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MDS Automation
& Section Q
Stacey Bryan RN, BSN, RAC-CT
State RAI Coordinator
MO Department of Health & Senior Services
October 16, 2019
MDS Automation
MDS Data Uses
• Part of the RAI Process
• QM reports for facility quality improvement
programs
• QM reports posted on Nursing Home Compare and
effects Five Star Rating
• Federal and State quality improvement programs
• Foundation for Medicare Part A reimbursement
(PPS) in SNFs
• Survey Process
Transmitting Data• NHs are required to transmit OBRA MDS records
for all residents in a Medicare and/or Medicaid certified bed, regardless of the resident’s pay source
• SNFs and non-critical access hospitals with swing beds are required to transmit additional PPS assessments for stays reimbursable under the SNF PPS
• Must transmit required MDS data records to CMS’ Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system
• Assessments that are completed for purposes other than OBRA and Traditional Med A reasons are not to be submitted (HMO, Medicare Advantage, etc.)
RAI Manual, Chapter 2, pgs 16 - 18
RAI Manual, Chapter 2, pgs 16 - 18
Correcting Data
The transmitted data is the “legal assessment”. Wrong
data that transmitted needs to be corrected. Ways to
correct inaccurate MDS data once the assessment has
been accepted into the QIES ASAP System include:
- Significant Correction To Prior Comprehensive MDS;
- Significant Correction To Prior Quarterly MDS;
- Modification;
- Inactivation.
Correcting Data – Significant Correction
If the error is significant or so serious that it provides the
wrong plan of care for a resident then the following may
be indicated:
• Significant correction to prior comprehensive
assessment (A0310A-05) (RAI manual chapter 2 page
30)
• Significant correction to prior quarterly assessment
(A0310A – 06) (RAI manual chapter 2 page 34)
Correcting Data – Significant Correction
When any significant error is discovered on the OBRA
MDS, the NH must:
- Complete the required Correction Request Section X
items and include with the corrected record. Item A0050
should have a value of 2, indicating a modification
request.
- Submit this modification request record.
- Perform a new Significant Correction to Prior
Assessment or Significant Change in Status Assessment
and update the care plan as necessary.
Correcting Data – Significant Correction
• If criteria for Significant Change in Status Assessment were not met, then a Significant Correction to Prior Assessment is required.
• When errors in an OBRA Comprehensive or Quarterly MDS in the QIES ASAP system have been corrected in a more current OBRA Comprehensive or Quarterly MDS, the NH is not required to perform a new additional assessment.
• In this situation, the nursing home has already updated the resident’s status and care plan. However, the nursing home must use the Modification process to assure that the erroneous assessment residing in the QIES ASAP system is corrected.
Correcting Data
• Modification or Inactivation in A0050 which will
then bring up Section X
–Modification: edits the wrong record. Used when
the correct record was transmitted but contains
errors. Used when errors are only in a few areas
and don’t significantly affect the care plan.
– Inactivation: removes the wrong record from the
database. Used when a record has been accepted
but the event did not occur.
Correcting Data - Modification
Do a modification when the MDS assess contains clinical or
demographic errors. Some of the items you can modify
include:
- Entry Date on a Entry tracking record (Item A1600)
- D/C Date on a Discharge/Death in Facility record (Item A2000)
- Clinical Items (Items B0100 - V0200C)
- ARD (Item A2300) on an OBRA or PPS assessment: The ARD
can be modified when the ARD on the assess represents a data
entry/typo error. However, the ARD cannot be altered if it results
in a change in the look back period and alters the assess timeframe.
- Type of Assessment (Item A2300): Can only be modified when
the Item Set Code of the assess does not change (see RAI manual
chapter 2 page 87 for list of Item Set Codes).
Correcting Data - Inactivation
Must do an inactivation when any of these areas are inaccurate
- Type of provider (A0200)
- Type of Assessment when the Item Subset Code would
change had the MDS been modified
- Discharge Date (A2000) on a Discharge/Death in Facility
when the look-back period and/or clinical assessment would
change had the MDS been modified
- Assessment Reference Date (A2300) on an OBRA or PPS
assessment when the look-back period and/or clinical
assessment would change had the MDS been modified
Correcting Data
• The request should be completed and signed within 14 days
of detecting an error
• Keep the request with the modified/inactivated MDS record
and retained in the medical record.
• Remember that your hard copy of any MDS (if you use hard
copies) must exactly match what is in the database.
• Should correct any errors necessary to insure info in QIES
system accurately reflects resident’s identification, location,
overall clinical status, or payment status.
• Correction can be submitted for any accepted record within
2 years of the ARD date of the record for facilities that are
still open.
• QIES (Quality Improvement and Evaluation System) is the
CMS National Reporting Database.
• CASPER is a part of QIES where you can request and/or
retrieve reports.
• The CASPER link is on the QIES Welcome Page.
• People who can access CASPER includes but is not limited
to MDS Coordinators, Administrators, Directors of Nursing,
QA Nurses and Corporate Nurses.
• Each person to access CASPER needs to have their own
user ID and password. Don’t use others ID and password
and don’t let others use your ID and password.15
CASPER (Certification and Survey Provider Enhanced Reports)
MDS Individual Access
All providers must request a CMSNet User ID to access secure CMS sites (e.g., submissions pages / reports) unless
an otherwise secure connection has been established.
Requesting access to CMS systems requires two steps to obtain two separate login IDs.
Step 1:
Use the CMSNet Online Registration application to request a CMSNet User ID.
The CMSNet ID is needed to access secure CMS sites (e.g., submissions pages/reports) unless an otherwise secure
connection has been established.
Step 2:
Use the QIES online User Registration tool to obtain a QIES Submission ID.
Once you have registered for a CMSNet User ID, you will receive an email from [email protected] containing
your login information. Using this information you will connect through the 'CMS Secure Access Service'.
Once securely connected, select the 'CMS QIES Systems for Providers' link to access the QIES online 'User
Registration' tool. New users must utilize the online 'User Registration' tool to obtain a QIES Submission login ID
(the only exception is Corporate/Third-Party accounts).
Please NOTE: CMS allows a total of TWO (2) Individual User accounts per facility. **Exception: CMS allows a
total of FOUR (4) ePOC user accounts**
MDS / ePOC / PBJ Individual User Account Maintenance Request (Only use this form to remove individual accounts
or request additional users.)
CMSNet Access Request Form (Only use this form to remove individual access or request access if online
registration is unavailable)
https://qtso.cms.gov/access-forms/mds-individual-access
Call CMSNet Helpdesk (888-238-2122) for questions with Step 1
Call QIES Helpdesk (800-339-9313) for questions with Step 2
To delete an access send an email to [email protected] with the access you need deleted and the CCN of the facility.
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CASPEROnce you are logged in, focus on:
• Reports button: Contains categories of reports you can run.
• Folders button:
oMy Inbox: Contains reports you have run.
oFacility MO [Fac ID] Inbox: Contains information automatically deposited from CMS for the facility to review.
- MO LTC [Fac ID] folder: Contains reports (other than Validation Reports) such as preview reports and special notifications from CMS.
- MO LTC [Fac ID] VR folder: Contains Validation Reports which are automatically deposited after MDS submissions.
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CASPER: Validation Report
Automatically-generated report that’s placed in the MO
LTC [Fac ID] VR Folder. The last 60 days of VRs will
show with the most recent date at the top.
You need to:
o Review to ensure every MDS record was accepted;
o If a record was rejected, determine why, correct if
needed and resubmit.
o Check for error messages and make corrections as
necessary.
o You may want to keep your VRs in a binder for
future reference (up to 10 years for Medicare audits).
Error Messages on Validation Report
Fatal Record Errors:
- Will say “Rejected” and “Fatal” on the validation report.
-The MDS record is rejected by QIES system, so the record
must be corrected and resubmitted.
Non-Fatal Errors (Warnings):
-Will say “Accepted” and “Warning” on the validation report.
-The MDS record is accepted into QIES system, but you must
evaluate each warning to see if corrective action is needed.
Explanation of error messages can be found in Section 5 of the
Provider User’s Guide located on the MDS Submissions page.
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MDS 3.0 NH Provider Report Category
Lists residents that CMS is expecting an OBRA assessment
on:
• Residents for whom the target date of the most recent
accepted OBRA assessment (other than a Discharge or
Death in Facility MDS) is more than 138 days ago;
• Residents for whom no OBRA assessments were submitted
for a current episode that began greater than 60 days ago.
The information included in this report is as current as the date
of the last submission by the facility.
Run this report monthly to ensure there are no names on it.
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MDS 3.0 Missing OBRA Assessment Report
If you have names on this report:
• If the resident is no longer in your building, ensure a
Discharge MDS was completed and accepted;
• Is the resident overdue for an MDS? If so, schedule and
complete one. If it appears they are up to date, check the
CASPER VR to ensure the last MDS was accepted;
• Call the State Automation Coordinator for a merge if
needed. If two resident identifiers in Section A differ from
the previous MDS, the system will create an additional
resident;
• May need to bring the issue to QA.
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MDS 3.0 Missing OBRA Assessment Report
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Section Q of the MDS:
Participating in
Assessment & Goal Setting
Q0100. Participation in Assessment
• Whenever possible, the resident should be actively
involved.
• While family, significant others, or, if necessary, the
guardian or legally authorized representative can be
involved, the response selected must reflect the resident’s
perspective if he or she is able to express it.
Section Q
Q0300: Resident’s Overall Expectation
• The resident’s expectation should be coded in this
item as long as he or she can communicate it (even
if others consider it to be unrealistic).
Section Q
Q0300: Resident’s Overall Expectation
• If the resident is unable to communicate his or her
preference, the information can be obtained from the
family or significant other, as designated by the
individual. If family or the significant other is not
available, the information should be obtained from
the guardian or legally authorized representative.
• Coding other than the resident’s stated expectation is
a violation of the resident’s civil rights.
Section Q
Q0400. Discharge Plan
• In addition to home health and other medical services, discharge planning may include expanded resources such as assistance with locating housing, transportation, employment if desired, and social engagement opportunities.
• If the resident’s discharge needs cannot be met by the facility, the LCA (Local Contact Agency) can evaluate the community living situation to determine whether the resident’s needs can be met in the community.
Section Q
Q0490. Resident’s Preference to Avoid Being Asked
• Directs staff to check the record to determine if the resident
and/or family, etc. have indicated on a previous OBRA
comprehensive assessment that they do not want to be asked
question Q0500B until their next comprehensive
assessment. Let the resident know they can change their
mind about requesting information regarding possible return
to the community at any time.
Section Q
Q0500. Return to Community
• This ensures the resident’s desire to learn about the
possibility of returning to the community will be obtained
and appropriate follow-up measures will be taken.
• This step in no way guarantees discharge (DC) but provides
an opportunity for the resident to interact with LCA experts.
• LCAs are experts in available home and community-based
service and can provide the resident and facility with
valuable information.
Section Q
Q0500. Return to Community
• A “yes” response will trigger follow-up care planning and
contact with the LCA within approximately 10 business days of
the “yes” response being given.
• Talking with the resident regarding discharge goals and plans
before referral to the LCA is a critical step.
• The SNF/NF should not assume the resident cannot transition
out due to their level of care needs. The SNF/NF can talk with
the LCA to see what is available that does not require family
support.
• It is a request for information, not a request for DC.
• Explain to the resident that they can change their mind at any
time.
Section Q
Q0550. Resident’s Preference to Avoid Being Asked Question
Q0500B Again
• Gives residents a voice and a choice about the services they
receive, while being sensitive to those individuals who may
be unable to voice their preferences or be upset by being
asked question about if they would like to talk to someone
about the possibility of leaving the facility and returning to
community.
Section Q
Q0600. Referral
• Code 0, No – referral not needed
- Determination has been made by resident and the
care planning team that the LCA does not need to be
contacted; if the resident’s DC planning has been
completely developed by facility staff, and there are
no additional needs that the SNF/NF cannot arrange
for; or if resident responded “no” to Q0500B.
Section Q
Q0600. Referral
• Code 1, No – referral is or may be needed
- If a resident wants to talk to someone about leaving
facility, but a referral is not made at this time then
care plan and progress notes should indicate the
status of DC planning and why a referral was not
initiated. This response triggers CAA #20, Return to
Community Referral which should be used to guide
the follow-up process.
• Code 2, Yes – Referral made
- if the referral was made to the LCA.
Section Q
Section Q Referral is made at https://apps.dss.mo.gov/mfpnursinghome/Login.aspx
• MO is contracted with Centers for Independent Living and Area Agencies on Aging to serve as the LCAs.
• You can only make a Section Q referral by going to:https://apps.dss.mo.gov/mfpnursinghome/Login.aspx
- Only “yes” responses to Section Q should be entered here.
- Can refer residents with or without Medicaid.- You should receive confirmation the referral was
sent.- If the resident requests referral not as a result of
Section Q, you can make a direct referral by contacting your DSDS Regional Office.
Section Q Referral
Once a Section Q referral is made:
- The LCA will schedule a meeting with the resident
and provide them with information via an Options
Counseling session.
- The LCA should provide information to the facility
on the outcome of the Options Counseling Session.
- The NH will continue to be part of the Discharge
planning team and communication between them
and the LCA is imperative to the resident’s
successful transition to the community.
Section Q Referral
MDS Section Q, Options Counseling
and MFP Quick Reference
• Developed by MOHealthNet
• Includes information about:
- How to make an Online Section Q Referral;
- How Q+ Index Algorithm is used as a way to reach
potential Medicaid individuals to learn about their
options to return to the community;
- The Options Counseling Process;
- MFP and the Direct Referral Process.
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573-751-6098573-751-6098
417-895-5789
573-290-5150
314-340-7495
816-889-2724
Central Office 573-526-3128
Resources
Subscribe to Section for Long-term Care &
Regulation’s weekly free LISTSERV at:
https://cntysvr1.lphamo.org/subscribeltc.html
• Is how the state communicates information with
providers.
• Includes changes/updates/educational opportunities.
46
Quality Improvement Program for Missouri
(QIPMO)
www.nursinghomehelp.org
573-882-0241
• Get on your local QIPMO nurse’s mailing list to receive updates from them.
• Monthly Webinars.
• Schedule of MDS Support Groups.
• MDS tools.
State MDS Unit
Stacey Bryan
State RAI Coordinator
573-751-6308
Danette Beeson
State Automation Coordinator
573-522-8421
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