Keane Carrier

Changes to Survey Guidance re: Homelike Environment
CMS has revised the Guidance for Surveyors to recommend more focus on creating a "homelike environment" for LTC residents, such as 24-hour access for visitors. It also includes more examples of how to ensure residents' dignity and privacy. Regulatory language is unchanged. Use the link below to read the transmittal.

State Operations Manual Transmittal 48

Latest Changes to MDS 3.0 Draft
In addition to FY 2010 payment for SNF Medicare, the Proposed Rule published in May 2009 includes information on MDS 3.0 and how it will be used to collect data through a revised payment system, RUG-IV, beginning October 2010. Differences between RUG-III/MDS 2.0 and RUG-IV/MDS 3.0 include:

How therapy is counted, including deleting Section T
Renaming RAPs to CATs (Care Area Triggers) and giving more choice in clinical guidelines
Requiring facilities to transmit MDS data to the national CMS system instead of the States within 14 days after the facility completes an MDS
Eliminating look-back periods in MDS 2.0 P1a

For an overview of all the changes, including those in the latest release, MDS 3.0-Version 26, download the free white paper prepared by Keane Care with the link below).

MDS 3.0 White Paper

MDS 3.0 Website for latest draft form

RUG-IV System Outlined
The Proposed Rule for FY 2010 SNF Medicare payment also addressed FY 2011 payment by outlining RUG-IV, a revised case-mix model that will use data collected in MDS 3.0. Both RUG-IV and MDS 3.0 are scheduled for implementation October 1, 2010.

Differences between RUG-III and RUG-IV:

- How therapy is counted

Therapy delivered concurrently to multiple patients will be allocated among the patients, not counted the same as individual therapy
Only therapy minutes administered in the last 7 days will be used (Section O-Therapies). Estimates will not be used and Section T will be deleted
By submitting an OMRA (Other Medicare Required Assessment)therapy started in the middle of a payment period can trigger a change in payment.

- Look-backs for Special Treatments and Procedures (MDS 2.0 Section P1a and MDS 3.0 Section O) will not be used in RUG calculations, the data will be used for care planning. This is significant for Extensive Services RUGs.

- Activities of Daily Living (ADL) totals would continue to be used as criteria for classifying residents to RUGs within larger categories. ADL totals were increased to 17 and renumbered. The eating item will no longer use Parenteral/IV feeding or feeding tubes.

- The eight hierarchy levels were modified and the case-mix groups were increased from 53 to 66. Some conditions and/or services used to calculate RUGs would move up or down within the hierarchy

CMS is accepting comments on the Proposed Rule until June 30, 2009. A Final Rule is scheduled to be published July 31, 2009. Comments can be sent electronically to http://www.regulations.gov, follow the instructions under the "More Search Options" tab. Send comments by regular mail to:
Centers for Medicare & Medicaid Services
Attention: CMS-1410-P
PO Box 8016
Baltimore, MD 21233-8016

Proposed Rule of May 2009

FY 2010 Medicare Part A Payment Rates Proposed
The Proposed Rule released May 2009 reviews how the RUG-III system was refined in 2006 to a 53-RUG system that included higher-paying RUGs for residents receiving therapy plus extensive services. Actual utilization of that system has resulted in higher Medicare payments than projected.

To maintain a budget-neutral system CMS is now proposing to readjust the case-mix weights, resulting in a $1.05 billion, or 3.3 percent, reduction in payment to SNFs. This reduction, when combined with a 2.1 percent increase in the "market basket" rate results in an overall 1.2 percent reduction in Medicare payment to SNFs for FY 2010, beginning October 2009.

A Final Rule is expected July 31, 2009 and comments will be accepted until June 30, 2009. Use the link below to read the Proposed Rule.

Proposed Rule of May 2009

LTC Pay for Performance
CMS accepted applications from LTC facilities in Arizona, Mississippi, New York, and Wisconsin that want to participate in the Nursing Home Value-Based Purchasing Demonstration through May 1. The demonstration will run from July 1, 2009 through June 30, 2012.

Performance payments will be based on nurse staffing, avoidable hospitalizations, MDS outcomes, and survey deficiencies. Whether payments are made depends on whether the demonstration produces savings for Medicare.

More information on the project is posted at the CMS Website (link below).

CMS Medicare Demonstrations Website

Personal MDS Login IDs
On May 5, 2009 people who submit MDSs and access CASPER reports will start changing from their shared login ID and passwords to a personal login ID and password. The rollout of this new security system is by state; the timetable is shown below. Only two login IDs will be allowed for each facility.

If you submit for multiple facilities, you will use another process; for instructions, send an email to help@qtso.com.

When it's time for people in your state to change IDs, here's what you do:
1. Select the MDS Individual User Registration link on the MDS Welcome Page.
2. In the login page, enter your existing shared provider login ID and password
3. Click on the Login button.
4. A page will display asking for your first and last name, phone number (without dashes), e-mail address, and password (use the rules available by clicking the Password Rules button).

With the Personal ID users can update login information and reset a forgotten password. Forms will be on the QTSO Website (www.qtso.com) to add or remove facility staff with Personal IDs, request additional user accounts if your facility needs more than two, and designate an agent (a non-employee to submit MDSs).

Facilities will change to Personal MDS Login IDs on the following initial schedule, with the transition complete in January 2010.
May 5, 2009 - IA, KS, MO, NV, OR
July 8 - CA, DC, MN, WA, WV, WI
August 12 - AZ, AR, DE, IL, TX, UT
September 9 - AK, KY, LA, MD, NE, NY, RI, TN, VA, WY

New MDS 3.0 Timeline Posted
CMS has posted a new version of its MDS 3.0 Implementation Timeline (link above). The next MDS 3.0 deadline is October 2009 when CMS will publish final MDS 3.0 data specs (RUGs, RAPs, and QM/QIs), data elements (Admission, Quarterly and Discharge MDS forms), and an RAI manual.

Train-the-trainer education forums are scheduled for February/March 2010 and October 1, 2010 is implementation of MDS 3.0 including data collection and Medicare PPS payment.

CMS MDS 3.0 Website

Care Transitions Project study hospital readmissions
CMS has chosen 14 communities for the Care Transitions Project, a pilot program to reduce hospital readmissions by promoting seamless transitions from the hospital to home, skilled nursing care, or home health care.

CMS is taking a local approach, watching hospital return rates and comparing them to CMS' historical rates. Each project is led by their state Quality Improvement Organization (QIO) and will implement system-wide interventions as well as target specific diseases and specific reasons for admission. Use the link below to see the 14 locations.

Care Transitions QIO Website

Five Star Rating System
CMS' Five Star Rating system awards all SNFs with an overall rating of 1 thru 5 stars on its Nursing Home Compare Website (link below).

A technical manual is available with complete details on how the stars were calculated (use the link below for an article that summarizes the 35-page manual) or click here to download the manual.

The ratings were calculated using survey data, staffing information, and Quality Measures.

Nursing Home Compare is generally updated on the 3rd Thursday of the month. CMS will post preview reports for providers that they can access from their MDS State Welcome pages.

To access the previews, select the CASPER Reporting link located at the bottom of the login page. Then click on the Folders button and access the report in your "st LTC facid" folder. A help desk will be available for that week at 1-800-839-9290; open from 9 to 5 EST.

Nursing Home Compare Website

Article: How the Five-Star Ratings are Calculated

ABN Forms and Therapy Caps
As of March 1, 2009, SNFs must use the revised ABN (FORM CMS-R-131) (Advance Beneficiary Notice of Noncoverage) for items/services expected to be denied under Medicare Part B only.

CMS issued a revised MedLearn Matters article on therapy caps on March 10, 2009 to clarify ABN language. It states that "Since therapy that exceeds the cap is statutorily excluded from Medicare coverage, the ABN is not required." However, the ABN may be used voluntarily to inform beneficiaries of potential financial liability. (Link below.)

During the Open Door Forum call officials reported that an ABN is not needed if a SNF is terminating therapy services because the beneficiary's goals were met. Instead, a Notice of Provider Noncoverage (Form CMS 1-123) should be used. Use the link below for full information.

CMS' ABN-G and L Website

Therapy Caps in 2009 - MLM 6321

MDS 3.0 Postponed
CMS officially announced that implementation of MDS 3.0 is postponed to October 2010. They are currently working to revise the MDS 3.0 timeline and announced that the data specs that were due for release in March 2009 will be released in October 2009.

In response to comments received about training, CMS officials pointed out that all the documents posted on their Website (link above) are draft.

Looking for a Cliffs Notes version of the draft MDS 3.0? Keane Care has prepared a paper summarizing the MDS 3.0 Final Report from Rand. It describes the changes made in each section, the reasons, and how they did in testing. Open it with the link below.

Draft MDS 3.0 Summary

CMS' MDS 3.0 site

Revised Survey Guidance on Pain effective 3/31/09
Revised guidance for LTC surveyors, including of Pain Management was released as part of Appendix PP of the State Operations Manual in January 2009. The protocols are effective March 31, 2009. The advance copy of this guidance and training materials are to be used to train surveyors. They can be downloaded with the link below.

Download Survey & Cert Letter 09-22

Stimulus Law and Long-Term Care
The Stimulus bill increases Medicaid funding for 27 months beginning 10/1/08 through 12/31/10, with an 6.5 percent across-the-board increase to all states for their federal match. An additional bonus structure is funded based on the state's unemployment rate.

States that qualify for this increased funding would have to comply with prompt-pay requirements (90 percent of providers' claims must be paid within 30 days of receipt).

Health Information Technology (HIT) Stimulus Funding:
To encourage Electronic Healthcare IT, $19 billion in funds were included in Title XIII of the Stimulus bill signed by the President on February 17. An additional $2 billion is available to the Office of the National Coordinator for Health Information Technology to jumpstart activities.

Standards
The bill includes funding and a deadline of December 31, 2009 for the adoption by the DHHS Secretary of an initial set of technological standards, implementation specifications, and certification criteria for a nationwide HIT infrastructure.

Loans for LTC to Buy HIT
Grants will be awarded to states to develop Loan Programs to further the widespread adoption of certified EHR (Electronic Health Record) technology. The loans will be awarded to healthcare providers, including skilled nursing facilities and other long-term care facilities to:
- Purchase certified EHR technology
- Enhance the use of certified EHR technology, including costs to upgrade HIT so that it meets certification criteria
- Train personnel in the use of such technology

The interest rate shall not exceed the market interest rate and the loan must be fully amortized not later than 10 years after it is awarded.

American Recovery and Reinvestment Act of 2009

RAI Manual Revisions - December 2008
CMS released changes to the RAI Manual effective January 1, 2009, including changes to these pages:

2-27 and 2-37 - clarify that facilities may not be paid even the default rate, for a beneficiary who dies or is discharged shortly after admission if an MDS is not submitted.

2-39 - clarify that early or late assessments with an ARD prior to the discharge date will be paid at the default rate.

3-136 - address UTI coding and the attending physician's involvement.

3-177 and 3-182 regarding Section O-Medications - if information on IV medication additive is not available, do not count in O1 and code P1ac with a dash.

3-215 and 3-216 (MDS Section T1b and c) - language was added about the initial evaluation.

The document updated contact information for MDS RAI Coordinators in AK, KS, MN, and PA. And for Automation Coordinators in AK, MN, and OR.

CMS' MDS 2.0 Manuals and Forms Web page

SNF Web-Based Training Updated
The Web-based training module on SNF consolidated billing and "arrangement agreements" between SNFs and other providers or suppliers was updated October 2008 and can be downloaded from CMS' Medicare Learning Network Website (use link above). Scroll down to the "Related Links Insider CMS" and select "Web-Based Training Modules."

Medicare Learning Network Website

Final Rules: ICD-10 and Version 5010
The Final Rule on the adoption of the ICD-10 code set for diagnoses was released January 16, 2009. It sets a compliance date of October 1, 2013 for adoption of ICD-10, replacing the ICD-9 code set. Also published was the Final Rule for Version 5010 of the standard for electronic health care transactions, including claims and remittance, that will replace the 4010 standard on January 1, 2012. The 5010 standard will support ICD-10 codes.

The HHS press release of January 15, 2009 (use link above) states that ICD-10 and 5010 will facilitate the United States' ongoing transition to an electronic health care environment. It gives an overview of the reasons for moving to the ICD-10 code set, including greater specificity, better support for quality data, more accurate payment, and comparison of US data to international data since most countries use ICD-10. The release also gives details of the benefits of ICD-10.

CMS' ICD-10 Fact Sheet is available at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2008.pdf

Final Rule on ICD-10 Adoption

Press Release on Final Rules

MDS Transmit Changes: Personal IDs and Dial-up Deadline
CMS set a deadline of February 1, 2008 for facilities to switch from dial-up to broadband connections for MDS transmission. If you already use a broadband connection, you are in compliance. If you are using a dial-up connection for MDS submissions, see the information CMS posted in December 2008 including broadband setup instructions (box at right labelled "Attention Broadband Connectivity Information") at https://www.qtso.com or use link below.

Personal IDs for MDS Transmits CMS soon will be requiring facilities to change the login ID and password used to transmit MDSs and access CASPER reporting. In early 2009 facilities will receive instructions for two staff to request Personal IDs and passwords. The IDs will belong to each user exclusively -- sharing passwords will be considered a security violation.

QTSO Website

HIPAA Privacy Fact Sheets
To clarify how the HIPAA Privacy Rule works with a providers' policies and procedures and to help providers update their policies for exchange of electronic health information, the Office of Civil Rights has released a series of fact sheets that give an overview and frequently asked questions.

The topics are Correction, Openness and Transparency, Individual Choice, Collection/ Use/Disclosure Limitation, Safeguards, and Accountability. Use the link below to download them.

OCR - HIPAA health information technology

2009 Medicare Coinsurance Rates
CMS reports no increase in the 2009 Part B premiums and a rate increase for Part A Coinsurance. Part A SNF Coinsurance rate for 2009 is $133.50 per day, effective January 1, 2009, up from $128. The daily rate is paid for the 21st thru 100th day in a SNF.

The Medicare Part B Deductible rate of $135 will continue for 2009 and the 2009 Part B premium rate of $96.40 also will not increase. See the CMS press release for full information (link is above).

CMS press release

Rehab Therapy Caps Exclusions Restored
The Senate and House of Representatives have overridden the President's veto of the Medicare bill and so restored the exclusions to the therapy caps to December 31, 2009.

The exclusions to the Medicare therapy caps for Part B therapy mean that caps do not apply to most nursing home residents for payment under Medicare Part B. CMS had earlier indicated that claims would be held for 10 days beginning Tuesday, July 1, 2008. It is expected that CMS will begin processing claims for services provided on or after July 1 (the date the exclusions were set to expire).

Read about the exclusion process in Medlearn Matters SE0826 (use link above).

Instructions regarding processing effected claims using VistaKEANE and Keane NetSolutions RAM are available in the RAM Insider blog (password required). Use link above.

Medlearn Matters SE0826

Instructions re KX modifer in RAM

National Provider Identifier Deadline Here
The final deadline is here: NPIs must be used in all provider identifier fields for all HIPAA electronic transactions (claims and remittance) and paper claims. Claims will be rejected that include a Medicare legacy identifier in any provider field.

Medlearn Matters SE0725 covers how to correct rejected claims and common errors. Use the link above to read it.

CMS NPI Website

Medlearn Matters SE0725

Volunteers Needed for Post-Acute Care Payment Reform Demonstration
CMS has been directed to develop a post-acute assessment tool to gather standardized data to evaluate the care that Medicare beneficiaries receive after being discharged from a hospital and how CMS pays for that care.

Providers in the study include acute care hospitals and providers that may treat patients after leaving the hospital, specifically skilled nursing, home health agencies, LTC hospitals, and inpatient rehabilitation facilities. Called the CARE (Continuity Assessment Record and Evaluation) Tool, it was tested during summer 2007 in five Chicago provider settings. A demonstration in Boston is underway.

This spring volunteers will be selected within a two-hour radius of the following cities: Dallas, TX; Lakeland/Tampa, FL; Lincoln, NE: Louisville, KY: Rapid City, SD; Rochester, NY: San Francisco/Bay Area, CA, and Seattle/Tacoma, WA. Data collection in those sites will continue through summer 2009, followed by an analysis phase. A report to Congress is due June 2011.

In response to a question at the SNF Open Door Forum of April 15, 2008 about whether the CARE tool will take the place of the MDS, a CMS official said that in the demonstration, volunteer sites will do both assessments. She said the goal is to have an integrated assessment instrument rather than providers in different settings completing different assessments.

If you would be interested in learning more about the demonstration or are interested in participating, contact Barbara Gage, Ph.D., Principal Investigator at RTI, by emailing PAT-COMMENTS@RTI.org.

Overview of the Initiative

Care Transitions Project study hospital readmissions
CMS has chosen 14 communities for a pilot program to reduce hospital readmissions by promoting seamless transitions from the hospital to home, skilled nursing care, or home health care.

CMS is taking a local approach, watching hospital return rates and comparing them to CMS' historical rates. Each project is led by their state Quality Improvement Organization (QIO) and will implement system-wide interventions as well as target specific diseaes and specific reasons for admission. Use the link above to see the 14 locations.

Care Transitions QIO Website

MDS 3.0 Information Available
At the special MDS 3.0 Open Door Forum on January 28, the project's lead researcher reported that testers of the revised assessment form found it took less time to complete and were positive overall.

Feedback from nurses who tested the draft:
- 85 percent rated MDS 3.0 as likely to help identify unrecognized problems
- 81 percent rated it more relevant than MDS 2.0
- 85 percent rated MDS 3.0 questions more clearly worded

Materials on the Open Door Forum Website include a draft form and the PowerPoint from the Forum (use link above).

MDS 3.0 draft, introduction, and timeline released

Postings from Open Door Forum

SNF Consolidated Billing training
CMS' Web-based training course on SNF Consolidated Billing is available for download (use link above). It's under Medicare Payment Policy.

The course is free of charge and a test score of 70 percent or higher, is approved for 1 CEU by the American Academy of Professional Coders.

CMS Web-based training courses

End of Survey Revisit Fees
The 2008 appropriations act did not grant CMS the authority to continue charging fees for conducting revisit surveys of healthcare facilities cited for deficiencies on initial certification, recertification, or substantiated complaint surveys.

The program was established as part of the 2007 appropriations law and went into effect September 19, 2007. The fee assessed to SNFs for offsite revisit survey was $168 and $2072 for onsite surveys.

Revisit User Fee Program Website

RAI Manual Revisions
CMS has released changes to the Resident Assessment Instrument Manual including clarifications of instructions for MDS 2.0 Sections I2j, I3, K2a, K3, L1e, M4, and M5. Use the link above to download the table of changes and replacement pages.

For updates to the MDS RAI Coordinators and/or RAI Automation Coordinators in CA, IA, MA, MO, NE, NV, NM, ND, PA, SD, TX, UT, WV, and WY download the full RAI User's Manual (zip 3.9 MG) and open Appendix B (use link above).

January 2008 RAI Manual Revisions

Benefits Exhaust and No-Pay Billing, including for Medicare Advantage plans
CMS is including the following clarifications to Chapter 6, SNF Inpatient Part A Billing, of the claims processing manual, effective March 17, 2008.

CMS does not require SNF providers to submit no payment bills for non-skilled beneficiary admissions. No-pay bills are only required for beneficiaries who have previously received skilled care and subsequently dropped to non-skilled care and continue to reside in the Medicare-certified care of the SNP; and

No payment bills may span both Medicare and Provider's fiscal year-end dates; and

No payment bills are not required for beneficiaries who are in current Medicare Advantage (MA) plans and no longer require skilled care while still under the plan.

CR5840 includes clarification of more points concerning no-pay billing. Use the link above to read the full document.

Change Request 5840

Billing for Medicare Advantage (MA) Plans
CMS clarified billing rules for Medicare Advantage plans in CR 5653. Implementation of this change was recently delayed to March 3, 2008.

The document specifies that facilities must submit claims for beneficiaries enrolled in MA (Medicare Advantage) plans and receiving skilled care in order to take benefit days from the beneficiary and/or update the beneficiary's spell of illness information in Medicare Systems.

Submit the claim using bill type 18X or 21X and include a HIPPS code (use default code AAA00 if no assessment was done), room and board charges and condition code 04 (informational only bill).

Keane Care Clients please note that the RAM SP 10 release will contain programming for this change.

Also delayed to March 3, 2008, is implementation of the Timeliness Standards for Processing Other-Than-Clean Claims as outlined in Change Request 5513 (use link above).

Change Request 5653

Change Request 5513

New Survey Rules for Paid Feeding Assistants and Accidents
Surveyor rules regarding Paid Feeding Assistants were released as a new tag, F373. The regulations are included in revisions to Appendix P and PP of the State Operating Manual. The new language is included in Transmittal 26 released August 17, 2007 (use the link above).

Revisions to surveyor guidance regarding accidents was released in Transmittal 27 (link above).

Transmittal 26 - Paid Feeding Assistants

Transmittal 27- Accidents

Advance Beneficiary Notice - 2nd draft
CMS used the comments received on an earlier draft of the Advance Beneficiary Notice (ABN) of Noncoverage to prepare a revised version that is now available (use link above and click on CMS-R-131.)

Formerly, CMS maintained two versions of the ABN, a general and a laboratory specific. CMS is now proposing to combine the two into a single ABN meeting both needs. Other proposed changes are described in the website posting.

CMS-R-131

Broadband MDS Transmissions Coming
Faster state connections are in the future for facilities due to broadband MDS submissions. AT&T will make broadband available starting in June 2007. Help with broadband connections will be scheduled by state, beginning in June and extending to the end of 2007. Facilities that do not need assistance from AT&T can connect any time after connections are available.

Information on the broadband submission is available at the QTSO/QIES Website (link above). Click on the "MDCN Information" box at top right.

QTSO/QIES Website

RAI Manual Revisions - March 2007
CMS has posted a set of revisions to the RAI manual that are effective March 1, 2007. The manual is the official instruction book for completing MDS 2.0. This update changes MDS Section W to specify that a dash can be used for a "none of the above" answer in W2b and W3b. It also changes the definition of "Any Scheduled Toileting Plan" for H3a. Use the link above to download all the changes.

RAI Manual update

Revised Surveyor Guidance re: Unnecessary Medications and more
Revised guidance for surveyors regarding Unnecessary Drugs, Pharmacy Services, Drug Regimen Review, and Labeling and Storage of Drugs and Biologicals will be effective December 18, 2006.

CMS released revisions to Appendix P and PP in Transmittal 22 dated December 15, 2006, with changes to tags and revisions to all interpretive guidelines for some tags. (Use link above for the 611 page document).

CMS Survey & Certification General Info page

Transmittal 22 / R22SOMA

Quality Measures for Immunizations
The immunization Quality Measures (QM) are now reported on CMS' Nursing Home Compare Website. There are two separate QMs, one for influenza and one for pneumococcal vaccination and are calculated from October 1 thru March 31. The two are shown separately by patient population: Chronic Care and Post-Acute (short stay). The QMs are calculated as a percentage of residents receiving vaccination using MDS Section W data.

Residents who have received the vaccine in or outside the facility (W2a=1 or W2b=2) are included. Residents are excluded from the denominator if they are not in the facility, not eligible, declined, or the facility was unable to obtain the vaccine.

Residents are included in the pneumococcal QM percentage when they have an up-to-date vaccination (W3a =1), residents are excluded if not eligible or declined the vaccination. Complete information on the new QMs is posted in a User's Manual Supplement (link above).

User's Manual Supplement

Nursing Home Compare Website

Paid Feeding Assistant Regulations
The State Operations Manual, 483.35(h), states that a facility may use a paid feeding assistant if the feeding assistant has completed a state-approved training course, and the use of feeding assistants is consistent with state law.

Feeding assistants must work under the supervision of an RN or LPN. In an emergency they must call a supervisory nurse for help.

Residents selected for this assistance must not have complicated feeding problems such as difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings. Selection must also be based on the charge nurse's assessment and the resident's latest care plan.

Transmittal 19 - CMS Manual System

Immunizations: Regulatory language
As stated in 483.25(n), LTC facilities must develop policies and procedures that ensure that each resident is educated about the benefits and side effects, offer influenza immunization annually (between October 1 and March 31), as well as lifetime immunization against pneumococcal disease, unless medically contraindicated or refused. An exception is that a second pneumococcal immunization may be given after 5 years.

The rule also requires that facilities document:

That the resident or representative was provided education
Whether the resident received the immunizations or did not, due to medical contraindications or refusal

Transmittal 19 - CMS Manual System

Posting Nurse Staffing F tag
The update to Appendix PP of the State Operations Manual regarding LTC facilities contains information on the F356 tag regarding posting nursing staffing information. It also includes regulatory language on Paid Feeding Assistance and Immunizations (Influenza and Pneumococcal). (See the next items)

A format wasn't specified for posting staffing information, only that it be clear/readable and posted in a prominent place. The posting must be daily at the beginning of each shift and include:

facility name
current date
total number and actual hours worked by these staff directly responsible for resident care per shift: RNs, LPN or Licensed vocational nurses, and Certified nurse aides
resident census

The data must be maintained for a minimum of 18 months, or as required by State law, whichever is greater. For the full language use the link above.

Transmittal 19 - CMS Manual System