In an effort to preserve institutional knowledge, the Washington Health Care Association has created an archive of all “Dear Administrators” from the year 2012 and earlier.

We attempted to retain as many links and enclosures as possible however, some links are broken and some enclosures are no longer available

. WHCA is unable to correct or fix issues.

All the following documents are strictly an archive of the DSHS database as of December 31, 2015.

Compiled by WHCA 2015

2012 NH "Dear Administrator" Letters

NUMBER DATE SUBJECT

012-017 February 7 S&C 12-09: Federal Requirements for the Independent Informal Dispute Resolution (IIDR) Process

012-016 November 27 CR 102 Formal Phase of Proposed Amendments to Chapter 388-97 WA

012-015 November 21 MDS Helpline & 2013 MDS Training Dates

012-014 September 26 S&C 12-42: Partnership to Improve Dementia Care

012-013 September 26 Emergency Preparedness

012-012 September 24 Reasonable Accommodation and Non-Discrimination for Services Animals

012-011 September 17 Influenza and Pneumococcal Immunization Reminders

012-010 August 13 CR-101 Filed to Propose Adding & Amending Sections to Chapter 388-97 WAC

012-009 July 24 S&C 12-35: Safe Use of Single Dose/Single Use Medications to Prevent Healthcare-Associated Infections

012-008 July 20 Physicians Orders for Life Sustaining Treatment (POLST)

012-007 July 20 Employment of Physicians

012-006 July 9 Revisions to Questions on the Complaint Hotline

012-005 June 7 S&C 12-30: Use of Insulin Pens

012-004 May 14 Admission Contracts and Agreements

012-003 February 28 Revisions to RAI User's Manual / MDS Training Sessions

012-002 February 22 Nursing Home Guidelines (aka "The Purple Book") Fifth Edition (February 2012) Effective Immediately

012-001 February 7 S&C 12-09: Federal Requirements for the Independent Informal Dispute Resolution (IIDR) Process

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December 19, 2012

ADSA: NH #2012-017 S&C 11-41: AFFORDABLE CARE ACT POSTING FACILITY-SPECIFIC INFORMATION ON WEBSITE

Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that the Center for Medicare & Medicaid Services (CMS) has issued a survey and certification (S&C) memorandum providing guidance on implementing Section 6103 of the Affordable Care Act (ACA). One of the provisions is that states create and maintain a consumer-oriented website that is useful in assisting the public in assessing the quality of long-term care options and care provided by individual facilities.

Effective January 2013, the Department will begin posting information on the ADSA Internet in accordance with this directive from CMS. This includes all 2567s, including health surveys, life safety code surveys, and complaint investigations that result in citation.

To read the details of the memorandum online, please visit: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter11_41.pdf

Please contact your RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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November 27, 2012

ADSA: NH #2012-016 FORMAL PHASE OF PROPOSED AMENDMENTS TO CHAPTER 388-97 WAC

Dear Nursing Home/Facility Administrator and Interested Parties:

In August 2012, the department filed a CR-101 to begin the rule adoption process for changes to Washington Administrative Code (WAC) 388-97, Nursing Homes.

Recently, the department filed the CR 102, a more formal phase of the rule making process. The CR 102, including draft rule language, is available on the ADSA website, under the heading "NH Rule Filings: Chapter 388-97 WAC" at: http://www.adsa.dshs.wa.gov/professional/nh.htm

You may either submit any comments in person at the public hearing listed below or in writing to the department's Rules and Policies Assistance Unit (RPAU). The formal hearing for the proposed rules is scheduled:

Date: January 8, 2013 Time: 10: 00 a.m. Location: Office Building 2 - Auditorium (DSHS Headquarters) 1115 Washington Olympia, WA 98504

You must submit written comments by 5:00 p.m. on January 8, 2013 to the following address or by email to

Jennisha Johnson at DSHSRPAURulesCoordinator@dshs.wa.gov DSHS Rules Coordinator /RPAU PO Box 45850 Olympia WA, 98504-5850

Driving directions to Office Building 2 can be accessed online at http://www.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html. Public parking is available at 11th and Jefferson Streets.

If you have any questions about the proposed rules, please contact Scott Bird, Program Manager at (360) 725-2581 or email at birdsa@dshs.wa.gov.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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November 21, 2012

ADSA: NH #2012-015 MDS HELPLINE & 2013 MDS TRAINING – SAVE THE DATE

Dear Nursing Facility/Home Administrator:

This letter contains important information for facility staff responsible for completing the Minimum Data Set (MDS) assessments.

MDS Helpline

Currently, Judy Bennett, Washington State MDS Automation Coordinator, (360) 725-2620, is responding to all calls related to technical issues and directing clinical issues to RCS Quality Assurance Nurses.

Effective January 1, 2013, clinical Sandy Kerrigan, Washington State RAI Coordinator, (360) 725-2487, will cover calls related to clinical issues. Judy Bennett will continue to cover technical/automation issues.

2013 MDS Training - Save the Date!

Residential Care Services (RCS) will be providing basic MDS 3.0 training in the spring and fall. These 2-day courses provide an overview of the RAI process including scheduling, significant change, coding of the MDS, error correction, and completion of tracking documents.

Lacey

March 6 & 7

March 27 & 28

October 9 & 10

October 23 & 24

Yakima

September 3 & 4

Spokane

May 6 & 7

September 23 & 24

Registration will begin on January 2, 2013. Further training details and registration contact information will be posted online athttp://www.adsa.dshs.wa.gov/professional/MDS/MDS3.0/.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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September 26, 2012

ADSA: NH #2012-014 S&C 12-42: PARNERSHIP TO IMPROVE DEMENTIA CARE

Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that CMS has launched the Partnership to Improve Dementia Care in Nursing Homes and is currently promoting comprehensive dementia care and therapeutic interventions for NH residents with dementia-related behaviors. The goals of this initiative include a focus on person-centered care and the reduction of unnecessary antipsychotic medication use in nursing homes.

CMS is pursuing several approaches to successfully implement this initiative:

Developing and conducting trainings for nursing home providers, surveyors, & consumers

Conducting research

Raising public awareness

Using regulatory oversight and public reporting to increase transparency

Both the American Medical Directors Association (AMDA) and the American Health Care Association (AHCA) have sent letters to their membership or State affiliates this summer; AMDA's letter sought to educate members about dementia issues and encouraging nursing home medical directors to join with AMDA and CMS in reducing the unnecessary use of antipsychotic agents by refocusing the interdisciplinary team on a better understanding of the root cause of dementia-related behaviors. That letter further provided medical directors and staff with the tools and resources they might use to achieve this goal (see http://www.amda.com/advocacy/antipsychotic_msg.pdf).

To read the details of the memorandum online, please visit: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-12-42.html

Please contact your local RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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September 26, 2012

ADSA: NH #2012-013 Emergency Preparedness

Dear Nursing Facility/Home Administrator:

Recently the Health and Human Services Inspector General's Office released information related to the lack of nursing home readiness to protect frail residents in the case of an emergency. Every nursing facility/home has a defined role and responsibility in the case of an emergency, natural or manmade.

You have a continuing obligation to plan for and meet resident needs in the event of a natural or human-made disaster. This obligation may continue even if residents are evacuated to another location.

In the event of a major disaster, Residential Care Services (RCS) will work with the Governor, Emergency Management Division (EMD) and other parts of the Department of Social and Health Services (DSHS) to establish priorities for responding to a particular disaster situation.

Collaboration with federal agencies will also be important, including the Centers for Medicare & Medicaid Services (CMS). CMS has been developing new, heightened expectations of state regulatory agencies and providers over the past several years. We expect this trend to continue.

In addition to existing Emergency Planning Information on the ADSA website at at http://www.aasa.dshs.wa.gov/professional/nh.htm, two new resources regarding preparing for emergencies and disasters are now available:

Nursing Home Response to Natural or Human-Made Disaster

CMS Information and Status Reports

Thank you for your continued commitment to the health and safety of Washington's nursing home residents.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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September 24, 2012 ADSA: NH #2012-012 Reasonable accommodation and Non-discrimination for service animals

Dear Nursing Facility/Home Administrator:

Recently, we have heard there have been some questions on reasonable accommodations and non-discrimination issues, in particular around residents with service animals. For example, we heard of a facility that had a "no pets" policy and used this as the basis to automatically refuse service animals. The purpose of this letter is to inform you of the state and federal laws and rules for reasonable accommodations and non-discrimination of residents who use a service animal.

There are many federal and state laws and rules that protect residents who use service animals from discrimination and ensure reasonable accommodations.

A service animal is not considered a pet. Under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1974, a

disabled person may request a reasonable accommodation for a service animal. RCW 49.60.222 does not allow a home to deny an accommodation against a person with a

disability who uses a trained dog guide or service animal. Under RCW 49.60.218, it is against the law for a provider to charge an individual with a service

animal a higher rate than what is charged to other residents.

For further details and information, here are links to the relevant state and federal laws and regulations that protect residents from discrimination and ensure reasonable accommodations for a service animal:

Federal requirements for service animals http://www.ada.gov/service_animals_2010.htm Americans with Disabilities Act of 1990, as amended http://www.ada.gov/pubs/ada.htm Non-discrimination for use of service

animal http://apps.leg.wa.gov/rcw/default.aspx?cite=49.60.222 Unfair practice - http://apps.leg.wa.gov/rcw/default.aspx?cite=49.60.218 Misdemeanor for interference - http://apps.leg.wa.gov/rcw/default.aspx?cite=9.91.170 Freedom from discrimination - http://apps.leg.wa.gov/rcw/default.aspx?cite=49.60.030# Exercise of resident rights - http://apps.leg.wa.gov/rcw/default.aspx?cite=70.129.020#

http://apps.leg.wa.gov/RCW/default.aspx?cite=74.42 Reasonable accommodation http://apps.leg.wa.gov/RCW/default.aspx?cite=74.42.450#

Please contact your local RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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September 17, 2012

ADSA: NH #2012-011 Influenza and pneumococcal Immunization reminders

Dear Nursing Facility/Home Administrator:

Nursing homes must meet federal and state requirements related to influenza and pneumococcal vaccinations. Residential Care Services is partnering with the Department of Health to remind providers about the benefits of:

Flu and pneumococcal vaccines – these vaccines can potentially reduce the rate of hospitalizations and deaths in many people, especially in those 65 and older.

Using the Washington State Immunization Information System, formerly Child Profile Immunization Registry, to keep track of your residents' and staff's vaccinations. For more information or to register, contact the system's Help Desk at 1-800-325-5599 or 206-205-4141https://fortress.wa.gov/doh/cpir/iweb/main.jsp

Get ready for flu! Help keep your residents and staff healthier this flu season by:

Encouraging all residents and employees to get the flu vaccine and making sure they are up-to-date on their pneumococcal vaccine.

Taking measures to minimize transmission in your facility such as washing hands or using hand sanitizers frequently. More information about infection control is available at: www.cdc.gov/flu/professionals/infectioncontrol/

Reporting flu outbreaks in your facility to your local health department (LHD). They can help with advice about testing, treatment, prophylaxis and infection control. The Centers for Disease Control and Prevention (CDC) defines an outbreak as a sudden increase of acute febrile respiratory illness cases or when any resident tests positive for influenza.

There are many websites that provide information on flu and pneumococcal disease. We encourage you to check these websites often for new information:

Department of Health: www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Flu.aspx Centers for Disease Control and Prevention: www.cdc.gov/flu/

We have also updated our internet website under Professionals & Providers to include the above links and other resources. Seehttp://www.adsa.dshs.wa.gov/professional/nh.htm

Sincerely, Joyce Pashley Stockwell, Director Residential Care Services Department of Social and Health Services

Maxine Hayes, MD, MPH State Health Officer Washington State Department of Health

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August 13, 2012

ADSA: NH #2012-010 CR-101 FILED TO PROPOSE ADDING & AMENDING SECTIONS TO CHAPTER 388-97 WAC

Dear Nursing Facility/Home Administrator:

The Department is considering adding and amending sections to Chapter 388-97 of the Washington Administrative Code. The enclosed CR-101 document was recently filed with the Office of the Code Reviser.

The CR-101 document can also be found on the Aging and Disability Services Administration (ADSA) internet website, under "NH Rule Filings" at: http://www.aasa.dshs.wa.gov/professional/nh.htm

The Department's purpose in filing the CR-101 is to add and amend sections to Chapter 388-97 WAC to comply and be consistent newly passed state laws and federal regulations:

Substitute House Bill 2056 – Relating to assisted living facilities;

Engrossed Substitute Senate Bill 5708 – Relating to reshaping the delivery of long term care services;

20 United States Code 1140 ("Rosa's law"); and

42 Code of Federal Regulations 483.20(d); and Social Security Act section 1128I(h), Affordable Care Act section 6113.

Highlights of the intended changes include the following:

Changing the term "boarding home" to "assisted living facility";

Changing the references to "mentally retarded individuals" to references to "an individual with an intellectual disability";

Re-define the parameters for nursing home administrators who manage small resident populations;

Adding the ombudsman to the list of persons/entities that must be notified in advance of a nursing home closure;

Updating the chapter with changes resulting from MDS 3.0.

Please check the ADSA website often as we will be posting draft language for review and comment before filing the CR-102.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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July 24, 2012

ADSA: NH #2012-009 S&C 12-35: safe use of single dose/single use medications to prevent healthcare-associated infections (NH)

Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that the Centers for Medicare & Medicaid Services (CMS) has issued a survey and certification (S&C) memorandum on the use of single dose/single use medications to prevent healthcare-associated infections.

CMS has recently received requests to relax its policies regarding the use of single dose vials (SDVs) for multiple residents. While there has been concern about resident access to critical medications that are in short supply, CMS remains equally concerned about healthcare-associated infections caused by unsafe medication preparation and injection practices, including using SDVs for multiple residents in the same manner as vials labeled as "multi-dose".

Highlights from the CMS memorandum:

The United States Pharmacopeia (USP) has established standards for compounded sterile preparations.

Under certain conditions, it is permissible to repackage single-dose vials or single use vials (SDVs) into smaller doses, each intended for a single resident.

Facility doing repackaging must use qualified, trained personnel under International Organization for Standardization (ISO) Class 5 air quality conditions within an ISO Class 7 buffer area and repackaging must be completed within 6 hours of the initial needle puncture.

All repackaged doses prepared under these conditions must be assigned and labeled with a beyond use date based on appropriate determination of contamination risk level.

Administering drugs from one SDV to multiple residents without adhering to specific standards is not acceptable.

To read the details of the memorandum online, please visit: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-12-35.html

Please contact your local RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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July 20, 2012

ADSA: NH #2012-008 PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST)

Dear Nursing Home Administrator:

Recently, we have received several questions from staff and providers on physician orders for life sustaining treatment (POLST) form. The purpose of this letter is to remind you of the requirements and provide guidance on this issue.

Here is some key information on POLST:

A POLST form is a way of summarizing wishes of an individual regarding life-sustaining treatment. It is not an advance directive; it is a physician's order that was designed for Emergency Medical personnel use only.

In the short term, the POLST form can provide guidance regarding a resident's end of life choices until additional advance directive information is obtained.

An advance directive refers to a resident's oral and written instructions about their future medical care in the event a resident is unable to express their medical wishes. An advance directive is not required for having a POLST form.

State law, (chapter 7.70 RCW) provides everyone with the right to be fully informed of health care issues that have the potential to affect their lives. RCW 7.70.050 allows a provider to implement an advance directive in good faith if, in an emergency, the provider cannot obtain an informed consent decision due to the incompetence of the resident or the unavailability of the legal decision maker.

Nursing homes are required to have policies and procedures on health care decision making and directing staff how to handle a resident's advance directives (WAC 388-97-1780 and WAC 388-97-0280). The policies and procedures should also include what staff can do with and about a POLST form.

Unless staff are a licensed medical or nursing professional, they likely do not have the scope of practice to evaluate the situation or implement the individual's advance directive.

Since the POLST is intended for emergency medical personnel, there are issues related to legal immunity for others to follow the POLST directions. In addition, some assessment and decisions about end-of-life issues may only be made by a licensed practitioner. For these specific situations, you may want to consult your attorney for legal advice.

Here are other resources available to learn about POLST:

Fact sheets on POLST, advanced directives and informed consent are available on the ADSA NH professional page athttp://www.adsa.dshs.wa.gov/professional/nh.htm under the heading "Health Care Decision Making"; and

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The Department of Health web page at:http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/PhysiciansOrdersforLifeSustainingTreatment.aspx; and

The Washington State Medical Association answers Frequently Asked Questions (FAQs) at http://www.wsma.org/patients/polst.html.

Please call your RCS Field Manager if you have any questions about the use of the POLST form.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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July 20, 2012

ADSA: NH #2012-007 EMPLOYMENT OF PHYSICIANS

Dear Nursing Facility/Home Administrator:

As you may recall, in June of 2011, we sent a letter informing you that Substitute House Bill 1315 (SHB 1315), an act relating to employment of physicians by nursing homes, was signed into law. To briefly summarize, the law allows nursing homes to employ physicians to provide professional services to nursing home residents or residents of a related living facility under certain circumstances.

The Department is required by law to submit a report to the legislature on consumer satisfaction and medical cost implications. If you chose to hire physicians in accordance with SHB 1315, please submit the following information via email to Lisa Yanagida at yanagln2@dshs.wa.gov by August 6, 2012:

Hire date;

End date (if applicable);

Total capacity of your facility; and

The number of residents who have chosen to be served by the hired physician.

To read SHB 1315, please see the following link: http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/Session%20Law%202011/1315-S.SL.pdf

If you have any questions about this letter, please contact Lisa Yanagida at (360) 725-2589 or email at yanagln2@dshs.wa.gov.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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July 9, 2012

ADSA: NH #2012-006 REVISIONS TO QUESTIONS ON THE COMPLAINT HOTLINE

Dear Nursing Facility/Home Administrator:

This letter contains important information regarding upcoming changes to the Complaint Resolution Unit (CRU) Hotline script. Residential Care Services (RCS) will be implementing a new automated system to manage information and complete intake reports received by the CRU. In anticipation of fully and effectively implementing this new system, RCS has revised some of the complaint hotline "script" questions that you and your staff answer when making an official facility report or a mandated report. Please review and share this information as needed.

Effective July 23, 2012 hotline callers will be required to respond to the revised questions. To assist you in this process, we are enclosing a copy of the revised script along with a worksheet that you may opt to use as a training tool or to complete as a guide when making your report.

The script revisions are relatively minor and are intended to gather more complete information at the time of the initial report. As a result, the "follow-up" report option will no longer be offered. Highlights of requested information that may be new or changed include:

Additional details regarding clients/residents named in the report including middle initial, date of birth, gender, and ADSA Identification (if known);

Date and time the allegation/incident was first reported to supervisors. (This is in addition to the original request or the date and time the incident was alleged to have occurred).

Resident mental status, ambulatory status and transfer status descriptors are taken from the MDS assessment. Refer to the enclosed worksheet for a list of options for each status type.

Please note that the enclosed script replaces Appendix F in the Nursing Home Guidelines (aka the Purple Book) and reflects the changes described above. The script and worksheet are also posted on the ADSA NH professional page at http://www.adsa.dshs.wa.gov/professional/nh.htm.

Do not delay calling in a report because you do not have all of the information. Reporting timeline requirements have not changed.

Pplease contact your RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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June 7, 2012

ADSA: NH #2012-005 S&C 12-30: Use of Insulin Pens

Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that the Centers for Medicare & Medicaid Services (CMS) has issued a survey and certification (S&C) memorandum on use of insulin pens in health care facilities.

CMS has recently received reports that insulin pens are being used for more than one resident, with at least one episode resulting in the need for post-exposure resident notification. Sharing of insulin pens is essentially the same as sharing needles or syringes and will be cited, consistent with the applicable provider specific survey guidance, in the same manner as reuse of needles or syringes.

Action highlights from the CMS memorandum:

To prevent bloodborne infections in residents under your care, insulin pens must never be used for more than one resident, even when the needle is changed.

Insulin pens must be clearly labeled with resident's name or other identifier to verify that the correct pen is used on the correct resident.

It is important to review your policies and procedures and educate your staff regarding the safe use of insulin pens.

To read the details of the memorandum online, please visit: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-12-30.html

Please contact your local RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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May 14, 2012

ADSA: NH #2012-004 ADMISSION CONTRACTS AND AGREEMENTS

Dear Nursing Home Administrator:

In the past few months, we have received questions on admission contracts or agreements. The purpose of this letter is to remind you of the requirements and provide guidance on this issue.

The admission contract or agreement is very important to residents and of great interest to the State Long-term Care Ombudsman. Over the years, the Ombudsman office has worked with the legislature to develop and strengthen requirements within the resident rights statute, chapter 70.129 Revised Code of Washington (RCW).

Some basic facts about admission contracts or agreements include:

The Department has the authority and responsibility to review any admission contract or agreement to determine if they meet the relevant federal or state statutes.

The resident rights statute does not require the applicant/provider to have admission contracts or agreements.

If applicants/ providers choose to have an admission contract or agreement, RCW 70.129.150 does require that the documents meet all of the requirements of the section.

Whether or not there is an admission contract or agreement, the applicant/provider still has to provide residents with all of the notices and policies required under relevant federal or state statutes, in writing and in language the resident understands,.

RCW 74.42.030 requires that the written information provided by the facility pursuant to this section, and the terms of any admission contract to be consistent with requirements of chapter 74.42 RCW and chapter 18.51 RCW, and for facilities certified under Medicaid or Medicare, with the applicable federal requirements.

In the early 2000s, the Department held several meetings with interested parties to review the admission contract or agreement requirements. They developed sample documents for Medicaid and for Private Pay which are now very out of date.

The Department is considering the need to reconvene a workgroup to address admission contracts and agreements. The workgroup could develop standardized admission contracts or agreements that meet the statutory requirements, be easily read and understood by residents, and that would be used by anyone who chose to have such a contract or agreement. Please review http://apps.leg.wa.gov/rcw/default.aspx?cite=70.129 and http://apps.leg.wa.gov/rcw/default.aspx?cite=74.42.030 for relevant statute requirements. Contact your RCS Field Manager if you have any questions.

Thank you for your attention to this matter that is so important for residents.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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February 28, 2012

ADSA: NH #2012-003 REVISIONS TO RAI USER'S MANUAL/MDS TRAINING SESSIONS

Dear Nursing Facility/Home Administrator:

This letter contains important information for facility staff responsible for completing the Minimum Data Set (MDS) assessments.

The Centers for Medicare and Medicaid Services (CMS) recently released the fourth set of updates to the Long Term Care Facility Resident Assessment Instrument User's Manual Version 3.0 as well as changes to the MDS Item sets (the MDS forms). Changes include updates and clarifications, some of which are minor "clean ups" such as correcting spelling, the addition of new items and some substantive changes as well. Multiple changes have occurred in Sections A, G, H, K, M, O and Q of Chapter 3. Portions of chapters 2, 4, 5 and 6 have also been updated. The updates are effective April 1, 2012.

One of the more significant changes is the addition of item A0310G-Type of Discharge. This asks you to identify if the discharge was planned or unplanned for the Discharge Assessment. When the discharge is unplanned, the assessment is abbreviated and the interviews for cognition, mood and pain have been eliminated via the use of skip patterns. Items have also been removed from the planned discharge assessment also. The net result is a shorter Discharge Assessment. Another section that has been significantly updated is Section Q: Participation in Assessment and Goal Setting. Several items have been deleted and others re-worded. Section K: Item K0510-Nutritional Approaches has also been updated to include two columns for coding whether or not the approaches were provided While a Resident and/or While Not a Resident (Mirrors the coding for the Treatments and Programs in Section O, item O0100).

The update includes "Track Changes" documents that describe the items in each chapter/section that have changed and the page number of the changes and the actual chapter/sections that have been changed. You may choose to download the entire chapters or only the pages where changes have occurred. Your software vendor should be updating your software package to accommodate the changes to the item sets.

To obtain the RAI Manual changes go to The CMS webpage at:https://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#TopOfPage

To obtain a hard copy of the changed MDS 3.0 item sets, go to:https://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp#TopOfPage It is the responsibility of the individuals who complete the MDS to have the most current RAI manual instructions in order to accurately complete the required assessments.

Residential Care Services (RCS) will be providing three 1-day seminars on the updates as well some information on the upcoming return of Quality Measures. The seminar schedule is listed below and facilities will need to pre-register the number of attendees for each session. Each session will begin at 9 am and end around 3 pm.

March 20 RCS Headquarters Building Blake West, Lacey

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March 21 Criminal Justice Training Center, main auditorium, Burien

March 26 Sacred Heart Medical Center Providence Auditorium, Spokane

Driving directions, special instructions (parking pass, meals, etc.) can be found on our ADSA website at: http://www.adsa.dshs.wa.gov/professional/MDS/MDS3.0/

In addition to the above seminars related to the April 1, 2012 MDS updates, there will be 3 basic MDS sessions provided this spring. These are 2-day courses that provide an overview of the RAI process including scheduling, significant change, coding of the MDS, error correction, and completion of tracking documents. Pre-registration for these sessions is also required. Each session will begin at 8 am and end around 4 pm.

May 8-9 RCS Headquarters Building Blake West, Lacey

May 22-23 RCS Headquarters Building Blake West in Lacey

June 20-21 Sacred Heart Medical Center, Providence Auditorium, Spokane

Driving directions, special instructions (parking pass, meals, etc.) can be found on our ADSA website at: http://www.adsa.dshs.wa.gov/professional/MDS/MDS3.0/

If you have any questions or need further information, please contact Marjorie Ray, RN, Washington State RAI Coordinator, at (360) 725-2487 or e-mail at rayma@dshs.wa.gov

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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February 22, 2012

ADSA: NH #2012-002 NURSING HOME GUIDELINES AKA"THE PURPLE BOOK" FIFTH EDITION – EFFECTIVE IMMEDIATELY Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that the Department is releasing its updated Nursing Home Guidelines – Fifth Edition,also commonly known as the "Purple Book". The primary reason for this update (February 2012) is to incorporate the Centers for Medicare and Medicaid Services (CMS) earlier survey and certification memorandum on required facility responsibilities for reporting reasonable suspicion of a crime against a resident in a long-term care facility.

In August 2011, the Department issued Dear NH Administrator - ADSA: NH #2011-013, a letter about these CMS facility reporting requirements. A link to the S&C Memo is included below for your reference and review. The 2010 federal health care legislation adopted new requirements for the reporting of possible crimes in long-term care facilities, including nursing facilities and skilled nursing facilities. Covered individuals, including facility employees, must report any reasonable suspicion of a crime against a resident of a long-term care facility, or against an individual receiving care from the facility. Some requirements of the law were new and some of them already existed under state law.

If there is a difference between federal and state reporting requirements, you must follow whichever law is the most stringent. If you would like to review again nursing facilities and skilled nursing facilities' responsibilities and other details of the memorandum online, please visit: http://www.cms.gov/SurveyCertificationGenInfo/PMSR/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=descending&itemID=CMS1248845&intNumPerPage=10

Since it is essential to be clear about the differences between federal and Washington State reporting requirements, the Department did a full review of the prior "Purple Book". This allowed the Department to make changes to reflect this federal health care legislation. This also gave the Department an opportunity to update other content as well as enhance the format of this Fifth Edition. When compared to the Fourth Edition, there are some new resources included, and some core information has been reorganized and/or relocated to different sections of the document.

Here are two examples, but not all, of the changes made to these NH Guidelines:

There are new Appendices on several topics – Key Triggers / Possible Criminal Indicators of types of Abuse, Neglect, Financial Exploitation; Medicaid Fraud Control Unit; Selected Resources; and, the Complaint Resolution Unit (CRU) Hotline Poster; and

The "Definitions" section has been expanded and this content is now found in an Appendix, rather than in a Chapter.

The Department is only able to provide this document, Nursing Home Guidelines – Fifth Edition, in an online version,as printing and mailing hard copies NH facilities statewide is too cost prohibitive, given current state agency staffing resources and budgetary constraints.

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Upon receipt of this letter, you and your staff members can access the document online to print it, and, then check periodically for updates to thisNursing Home Guidelines ("Purple Book") by visiting: http://www.adsa.dshs.wa.gov/professional/nh.htm.

You and your staff are encouraged to become thoroughly familiar with the content and layout of this Fifth Edition of these updated Nursing Home Guidelines. This Fifth Edition does not necessitate formal training by the Department for nursing facilities, skilled nursing facilities, and, ICFs/ID facilities and their respective staff members who are mandated reporters. For quality assurance purposes, these Guidelines are effective immediately.

Each resident in nursing facilities or skilled nursing facilities deserves our full efforts to keep him or her from being harmed by, or being placed at risk for, abuse of all types, neglect, criminal mistreatment, abandonment, and, financial exploitation. Thank you for your ongoing work with Residents as "Partners in Protection" with the Department.

Please contact your local RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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February 7, 2012

ADSA: NH #2012-001 S&C 12-08: Federal Requirements for the Independent Informal Dispute Resolution (IIDR) Process

Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that the Centers for Medicare & Medicaid Services (CMS) has issued a survey and certification (S&C) memorandum on the independent informal dispute resolution (IIDR) process for nursing homes. New regulations were added at 42 CFR, Sections 488.331 and 488.431 as required under section 6111 of the Patient Protection and Affordable Care Act of 2010. This included federal requirements for the IIDR process for nursing homes.

PLEASE NOTE: This requirement only applies if CMS imposes a civil monetary penalty (CMP) against the facility and the CMP amounts are subject to being collected and placed in an escrow account.

Highlights from S&C 12-08-NH Memorandum:

The IIDR opportunity will begin on January 1, 2012, for any CMP imposed by CMS that meets the above criteria.

CMS will begin collecting and escrow only those CMPs which are imposed as a result of the most serious deficiencies, actual harm or immediate jeopardy to resident health or safety including from life safety code surveys (i.e., at a scope and severity (S/S) level of G or above).

An IIDR will not include the survey findings that already have been the subject of an informal dispute resolution for the particular deficiency citations at issue, unless the informal dispute resolution was completed prior to the imposition of the civil money penalty.

After receiving the imposition of CMP notice from CMS, if you want an IIDR, you must request it by the date indicated in the notice. The IIDR form request can be found online at: http://www.adsa.dshs.wa.gov/professional/nh.htm under IIDR request form. You may also find the state agency IIDR process and procedures at that link under IIDR state process.

The IIDR will be document review only; you must submit a form for each deficiency disputed along with the documents relevant to only that deficiency.

Submission of documents not relevant to the deficiency may result in the IIDR person being unable to find pertinent information or they may not find it within the timeframe required for completion.

To read the details of the memorandum online, please use the following link: Federal Requirements for the Independent Informal Dispute Resolution (Independent IDR) Process

Please contact your local RCS Field Manager if you have any questions.

Sincerely,

Joyce Pashley Stockwell, Director Residential Care Services

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