EDITOR’S NOTE: Respected long-term care payment and assessment expert Leah Klusch is sharing with mcknights.com readers her observations from the front line of the sold-out 2012 MDS 3.0 National Conference taking place this week in St. Louis. The initial two-day session ended Wednesday; it is being repeated Thursday and Friday.

The most significant takeaway I have from being here is that the industry and CMS [the Centers for Medicare & Medicaid Services] have actually problem-solved some of these potential changes and the impact of them together.

The first day there was a lot of back-and-forth that was not necessarily positive. The second day, everyone had had a chance to think about this; some of the suggestions that came from the audience were exceptional. CMS was presenting information about the changes and was at least listening to the reaction.

It doesn’t mean that things that they’ve already written won’t happen, but CMS officials were listening, and that was positive. Very positive.

Many changes April 1

It’s very important providers take advantage of any learning experiences they can before April 1. They need to have updated RAI manual materials, either hard copy or online.

I recommend facilities pay a lot of attention to the Section Q part of the RAI manual. It used to be something like four pages long and now it’s 22. So there are a lot of new items, instructions and coding directions.

Chapter 4 of the manual also has been totally updated, with many changes in effect April 1. Facilities need to be very careful that who’s responsible for care planning has taken a good look at them. Operators also really need to make sure that their interdisciplinary team as a whole understands the new coding on the MDS so they can interpret some of the new items, such as weight loss. Nutritional status is a very important part in all care planning.

More about discharge planning

The second day of sessions did not contain the level or the number of changes that the first day did. It was first focused on participation in the assessment and discharge planning section, which has a lot of content changes on the form, if not a lot of procedural changes.

There are also changes to the care planning process. But if you’ve been doing the care planning process according to Chapter 4 so far, you’re probably not going to have to change a lot. Just be careful how you summarize and document the information.

We talked about the whole process of discharges and the resident’s overall expectations, as far as whether they want to stay in the long-term care facility and if there’s availability of community resources if they choose not to stay in the facility.

We experienced this change in CMS’s documentation when the MDS changed in October 2010, so we’ve had a year and a half of talking to residents about their needs and desires to get back in the community, and documenting it on the MDS.

Regulators have redesigned Section Q. It’s almost totally redesigned for use starting April 1, as far as the questions and coding go. It’s much more specific, and it really targets the resident or their significant other’s opinions about the prospect of the resident leaving the facility and returning to live and receive services in the community.

Resident can cut off questioning

The other thing it does, thankfully, is if the resident in the facility does not want to leave and does not want to be asked about whether he wants to leave every time, the resident can indicate, “I don’t want to be asked.”

This is very positive. That question started when MDS 3.0 started and CMS got a number of complaints from residents and families who said, “They’re always asking me if I want to leave.”

There are a couple of issues with Section Q. First, we have to be very specific with how we communicate with residents about their expectations to either stay in the facility or return to the community, with services.

Second, facilities have to be very aware and connected to community services. This is really forging into a new area where no facility can isolate itself. We haven’t had the specificity of dealing with it much before and the questions are much more specific now.

Every facility has to know who its Local Contact Agency (LCA), unless in the case of a resident who wants to use private services. There was a lot of discussion about transitioning people into the community. LCAs are determined by state Medicaid agencies. In metro areas, there’s not often a problem, but in rural areas or where there’s low population, the facility could have a problem finding out who a LCA is.

Using the ombudsman

The role of the ombudsman in the entire process was another interesting discussion. It’s different state to state, but we had a federal ombudsman speak and she was very candid. She wants providers to look at the ombudsman service as an additional resource for providers to open discussions about community services.

It was a lot of information, and some was in topic areas that some of the people there had not traditionally discussed — such as actually working with community agencies and setting up services.

I don’t know that they won over a skeptical crowd. Everyone knows you have to code this section of the form differently, and honestly represent in your documentation what you did. It’s part of a learning curve

Leah Klusch, is the executive director of The Alliance Training Center. A 45-year veteran of working with provider assessment and payment issues, she is a McKnight’s Online Expo keynote speaker (“Making the most of the newest MDS 3.0”) at 9 a.m. on March 21. Registration and the accompanying continuing education credit are both no-cost.