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Indiana FSSA Division of Aging Issues Updates to e450B Process
'Why' I Originally Chose to Work in Long-Term Care
ISDH Publishes Update to Advance Directives Brochure
CMS QAPI Material Rollout for Nursing Homes
National Nursing Home Week - Team*Care - 10 Simple Ways to Work as a Team


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CMS QAPI Material Rollout for Nursing Homes

CMS (Centers for Medicare & Medicaid Services) has issued a letter (Ref: S&C: 13-37-NH 06/07/2013) to State Survey Agency Directors regarding the rollout of QAPI (Quality Assurance & Performance Improvement) materials available for nursing homes. 

CMS Rollout of Quality Assurance & Performance Improvement (QAPI) Materials for Nursing Homes Page 1CMS Rollout of Quality Assurance & Performance Improvement (QAPI) to Nursing Homes Page 2

CMS Rollout of Quality Assurance & Performance Improvement (QAPI) to Nursing Homes Page 3
In need of assistance with compliance for your Social Service or Activities departments? Looking for help with QIDP (QMRP) documentation? Contact Simmons Healthcare Consulting, LLC at (260) 894-1417 or click here.

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CMS Updates Forms for QIS Survey Process

CMS has posted changes to a few QIS forms.  Full information can be found at  

Resources - 

Entrance Conference - 

Mandatory Facility Task Pathway Forms - 

Stage I Forms - 

Stage 2 CE Pathways Forms - 

Triggered Facility Tasks Pathway Forms - 

Need assistance with preparation for QIS?  Does your nursing facility need increased support while awaiting a PSR?  Contact Simmons Healthcare Consulting, LLC, to discuss many options that can assist with regulatory compliance.

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Has Your SNF Registered for the CMS National Provider Call to Improve Dementia Care?

Registration is now open for the National Provider Call: CMS National Partnership to Improve Dementia Care in Nursing Homes scheduled for January 31, 2013 - 1:30pm - 3:00pm.

Background - CMS developed a national partnership to improve the quality of care for those with dementia residing in nursing facilities.  The focus includes person-centered, comprehensive, and interdisciplinary care.  One of the goals of the partnership is to help reduce antipsychotic medication use in facilities, which CMS has already stated is a primary focus in 2013.  

During this particular call, CMS plans to discuss the mission of the partnership, along with goals, quality measures, and 'ongoing outreach efforts'.  As expected, there should be time for a question and answer session following their presentation.  CMS is listing the agenda as follows - 

  • Welcome and Opening Comments
  • National Partnership Mission
Goals for 2012 and Beyond
The Three R's: Rethink, Reconnect, Restore
Multidimensional Approach: 
public reporting
partnership and state-based coalitions
training for providers and surveyors
revised surveyor guidance
  • Next Steps:
Ongoing Outreach
  • Questions and Answers

Registration - You will need to register for the call on the CMS Upcoming National Provider Calls registration website.  CMS states that registration must be made by noon on the day of the call or before space has been filled.  

Miscellaneous - CMS plans to have the presentation for the call posted prior and is to be found on the FFS National Provider Calls page.  CMS is expected to email a slide presentation to all participants on the day of the call.  

Are you or your nursing facility planning to participate in the call?  Has your interdisciplinary team (including your pharmacist) developed a 'plan of attack' for psychoactive medication reductions in 2013?

Need assistance with your facility's Behavior Management program or Social Service documentation?   
Is your current Social Service consultant providing the results that your nursing facility needs?  Contact Simmons Healthcare Consulting, LLC (260-894-1417 or, and we'll begin discussing how SHC can assist you in achieving positive outcomes.

Have a great weekend! 

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Recent ISDH and CMS Updates / Resources for Nursing Facilities

Several important pieces of information to pass on to our long-term care followers today - 

  • ISDH (Indiana State Department of Health) has recently increased the number of survey areas to 10. They have released an updated map and the roster of surveyor assignments / supervisors.  If you need assistance obtaining the new map and roster, send us an email ( and we'll get that information to you in the form of a Word document.

  • CMS (Centers for Medicare & Medicaid Services) has stated that under healthcare reform there must be regulations requiring nursing facilities to have an effective compliance and ethics program by March 23, 2013.  CMS is expected to publish a 'draft' regulation by December 31, 2012.  
  • The "Hand in Hand" training materials should be arriving to nursing facilities shortly from CMS.  If you're not familiar, the program focuses on person-centered care for residents with Dementia and abuse prevention.  All facilities are supposed to receive one free copy of the training program.  SHC would like to hear feedback from facilities once you review the toolkit.  Contact SHC if you need assistance with implementation of the program.  
  • The most recent information that SHC has on the top F-tag citations for Indiana - F441 (Infection Control), F323 (Supervision/Accidents), and F282 (Comprehensive Care Plans).
  • CMS has released a webinar (available via YouTube at this link) on the CMS National Partnership to Improve Dementia Care in Nursing Homes - formally referred to as the Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Home Residents.  The webinar provides an overview of the national partnership, resources for technical assistance, and plans for upcoming educational offerings.
  • CMS has also released a "Discharge Planning" booklet (ICN 908184).  It is designed to provide education on Medicare discharge planning.  Again, email SHC if you need assistance obtaining a copy of the booklet and we'll send you the PDF version.  

Hope everyone stays safe and has provisions in place for staffing today & tomorrow with the pending winter storm!

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Don't Overlook the "Easy" F-tags in Your #SNF

Many of us know that there are certain F-tags that are difficult to avoid no matter how fantastic the nursing facility is.  F309, F329, and F441 come to mind.  However, there are citations that can be avoided with little effort.  Several different tags deal with the posting of information and information provided to residents/families.  For example, F156 (Notice of Rights, Rules, Services, Charges) has seemed to be an issue recently in some areas.  

  • Assign rotating staff in your facility to conduct a regular walk-through to look for the required postings.
  • Do the required postings have the correct information?  Example, current Ombudsman / Administrator, correct phone numbers?
  • Are the postings printed with a larger font?
  • Are the postings at an appropriate height?
  • Are residents being given a copy of the facility charges along with their Medicare denial letters?
  • Is the facility using the most recent Medicare denial letter?
  • Is the facility using the most recent Notice of Transfer/Discharge and Request for Hearing?
  • Is information on how to obtain Medicaid assistance posted?
  • Is the required staffing information posted in an accessible area?
  • If your facility has an electronic wandering system, is information available that those residents would have access to also?

Taking a few minutes each week to ensure compliance with these areas can potentially save a lot of headaches once the surveyors enter the home.  Need assistance with your Social Service or Activity department?  Is your Indiana facility in compliance with required QMRP visits?  Contact Simmons Healthcare Consulting, LLC, and we will schedule a visit to help continue improving Quality of Life services for your residents.

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CMS Releases Updated MDS 3.0 RAI User's Manual

The new updated MDS 3.0 RAI Manual and sample Item Sets, V1.09, effective November 7, 2012 can be downloaded from the CMS (Centers for Medicare and Medicaid Services) site here.  If you download the 'All Change Tables and Pages for Version 1.09', the changes are highlighted beginning on appoximately page 134 of the document.  As with any update, it's always a good reminder for Social Service and Activities staff to review their MDS/CAA/CP procedure.  Do you have an efficient process for completing your sections in a timely manner?  For Indiana staff, are you giving specific examples for behavioral symptoms?  Are you capturing relevant signs/symptoms of delirium?  Do you compare the current BIMS/PHQ-9 score to the previous score to track improvement/decline?  Are you utilizing the information gathered from the resident interviews to establish realistic care plan goals and interventions?  As always, if your department or facility needs assistance with the RAI process, contact SHC and we'll schedule a visit to help continue improving Quality of Life services.