Residential Care Facility - PowerPoint Presentation

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Residential Care FacilityForum Call

Case Mix Unit / Office of MaineCare ServicesSeptember 8, 2016

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Welcome to the 3rd Quarter Residential Care Forum callDepartment of Health and Human Services

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AgendaWelcomeHIPAA RemindersReview of MDS-RCA Questions and Answers

Snippet TrainingAnnouncementsQuestions

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HIPAA Reminder: When sending email, please do not include any

identifying information. This table developed by the Federal Department of Health and Human Services gives definitions of 18 examples of identifying information. Department of Health and Human Services

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Department of Health and Human Services

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If you need to send a portion of an MDS record:

Fax is preferred over email

If you must email, paste the document into an word document and

apply a password

. Do NOT send the password in the same email as the attached MDS document,

OR

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Department of Health and Human Services

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Black out all identifying information, such as name, social security number, DOB, etc. It is acceptable to refer to a resident as #1, #2, according to a list of residents left during a case mix review.

If you mail information, please label as confidential and identify the person to whom it is being sent.

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Department of Health and Human Services

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For more information

:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html

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Department of Health and Human Services

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Department of Health and Human Services

9Questions, Questions, Questions

… and Answers

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If a resident sleeps in their recliner and never in their actual bed, how do we chart bed mobility and does this need to be Care-Planned?Bed Mobility – How the resident moves to and from a lying position, turns side to side, and positions body while in bed, in a recliner, or other

type of furniture the resident sleeps in, rather than a bed. Department of Health and Human Services

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If a resident is documented as being a total assist, is that inaccurate if they are not documented that way every shift, every day?Each shift must document, in accordance with their facility policy, the resident’s actual level of self-performance and support required each shift. Total Dependence – Full staff performance of the activity during entire seven-day period. Complete non-participation by the resident in all aspects of the ADL definition.

Department of Health and Human Services

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Is it considered total assist if staff does all of the catheter/ colostomy care for them?Code the level of self-performance and staff assistance needed with caring for the ostomy and/or catheter. This would be coded under toileting as part of Section G.

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If a person has an in-dwelling catheter and/or a colostomy bag, are they considered continent or incontinent? Department of Health and Human Services

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Section H

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This item describes the resident's bowel and bladder continence pattern even with scheduled toileting plans, continence training programs, or appliances.

Choose one response to code the level of bladder continence and one response to code level of bowel continence for the resident over the last 14 days.H3: Appliances and Programs: H3d: indwelling catheterH3i: Ostomy present

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If the indwelling catheter and/or colostomy bag are not leaking they are considered continent. For

toileting, you must consider the level of functioning for both bowel and bladder. If they have an indwelling catheter but use the toilet, bedpan, commode, or briefs, for bowel movements, you must factor in the level of functioning with any of these for BM’s as well as the cath. The same is true for a colostomy. If they use the toilet, bedpan, commode, urinal, or briefs for urination you must factor in the level of functioning with any of these for urination.

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Section APlease review the reasons and requirements for a significant change assessment.Department of Health and Human Services

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When to complete a Significant Change MDS-RCA assessment:Resident has experienced a “major change”Not self-limitedImpacts more than one area of the resident’s clinical statusRequires review and/or changes to the service planImprovement or declineCompleted no later than the end of the 14th day following the

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Can a nurse practitioner in private practice (not affiliated with a physician) function as a primary care provider for a resident in a residential care facility?Per the Maine State Board of Nursing, nurse practitioners may practice independently, with no restrictions, after they have completed their 24-month supervision

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Section I

What is active treatment in the areas of Hemiplegia/Hemiparesis, MS, Quadriplegia, 2nd and 3rd

degree burns, and ulcers?  With this question in mind, if a resident who has hemiplegia is not receiving active treatment, can hemiplegia be coded as a diagnosis? 

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Intent: To document diagnoses that currently have a relationship to the resident's ADL status, cognitive status, mood or behavior status, medical treatments, monitoring, or risk of death. In general, these are conditions that drive the current service plan. (page 79)Check the diagnosis only if it has a relationship to current ADL status, cognitive status, behavior status, medical treatment, nursing monitoring, or risk of death. (page 84)Do not record any conditions that have been resolved and no longer affect the resident's functional status or service plan.

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In the old MDS RCA documentation requirements it stated that burns must be documented in the resident record by the physician or a registered nurse.  The new MDS RCA training manual does not state that the 2nd or 3rd degree burn must be confirmed by the physician.  Can you please clarify.   

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The Board of Nursing has ruled that a Registered Nurse may determine the degree of a burn

. The status of the burn must be documented in the clinical record by a registered nurse or physician.

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Section X

I received a validation report indicating an assessment was accepted. When I did an inactivation the validation report came back rejected, indicating “Inactivation Rejected: No matching record was found in the data base for the correction / inactivation”.  Could you please explain this?Department of Health and Human Services

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When you complete a Correction Form, all data in the Prior section must match the data on the assessment you want to modify or inactivate, exactly.    If any of these

fields do not match, the computer system cannot find the record that needs to be modified or inactivated. You must also make sure that the previous assessment you are trying to modify or inactivate was Accepted into the State system according to the validation report receiving through the SMS system. 

Your Validation Report will let you know if an assessment was Accepted or Rejected. If there was an error, the code definition or reason is displayed on the Validation Report.  

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Section MI have a resident who has 6 pressure ulcers. The wound nurse writes “unstageable full thickness skin and tissue loss”. She has just quoted a stage 4 minus the word unstageable. There is 20% slough. She has done this on all 6 ulcer. There is no place to code unstageable . Can I code stage 4 ?

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Department of Health and Human Services28Ulcer

– Any lesion caused by pressure or decreased blood flow resulting in damage to underlying tissues.  Stage 1. A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved. Stage 2. A partial thickness loss of skin layers that presents clinically as an abrasion, blister, or shallow crater.

 Stage 3. A full thickness of skin is lost, exposing the subcutaneous tissues - presents as a deep crater with or without undermining adjacent tissue. Stage 4. A full thickness of skin and subcutaneous tissue is lost, exposing muscle or bone.

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If eschar and necrotic tissue are covering and preventing adequate staging of a pressure ulcer, the assessor will document and code the pressure ulcer as a Stage IV until the eschar has been debrided (surgically or mechanically) to allow staging.

These

instructions must be followed for MDS-RCA coding purposes until they are revised. Although the AHCPR and NPUAP system for staging pressure ulcers indicates that the presence of eschar precludes accurate staging of the ulcer, the facility must use these directions in order to code the MDS-RCA, but not necessarily to render treatment.

Documentation must accurately reflect findings from assessments that were conducted.

(MDS- RCA Training Manual, page 96)

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Department of Health and Human Services

30For the MDS-RCA assessment, staging of ulcers should be coded in terms of what is seen during the look back period. For example, a healing stage 3 that has the appearance of a stage 2 pressure ulcer must be coded as a

stage“2” for purposes of the MDS-RCA assessment. Facilities certainly may adopt the National Pressure Ulcer Advisory Panel (NPUAP) language.

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I need to have some clarification regarding injections.  Staff are questioning whether this needs to be documented on a daily basis or can this just be in the assessment window one time? Department of Health and Human Services

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Communicate with the resident regarding the actual administration of the injection, any difficulties with the administration procedure, any distressing signs or symptoms that could be attributed to the injected medication and any signs or symptoms of problems at the injection site.There must be evidence to support the coding on the MDS-RCA for the look back period in question, which is 7 days for this item.

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Section EHow do I code number of times per week for 30 days, as 30 days equals 4 weeks plus 2 days? There is a 30 day look back for Section E1 Mood items

Coding instructions:0. Indicator exhibited less than one day per week in last 30 days 1. Indicator exhibited one (1) to five (5) days per week during the past 30 days). 2. Indicator exhibited daily or almost daily (6 or 7 days each week) during the past 30 days

.Department of Health and Human Services

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Assessment Date (definition): Last day of MDS-RCA observation period. The date refers to a specific end-point in the process. Almost all MDS-RCA items refer to the resident's status over a designated time period, most frequently the seven day period ending on this date. The date sets the designated endpoint of the common observation period, and all MDS-RCA items refer back in time from this point. (MDS-RCA Training Manual, page

31)Within the 30 day look back period, there are 4, seven-day periods of time (one week each). Seven day periods cannot overlap and must be consecutive days.

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272829304 groups of 7 consecutive days with no overlaps between the four groups. There are two days that

may be excluded from the calendar. In this example days 8 and 23 have been excluded

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Questions??

Comments??

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The first line of information is the training manual for the MDS Resident Care Assessment Tool. If there is a specific case that you are unsure of coding, call your case mix nurse or the MDS help desk for more guidance.

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The web site to obtain copies of the

training calendar

, Training Manual, the training power point and handouts, etc is:

http://www.maine.gov/dhhs/oms/provider/case_mix_manuals.html

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Upcoming MDS-RCA training

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September 21, 2016 – Biddeford DHHS

October 21, 2016 – Augusta

November TBD - Lewiston

Call or email to register:

MDS3.0.DHHS@maine.gov

Next call: December 1, 2016

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Department of Health and Human Services

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MDS Help Desk: 624-4019,

or

1-844-288-1612 (toll free)

MDS3.0.DHHS@maine.gov

Lois Bourque RN: 592-5909

Lois.Bourque@maine.gov

Darlene Scott-Rairdon RN: 215-4797

Darlene.Scott@maine.gov

Maxima Corriveau RN: 215-3589

Maxima.Corriveau@maine.gov

Sue Pinette RN: 287-3933 or 215-4504 (cell)

Suzanne.Pinette@maine.gov

Contact Information:

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Thanks for spending time with the case mix team!See you in DecemberDepartment of Health and Human Services

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Questions?