flu
Outbreak 09-33 |
This memo introduces revised CMS memo 09-33 regarding
Survey and Certification Issues Related to Swine Flu. The memo also
provides useful Centers for Disease Control and Health and Human
Resources web links. |
Ambulatory Surgical Ctrs.
End Stage Renal Dialysis Units
Facilities for the Develop-mentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehab Facilities
Rural Health Clinics |
|
09-018 |
Novel Influenza A (H1N1)/2009 (Swine Flu) |
Because of H1N1's newness and potential for harm,
several healthcare organizations have developed resources and
guidelines to bring necessary information to healthcare providers,
healthcare workers, and citizens of Wisconsin. This memo lists and
provides links to some of the most current and valuable sources of
information. |
Ambulatory Surgical Ctrs
Adult Day Care Centers
Adult Family Homes
Certified Mental Health and AODA
CLIA Laboratories
Community-Based Residential Facilities
End Stage Renal Dialysis Units
Facilities for the Develop-mentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehabilitation Facilities
Residential Care Apartment Complexes
Rural Health Clinics |
|
09-019 |
Personal Protective Equipment |
This memo introduces a Division of Public Health
process that provides guidance for accessing and ordering personal
protective equipment.
Attached are Guidelines for Access to and Ordering of Personal
Protective Equipment and the Pandemic Influenza Medical
Countermeasures Order Form. |
Nursing Homes |
|
09-020 |
Novel Influenza A (H1N1)/2009 (Swine Flu) Training
and Information Resources |
This memo provides Novel Influenza A (H1N1)/2009
training and information resources for just-in-time training needs. |
Ambulatory Surgical Ctrs
Adult Day Care Centers
Adult Family Homes
Certified Mental Health and AODA
CLIA Laboratories
Community-Based Residential Facilities End Stage Renal Dialysis Units
Facilities for the Develop-mentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehabilitation Facilities
Residential Care Apartment Complexes
Rural Health Clinics |
|
09-021 |
Immediate Jeopardy Citations |
In the first four months of 2009, DQA saw a sharp
increase in the number of immediate jeopardy citations in Wisconsin
nursing homes. As of today's date, long term care surveyors in the
Bureau of Nursing Home Resident Care have issued 52 citations at the
level of immediate jeopardy. This is more than half of the number
issued in 2008.
This memo highlights types of situations cited at the level of
immediate jeopardy over the last 15 months and encourages review of
your facility's policies, procedures, and practices to ensure
compliance with all state and federal regulations. |
Nursing Homes |
|
09-022 |
Health Facility Construction Plan Reviews and Onsite
Inspections |
This memo provides notice of interim measures DQA has
implemented to ensure a timely response to the review of construction
/remodeling plans and their subsequent construction inspections. |
Ambulatory Surgical Ctrs
Community-Based Residential Facilities
End Stage Renal Dialysis Facilities
Hospices
Hospitals
Nursing Homes |
|
09-023 |
Preadmission Requirements for Community-Based
Residential Facilities
New Requirements Effective July 1, 2009 |
This memo presents guidance to Community Based
Residential Facilities about their responsibility to make referrals on
behalf of and to provide information to prospective residents. The
information and referral requirements, often referred to as
Preadmission Consultation (PAC) requirements, go into effect on July
1, 2009. |
Community-Based Residential Facilities |
|
09-024 |
Preadmission Requirements for Residential Care
Apartment Complexes
New Requirements Effective July 19, 2009 |
This memo presents guidance to Residential Care
Apartment Complexes about their responsibility to make referrals on
behalf of and to provide information to prospective tenants. The
information and referral requirements, often referred to as
Preadmission Consultation (PAC) requirements, go into effect on July
1, 2009. |
Residential Care Apartment Complexes |
|
09-025 |
Preadmission for Nursing Homes
New Requirements Effective July 1, 2009 |
This memo presents guidance to nursing homes about
their responsibility to make referrals on behalf of and to provide
information to prospective residents. The information and referral
requirements, often referred to as Preadmission Consultation (PAC)
requirements, go into effect on July 1, 2009. |
Nursing Homes |
|
09-026 |
Discontinuing the Issuance of Annual/Biennial
Certificates |
The Bureau of Assisted Living, beginning July 1,
2009, will no longer routinely issue renewal certificates or send
confirmation letters. |
Adult Day Care Centers
Residential Care Apartment Complexes |
|
09-027 |
Heat Awareness |
The purpose of this memo is to introduce Heat
Awareness information that was developed by Wisconsin Emergency
Management (WEM) and the National Weather Service (NWS). |
Ambulatory Surgery Ctrs
Adult Day Care
Adult Family Homes
Certified Mental Health and AODA
CLIA Laboratories
Community-Based Residential Facilities
End Stage Renal Dialysis Units
Facilities for the Develop-mentally Disabled
Home Health Agencies
Hospices
Hospitals
Nursing Homes
Outpatient Rehabilitation Facilities
Residential Care Apartment Complexes
Rural Health Clinics |
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DHS Administrative Rules Update
Administrator's Office
DHS 12 - Caregiver Background Checks
On September 15, 2008, the Wisconsin Administrative Rules website
published the Initial Proposed Rulemaking Order including a summary and text
of the proposed rule, Wisconsin Administrative Code, Chapter DHS 12. Section
50.065(2m)(d), Wis. Stats., requires the Department to promulgate rules to
specify crimes for which an entity must disclose to a client or the client's
guardian, a conviction of a caregiver who is assigned to provide personal
care services to the client in the client's personal residence, and to
specify who is a "substitute caregiver."
The proposed rule was revised based upon comments received from advocacy
organizations, trade and professional associations, and other interested
parties. The Department adopted and filed its final rules specifying those
crimes for which an entity must disclose a conviction of its caregivers who
are assigned to provide service in a client's personal residence. The
anticipated effective date of the new rule is July 1, 2009.
For more information, you may view the final rule order on the Wisconsin
Administrative Rules website at: http://adminrules.wisconsin.gov
DHS 83 - Community Based Residential Facilities
On April 1, 2009, revisions to Wisconsin Administrative Code, Chapter DHS
83 went into effect. The revised rule contains several changes that CBRF
providers need to be aware of, including changes to the administrator
qualifications, training requirements, medication administration
requirements, and sprinkler system requirements for small class C
facilities. The rule may be viewed at: http://www.legis.state.wi.us/rsb/code/dhs/dhs083.pdf
Staff from the Bureau of Assisted Living has developed industry training
on the new requirements in DHS 83 for CBRF staff. The training is presented
in four (4) modules and includes valuable, downloadable handouts that
provide information on how the new rule will affect your facility. The
training is web-based and available on the Wisconsin Department of Health
Services website. The training modules and handouts can be accessed at http://dhs.wisconsin.gov/rl_DSL/Training/dqaWebcasts.htm
Please watch for important memos related to the implementation of DHS 83.
The link to the CBRF memos can be found at: http://dhs.wisconsin.gov/rl_DSL/CBRF/CBRFnodMemos.htm
DHS 85 - Non-Profit Corporation as Guardian
On September 19, 2006, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter DHS 85, Non-profit
Corporation as Guardian. Through this initiative, the Department proposes to
make the rule reflect current standards of practice, recognizing the
increase in the number of adults in need of guardianship and the increase in
the complexity of their needs.
An Advisory Committee, including advocates, providers, registers in
probate, and County adult protective services staff, met and reviewed
proposed rule language and made recommendations for change. The Department
revised the proposed rule based upon comments from the Advisory Committee.
The proposed Rule Order is currently under review by the DHS Office of Legal
Counsel. For more information, you may view the Statement of Scope on the
Wisconsin Administrative Rules website at: http://adminrules.wisconsin.gov
DHS 124 - Hospitals
On April 1, 2005, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter DHS 124. The
Department is planning to update Chapter DHS 124 to eliminate overly
prescriptive and outdated regulations, clarify the Department's enforcement
authority, and make the rule more consistent with the federal Medicare
requirements.
The Department asked representatives from a large number of trade and
professional associations, hospitals, and other interested parties, to
review proposed revisions to the rule and make recommendations for change.
The Department is reviewing their recommendations and preparing a revised
draft of ch. DHS 124 for further review by stakeholders.
On May 31, 2009, the Wisconsin Administrative Register published a
Statement of Scope to amend Chapter DHS 124. The Department proposes to
update Chapter 124 to establish standards for satellite emergency
departments, to cross-reference applicable provisions relating to anatomical
gifts under s. 157.06 (14m), Wis. Stats., to specify standards relating to
forfeiture assessment for violations of s. 50.375, Wis. Stats., and to
include requirements under s. 50.36 (5), Wis. Stats., relating to training
and proficiency of hospital staff in the use of automated external
defibrillators. For more information, you may view the Statement of Scope on
the Wisconsin Administrative Rules website at: http://adminrules.wisconsin.gov
DHS 131 - Hospices
On December 15, 2008, the Wisconsin Administrative Rules website
published a Statement of Scope of proposed rules to revise Chapter DHS 131,
Hospices. The Department proposes to revise ch. DHS 131 to align the rule
with revised federal Medicare regulations, to eliminate outdated
regulations, and to reflect current professional standards of practice.
The Department has asked the Hospice Organization and Palliative Experts
(HOPE) of Wisconsin, hospices, and hospice consumers to participate in
revising ch. DHS 131. For more information, you may view the Statement of
Scope on the Wisconsin Administrative Rules website at: http://adminrules.wisconsin.gov
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CMS Survey & Certification Letters (April, May,
June 2009)
Listed below are Survey and Certification (S&C) Letters distributed
by CMS during the last quarter. Please note that the CMS Internet site where
you can review all S&C memos is
http://www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/list.asp
|
S&C No. |
Title |
Summary |
Providers Affected |
|
09-31 |
Issuance of Revisions to Interpretive Guidance at
Several Tags, as Part of Appendix PP, SOM |
Revisions have been made concerning Quality of Life
and Environment. Included is a training document with speaker notes
for CMS Regional Offices ROs and State Survey Agencies to use to train
surveyors in this revision to the SOM. |
|
|
09-32 |
Expansion of Moratorium Exception on Classification
of Long Term Care Hospitals or Satellites |
The American Recovery and Reinvestment Act (ARRA),
enacted 02/17/09, expands exceptions to the 3-year moratorium on LTCH
or LTCH satellites previously enacted in the Medicare, Medicaid, and
SCHIP Extension Act
(MMSEA) (Pub. L. 110-173). The new exception permits an increase in
the number of beds when the bed increase was authorized under a
Certificate of Need (CON) issued within a specified timeframe. CMS is
amending the guidance issued in S&C-08-26 to reflect this
statutory change. CMS Regional Offices will determine whether a
facility qualifies for the new exception. |
Long Term Care Hospitals
or Satellites |
|
09-33 |
Survey and Certification Issues Related to Swine Flu
Outbreak |
Human cases of swine influenza A(H1N1) have been
identified in several States in the US, as well as internationally.
Charles Johnson, Acting Secretary of the US DHHS, declared that a
public health emergency exists nationwide. In emergencies where
certain conditions precedent have been met, the Secretary of may
invoke
waiver authority under Section 1135 of the Social
Security Act and delegate to CMS the authority to waive or modify
certain survey and certification requirements. |
|
|
09-34 |
Release of Form CMS-2567 (Statement of Deficiencies)
by State Survey Agencies (SAs) |
This memo reiterates current law and regulations and
guidance contained in Chapters 3 and 7 of the CMS State Operations
Manual that involve the release of the survey findings as reflected in
the Statements of Deficiencies, commonly referred to as the 2567. |
|
|
09-35 |
Clinical Laboratory Improvement Amendments (CLIA) --
Impact of A/H1N1 Swine Flu on CLIA Operations |
CMS has agreed to delay routine surveys of State PHLs
temporarily, unless there is immediate jeopardy to patient health and
safety, until May 15, 2009, at which time CMS will re-assess this
determination. Suspended Influenza Proficiency Testing (PT) for One
Event: CMS has notified the PT Programs with viral antigen modules
which contain testing for influenza A that these should be suspended
until May 15, at which time this decision will be re-assessed.
Laboratories subject to PT for viral flu testing have discretion
regarding their participation for this event. |
CLIA Laboratories |
|
09-36 |
H1N1 Flu State Survey Agency Guidance and Provider
Tracking Tools |
To assist surveyors to observe signs of the H1N1 flu
virus infection, and proper facility etiquette, a guidance document
has been developed in collaboration with CDC. To assist in reporting
any impact to State survey
activities and providers that
have been affected by the H1N1virus infection to the CMS Regional
Office, a tracking tool has also been developed. |
|
|
09-37 |
State Operations Manual (SOM) Appendix L, Ambulatory
Surgical Centers (ASC) Comprehensive Revision |
New ASC Conditions for Coverage (CfCs) take effect
May 18, 2009. SOM Appendix L has been revised: Part 1, Survey Protocol
has been added. Interpretive Guidelines have been extensively updated
to reflect the new and revised CfCs and provide more detailed guidance
for existing CfCs. ASPEN Tags for ASC surveys have been revised and
renumbered. |
Ambulatory Surgical
Centers |
|
09-38 |
One-Time Cash Benefit to Nursing Home Residents |
The Recovery Act provides for a one-time cash benefit
of $250 to certain eligible individuals who receive a Social Security
benefit, Railroad Retirement pension, Veterans Administration
disability pension, and Supplemental Security Income (SSI). The
payments will begin in May of 2009 and be distributed by check or
electronic transfer to eligible beneficiaries by 06/04/09. |
Nursing Homes |
|
09-39 |
Nursing Home Requirements for Food Procurement, Self
Determination, and Participation |
This memorandum clarifies that 1) the language at 42
CFR 483.35(i), Tag F 371 'Procure food from sources approved or
considered satisfactory by Federal, State or local authorities' is
intended solely for the foods procured by the facility. A
revision has been made to the interpretive guidelines at F371 to
further clarify this
intent; 2) Foods accepted by residents from visitors, family, friends,
or other guests are not subject to the regulatory requirement at F
371; and 3) Residents have the right to choose to accept food from
visitors, family, friends, or other guests according to their rights
to make choices at 483.15, F 242, Self Determination and
Participation. |
Nursing Homes |
|
09-40 |
One-time Cash Benefit to
ICF/MR Clients |
The American Recovery and Reinvestment Act of 2009
provides for a one-time cash benefit of $250 to certain eligible
individuals who receive a Social Security benefit, Railroad Retirement
Pension, Veteran's Administration disability pension and Supplemental
Security Income (SSI). Many ICF/MR clients may be eligible for this
one-time cash benefit. |
ICF/MR |
|
09-41 |
Policy Regarding Unannounced Surveys |
This memorandum reiterates current policy that all
surveys must be unannounced for all providers and suppliers, except
for standard surveys of Clinical Laboratory Improvement Amendments (CLIA)
laboratories and other limited exceptions. |
|
|
09-42 |
June 30, 2009 Healthcare Associated Infections
Professional Stakeholder Meeting |
On 06/30/09, the DHHS plans to gather key partners in
the Action Plan to Prevent Healthcare Assoc-iated Infections to
provide updates on the initiative and engage in a dialogue about
potential next steps. The 06/30/09 meeting is in Washington, DC. |
|
|
09-43 |
Recovery Act Ambulatory Surgical Center Healthcare
Associated Infection Prevention Initiative |
CMS and States will improve quality assurance of ASCs
during FY 2009 and FY 2010 by implementing a new survey process to
promote better infection control practices. |
Ambulatory Surgery Ctrs. |
|
09-44 |
Use of Civil Money Penalty (CMP) Funds by States and
Reporting of CMP Funds Returned to the State |
The purpose of this memorandum is to clarify that
States may direct collected CMP funds to entities other than nursing
homes as long as funds are
used in accordance with statutory intent; share innovative practices
that States may want to consider when making decisions about how CMP
funds can be directed and used to improve the quality of care and life
for nursing home residents; and announce CMS will consider reporting
CMP amounts that have been returned to each State. |
|
|
09-45 |
North Dakota and Minnesota Flooding Public Health
Emergency and 1135 Waiver Termination |
The Secretary has determined that the Public Health
Emergency no longer exists in North Dakota and Minnesota and the 1135
waiver authority is ending concurrently with the termination of the
public health emergency. |
|
|
09-46 |
The Secretary has determined that the Public Health
Emergency no longer exists in North Dakota and Minnesota and the 1135
waiver authority is ending concurrently with the termination of the
public health emergency. |
Announces the release of the Evaluation of the
Quality Indicator Survey (QIS) and the posting of the Executive
Summary on the CMS Web site. Outlines Action Plan for future QIS
Evaluation Initiatives. |
|
Content contact: Gina
Bertolini
Phone: (608) 266-6691
E-MAIL SUBSCRIPTION SERVICES
http://dhs.wisconsin.gov/rl_DSL/Listserv/signup.HTM
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Last Updated: July 24, 2009
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