Provider Notice issued 05/31/13

MDS 3.0, Section Q Requirements/HFS Online Referral System

This notice is to provide guidance on implementation of MDS 3.0, Section Q as well as on the development and implementation of the Healthcare and Family Services (department) online referral system designed to receive and transmit referrals received under MDS 3.0, Section Q to the appropriate Local Contact Agency (LCA).

Revisions - MDS 3.0, SECTION Q

42 CFR 483.20 requires nursing facilities (NFs) participating in the Medicare and/or Medicaid programs to complete the Minimum Data Set (MDS) 3.0 assessment on all residents at admission and on a regularly prescribed schedule thereafter. Section Q of the MDS 3.0 is used to record the participation and expectations of the resident, family members or significant others in the assessment and to determine the resident's goals regarding discharge and return to the community. In implementing Section Q provisions, NF staff is required to engage the resident utilizing a participatory interview process.

Section Q changes implemented effective April 2012

• The "Feasibility of Discharge" item (Q0400B, "Was determination made by the resident and the care planning team that discharge to the community is feasible?") was eliminated. By eliminating this question, all residents are expected to be asked annually if they would like to talk with someone about the possibility of leaving the facility and returning to live and receive services in the community. This change provides for a more person-centered approach.

• Individuals may opt-out of being asked if they want to speak to someone about returning to the community during quarterly assessments, however; residents must still be asked during the annual review. Item Q0400B was replaced with Q0550A which asks, "Does the resident (or family member if resident unable to respond) want to be asked again every quarter about returning to the community?" Item Q0550A is more effective than the feasibility-of-discharge question in targeting who should be asked the "return to community" question.

PROCESS FOR SECTION Q REFERRALS

Based on feedback to the Illinois Money Follows the Person (MFP) Program, the department initiated a system to streamline the referral process and developed an online referral process to improve the tracking of referrals and to ensure that follow-up occurs timely on referrals. The online referral system can be accessed at the MFP/Pathways to Community Living section of the HFS website.

Facilities must utilize the new online referral system for all referrals. Using this approach, residents who are referred will be assigned to their LCA by department staff. The Resident Assessment Instrument (RAI) Manual requires that NF staff submit referrals within approximately 10 business days of a "Yes" response being given in Q055B. Facilities should print the completed referral page prior to transmitting and retain for documentation purposes.

Once the department receives an online referral, it will be e-mailed to the LCA with the expectation that the designated agency make contact with the NF resident within ten business days of receipt of the referral. Based upon the resident's response to Section Q, permission is granted to the LCA to see the resident. The online referral system provides both ombudsman and NF staff with a mechanism to inquire about the status of the referral if follow-up has not occurred in a timely fashion.

Referrals received online from NFs in Cook County will be routed directly to Aetna Better Health and IlliniCare Health Plan for follow-up. The department has contracted with Aetna and IlliniCare to provide care coordination services for individuals residing in Cook County NFs under the Colbert Consent Decree Implementation Plan (Colbert v. Quinn (07 C 4737) Implementation Plan Provider Notice dated February 19, 2013). These Health Plans will be responsible for the evaluation of residents to determine appropriateness for community transition as well as for development of a service plan of care.

The department appreciates your assistance in making referrals on behalf of the residents you serve. We have determined that our most effective referral sources include NF staff.

If you have questions regarding this informational notice, please contact the Bureau of Long Term Care at 217-524-7245.

Theresa A. Eagleson, Administrator

Division of Medical Programs