DQA Quarterly Information Update

July 2002

[PDF Version of this month's Quarterly Update (PDF, 177 KB) - blue text indicates links to other sections or to Internet pages]

• Focus 2002 Pride in Caring Conference

• Home Health Hotline Brochure

• BQA Numbered Memos

• Summertime Heat Information

• New DHFS Web Page Look

• New Shorter Assessment Form

• RCAC Oversight to Regional Offices

• CMS Program Letters

• Rule Revisions

• Upcoming Seminar/Training (OASIS/OBQI reports, Pain Management)

• Wisconsin Caregiver Program Website

• All Current BQA Memos Going Online

• Energy Incentive for Nursing Homes

Do Not Miss This Opportunity

The Bureau of Quality Assurance's (BQA) Health Care Provider Conference, "Focus 2002: Pride in Caring" will be here soon. Whether you are a first-time or a regular attendee, you will want to be at this conference!

This year's conference will spotlight Nursing Home and Assisted Living Facilities issues. There will be three keynote speakers in the morning and in the afternoon you can choose from eight breakout sessions, all brand new topics this year. These presentations will help increase your value to your organization and give you information and techniques that will help you design solutions to improve results.

Experienced professionals developed all of the presentations. There will also be ten resource booths available that will include beneficial health care information, best practices and handouts.

The conference will be held on August 15, 2002 at the Holiday Inn in Fond du Lac, Wisconsin. Please go to the following BQA web site for more information on the conference and how to register: www.dhfs.state.wi.us/rl_DSL/ Publications/focus2002.pdf [removed from web 2/03] or call (608) 267-1438. The registration deadline is July 29, 2002, so hurry and register today.

Do not miss this exciting conference. Better yet, bring additional staff from your facility to fully take advantage of the knowledge and opportunities available at this event. We are looking forward to seeing you there!

Home Health Hotline Brochure

The Home Health Hotline brochure about the toll-free number to call regarding home health and hospice agencies in Wisconsin has been updated and posted to the Internet at www.dhfs.state.wi.us/rl_DSL/HHAs/ HHAhotline.htm. Both an HTML (viewable using any browser) and a PDF version (for printing purposes) are available. The toll-free Home Health Hotline helps provide Wisconsin residents with information about home health care agencies, including results of state inspections and complaints lodged against the agency within the last two years. The hotline can also be used to file complaints.

We encourage facilities and providers to print the PDF version and make copies to give to clients and families.

BQA Numbered Memos

There were no BQA memos published April-June 2002. We retired two memos: 02-003, Home Health OBQI Training and 02-010, Temporary Authorization to Use Hospital Beds for Emergencies. However, we are planning to publish the following in upcoming weeks.

Access BQA memos via either www.dhfs.state.wi.us/rl_DSL/ Publications/BQAnodMems.htm for all memos or individual providers' Publications pages at www.dhfs.state.wi.us/licensing.htm.

Summertime Heat Memo Converted to Permanent Web Page

Facility staff expecting a new BQA memo on heat illness, power outages, and severe weather/ tornado awareness should note that we have converted the last memo (01-020) into a standing Internet feature at www.dhfs.state.wi.us/rl_DSL/Providers/heat.htm. It is now accessible via all Providers pages for health care and residential facilities. We will update this page as necessary rather than issue future BQA memos on the subject.

The Governor also proclaimed June 20, 2002 Heat Awareness Day and information from the Divisions of Public Health and Supportive Living has been posted on the DHFS Licensing pages. You can access this information from the BQA Summertime Information page or go to www.dhfs.state.wi.us/rl_DSL/Providers/heatDPHdsl.htm.

The flu and winter safety memos of previous years will also be converted to permanent web features, although we may issue season-specific information separately as formal BQA memos.

New DHFS Web Page Look

If you have not taken a look at the Department of Health and Family Services pages since mid-June, you will find they have a new color scheme and more navigation information. This was done to bring the DHFS web pages in line with the entire wisconsin.gov site (www.wisconsin.gov/state/home). It will now be easier to access other state agency pages (such as the Department of Regulation and Licensing, Department of Corrections, Office of the Commissioner of Insurance, etc.). There were no changes made to site addresses, so any bookmarks or publications including them should still be current.

There may be future changes to improve navigation within the DHFS Licensing Pages. As always, your comments and suggestions will be welcome. Contact Todd McCall at (608) 267-3808 or E-mail mccaltw@dhfs.state.wi.us.

New Shorter Medicare Nursing Home Assessment Form

The Centers for Medicare and Medicaid Services (CMS) recently announced the release the new MDS Medicare PPS Assessment Form (MPAF) that will provide facilities with new options concerning the forms used for Medicare PPS assessments. As of July 1^st, facilities can choose to use the shorter form rather than full MDS for PPS assessments. The use of the MPAF form is completely optional and does not change the OBRA assessment requirements. If a facility submits a full assessment for PPS reasons only, the extra MDS elements that are not on the MPAF form will be ignored and will not be entered into the state database. The MPAF will meet the OBRA requirement for the 2-page Quarterly Review assessment.

This new form is part of an effort in CMS to streamline processes. For more information, see www.hcfa.gov/medicaid/mds20/man-form.htm (address updated - exit DHFS).

RCAC Oversight to the Regional Office

Effective June 17, 2002, the Bureau of Quality Assurance transferred all RCAC technical assistance and on-site review activities, e.g. initial surveys, complaint investigations, etc., to the regional office staff in the Resident Care Review Section. The Bureau has determined that this is the most logical and efficient move to make and is consistent with other assisted living facility types of survey activities being conducted out of the regional office.

Within the last two years, BQA transferred the oversight of RCACs attached to either a nursing home or a CBRF to the regional offices. This recent decision completes the transfer of remaining responsibilities relating to the oversight of free-standing RCACs.

The Regional Office Field Operations Directors are as follows:

Patricia Benesh, Southeast Regional Office Field Operations Director, 819 North 6th Street, 2nd Floor, Milwaukee, WI 53201 (414) 227-4908

Susan Blount, Interim Southern Regional Office Field Operations Director, 2917 International Lane, Suite 210, Madison, WI 53704 (608) 243-3868

Joseph Bronner, Western Regional Office Field Operations Director, 610 Gibson Street, Suite 1, Eau Claire, WI 54701 (715) 836-4753

Kevin Coughlin, Northeastern Regional Office Field Operations Director, 200 North Jefferson Street, Suite 211, Green Bay, WI 54301 (920) 448-5249

JoAnne Powell, Northern Regional Office Field Operations Director, 1853 North Stevens Street, Suite B, Rhinelander, WI 54501 (715) 365-2802

Latest CMS Survey & Certification Letters

Two recent CMS S&C letters are of significant importance to BQA-regulated entities: 02-19, "Recalled Sprinkler Heads," and 02-29, "Promising Practices for Implementing the Medicare Hospice Benefit for Nursing Home (NH) Resident." S&C letter 02-19 at www.cms.hhs.gov/medicaid/ltcsp/042902b.asp (exit DHFS) concerns the voluntary (by the company) replacement of sprinkler heads that are at risk of failure. BQA had already alerted providers in August 2001 of the problem via BQA memo 01-034, which is accessible at www.dhfs.state.wi.us/rl_DSL/Publications/01-034.htm.

S&C 02-29 discusses several promising practices developed by CMS for the successful implementation of the Medicare Hospice Benefit for nursing home residents. A PDF version of this letter will be posted to the Nursing Home and Hospice Providers' information pages on the DHFS Licensing site.

To obtain the latest information from the Centers for Medicare and Medicaid Services (CMS), you should check the CMS website frequently: www.hcfa.gov/medicaid/scindex.htm [no longer operable as of 9/02]. Below is a list of the Survey and Certification Letters that were distributed in the last quarter (via www.hcfa.gov/medicaid/ltcsp/ ltcmemos.htm [link not operable at this time].). Please be aware that some letters pertain only to state agency operations.

Looking for Rule Information

The State of Wisconsin’s rule making process involves the public by including experts to assist in the actual drafting of proposed rules to gather public information, and by holding public hearings before a rule is promulgated.

Providers become aware of and contribute to the rule making process through their involvement with various associations or reading public notices. Another excellent source to learn more about the proposed rules under development is by viewing the following DHFS web-site: www.dhfs.state.wi.us/reference.htm

By visiting this web-site, providers can view a "Statement of Scope" for any proposed rules under development and view the other various stages of the rules promulgation process. The scope document must be approved by the Department of Health and Family Services (DHFS) Secretary’s office and published in the Wisconsin Administrative Register before drafting rules. It is also a notice of our rule making intent to the public.

BQA ADMINISTRATIVE RULES UPDATE

HFS 83 -"Community Based Residential Facilities" (CBRFs)

• BQA internal workgroup is currently drafting the rulemaking order

HFS 124 -"Hospitals"

• BQA Internal workgroup is in the process of drafting rules for the rulemaking order.

HFS 132 -"Nursing Homes"

• The Statement of Scope (SOS) was published in the Wisconsin Administrative Register on May 15, 2002.

• The BQA internal workgroup will begin drafting rules that are subject of the SOS.

For Questions about BQA rules, contact Cheryl Bell-Marek at (608) 264-9896 or at bellmcj@dhfs.state.wi.us

Upcoming Seminar/Training Opportunities

Also check the Provider or What's Happening sections for individual health care providers on the DHFS Website www.dhfs.state.wi.us via the Licensing page. For registration questions, contact the Bureau of Quality Assurance Training Coordinator at (608) 267-1438.

Upcoming OASIS/OBQI Training Opportunity for Home Health Agencies

The Bureau of Quality Assurance (BQA) will provide a workshop on Home Health Outcome-Based Quality Improvement (OBQI) reports. The OBQI reports are based on Outcome and Assessment Information Set (OASIS) data, which is a federally required data set for Medicare-certified home health agencies (HHAs). The OBQI reports are tools available for Medicare-certified HHAs wishing to implement outcome enhancement activities for quality improvement. The Centers for Medicare and Medicaid Services (CMS) made OBQI reports available to HHAs in February 2002.

The day-long workshop will provide detailed instruction on the OBQI reports, including how to:

• access the OBQI reports from the state system.

• read and interpret the case mix, risk-adjusted and descriptive OBQI reports.

• identify the steps to integrate OBQI reports in agency quality improvement programs.

The OBQI Report Workshop is intended for:

• home health agency quality improvement managers, trainers and team members.

• home health agency staff with an interest in quality improvement, including: directors of nursing, clinical supervisors, staff nurses, therapists, administrators, clerical, technical and business office staff.

Mark your calendars now and plan to attend the OBQI Report Workshop at one of the following locations:

• Wednesday, October 2, 2002 Madison, Wisconsin

• Tuesday, October 8, 2002 Wausau, Wisconsin

BQA will mail training brochures with detailed information and registration forms to HHAs approximately 6 weeks prior to the workshop. At that time, HHAs can also access training information by clicking on Bulletins on the State OASIS System Welcome Page.

Pain Management Presentation

BQA has received complaints and observed issues related to pain management in WI nursing homes and recently has provided ongoing pain management training to surveyors. In an effort to improve the pain management provided to residents in WI nursing homes, BQA will be conducting a full day presentation on pain management in Eau Claire (Ramada Inn) on October 23, 2002 and in Fond du Lac (Holiday Inn), October 30, 2002. The program will focus on the following:

• Why do we have problems with untreated pain?

• Pain Assessment Principles

• Pain Medications and their Management

• Pain Management in Dementia

Again, for registration information, contact the Bureau of Quality Assurance Training Coordinator at (608) 267-1438.

Wisconsin Caregiver Program Website

The Wisconsin Caregiver Program Website is part of a larger state government initiative to use new technology to create opportunities for you to access needed services and information 24 hours a day, 7 days a week. It is designed to provide you with clear, concise information regarding the implementation of the Caregiver Law, to supply you with all the forms you need for compliance, and to offer assistance regarding any questions or problems you might experience. The Caregiver Program Website main page is divided in 3 main sections which include the following information:

All Programs:

• Background Check Forms – forms needed to complete a caregiver background check or request a Rehabilitation Review.

• Rules and Regulations – links to the rules and statutes associated with the Caregiver Law, including the Offenses Affecting Caregiver Eligibility, the offenses that bar a person from employment in a BQA regulated entity.

• Contact Information and Related Links – links to the Caregiver Intake Unit, the mailing list for County Clerks of Court, the Rehabilitation Review Coordinator, the Circuit Court records website, the Department of Justice, the Department of Regulation and Licensing, the Department of Veteran Affairs, and other state criminal record information contacts.

Adult Programs:

• The Caregiver Program Manual – detailed information about the Caregiver Law as it relates to BQA regulated entities designed to provide clear policy direction.

• The Wisconsin Caregiver Misconduct Registry – lists nurse aides and other noncredentialed caregivers with a substantiated finding of caregiver misconduct.

• Reports of Decisions – the newest addition to the website links to the Department of Regulations & Licensing’s disciplinary orders issued against credentialed professionals (Doctors, Registered Nurses, Licensed Practical Nurses, etc.).

• Complaints – contact information and forms to file a complaint against either a noncredentialed or credentialed caregiver.

• Publications – publications that might be helpful in providing additional information related to responsibilities under the Caregiver Law.

• The Wisconsin Nurse Aide Training and Directory – comprehensive information regarding Wisconsin’s nurse aide training and directory program.

Children’s Programs:

• Frequently Asked Questions for children’s program background checks

• Bureau of Regulation and Licensing for child care issues

• Bureau of Programs and Policies for foster care issues

You can visit the Caregiver Program Website at www.dhfs.state.wi.us/caregiver. We think that you will find all the Caregiver Program information that you need in an easy to use format. The website is updated frequently and can be relied on to provide you with the most accurate and current information available. If you need additional resources or answers to questions, please feel free to e-mail the Caregiver Intake Unit at Caregiver_Intake@dhfs.state.wi.us.

All Current BQC/BQA Memos Going Online

We have now posted all current BQA/BQC memos up on the Internet via this address: www.dhfs.state.wi.us/rl_DSL/Publications/ BQAnodMemIndex.htm. Memos dated 1997 and earlier have been converted to PDF files viewable using Adobe Acrobat. We took the opportunity to review these files, eliminating a number of obsolete or unneeded memos. Also, a number of attachments were incorporated into the text of individual files. Because all memos had to be retyped during this preparation process, letterheads and excess formatting were removed. These versions therefore cannot be considered "official." If it is important to have an "official" document, or copies of any attachments mentioned that were not prepared for the Internet, please call the Bureau of Quality Assurance Director's Office staff at (608) 266-8481 or E-mail Denise LeCaptain via [no longer in position].

We will continue to make electronic versions of memos available as diskettes for purchase via the link listed above.

Energy Saving Incentive for Wisconsin Nursing Homes

Looking for a way to improve your Medicaid reimbursement rate? The Medicaid nursing home formula section 2.730 states:

2.730 Energy Savings Incentive
If an existing facility completes a remodeling or renovation project specifically designed to reduce consumption of electricity or heating fuels, or to reduce their electricity or heating fuel rates per unit of energy, the facility may receive an incentive per the calculation method in Section 3.652.

To qualify for this incentive, the project must have been approved in advance by the Department of Health and Family Services. During the approval process, the Department will consider:

1. The projected savings from the project based on an independent analysis to be provided by the facility. Such analysis may be provided by a public utility or an independent contractor qualified in engineering, architecture, or energy audits.

2. The projected cost of the project.

3. The combined simple payback for all projects propose for the facility must be less than ten years.

Allowable costs for the incentive will be the lower of: 1) the amount approved in advance by the Department, or 2) the cost of equipment, installation, engineering, energy management and consultant fees prior to rebates. Interest, bond discounts, premiums and financial and/or auditing fees will not be an allowable cost for the incentive.

Replacement boilers that are not part of a co-generation project, replacement central air conditioners, condensers and windows, if included in a project approved or started after July 1, 2000, are excluded from this incentive. However, fuel conversion projects are valid projects for consideration.

If you have questions, contact Al Reinhard, (608) 267-7849 or email reinhae@dhfs.state.wi.us.

Division of Health Care Financing
Nursing Home Analysis Unit
Attn: Alan E. Reinhard
PO Box 309
Madison WI 53701-0309

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