Provider Notice issued 09/12/14

Minimum Data Set, 3.0 Federal CMS Section Q Requirements and HFS Web Referral Form

Federal CMS Requirements: MDS 3.0, Section Q

Federal law (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 upon admission and on a 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 community. All residents are required to be asked upon admission and annually thereafter if they would like to talk with someone about the possibility of returning to the community. Individuals may opt-out of being asked if they want to speak with someone regarding discharge and return to community during MDS quarterly assessments, however residents must still be asked during the annual review.

Process for Submitting Section Q Referrals

The Department of Healthcare and Family Services (HFS) implemented a web referral form as part of the Money Follows the Person (MFP) Program in the spring of 2012. The form streamlines the MFP referral process on the MFP website. To facilitate compliance with Section Q reporting requirements, facilities may complete the web referral form for those individuals that have answered yes to Section Q, Q0500B. Please note that the MDS requires that within a reasonable timeframe of a “Yes” response, NF staff submit referrals. The expectation in Illinois for a referral to be made is within 10 business days. Facilities may print the completed referral page prior to transmitting and retain for documentation purposes. This notice reiterates information contained in an earlier Provider Notice dated May 31, 2013 (pdf), defining requirements for the implementation of MDS 3.0 Section Q. Referrals can also be made by contacting the Senior Helpline at 1-800-252-8966, 1-888-206-1327 (TTY).

Upon receipt of a referral, HFS routes the referral to a Local Contact Agency (LCA) for follow-up. There is a 10 day requirement of follow-up after receipt of a referral by an LCA. To comply with federal reporting requirements, HFS tracks Section Q referrals received from NF staff through the web referral form and compares the Section Q responses to referrals received. HFS is also tracking follow-up on referrals by LCAs. Since April 2012 through July 2014, 4,066 referrals have been generated by nursing facilities through the online referral system HFS data shows that only one third of the State’s nursing facilities that serve the Medicare/Medicaid population have utilized the online referral system.

If you have questions regarding this informational notice, please contact: HFS.MFP@illinois.gov or 217-557-1868.