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ear Mabel: Where can I go to submit questions about the Minimum Data Set (MDS) to the Centers for Medicare and Medicaid Services (CMS)? There used to be a site for frequently-asked questions (FAQs), but now I cannot find it." (registered nurse, Texas)
       Answer: CMS has deleted the FAQ site. They have a whole new system that is explained in the new Resident Assessment Instrument (RAI) manual, which was released December 31, 2002, on pages 1 through 7. The new process goes something like this. If you have a question about the MDS, you are to contact your state RAI coordinator for an answer. In most cases, the state RAI coordinator should have the answer. If the RAI coordinator does not have the answer, the coordinator will contact CMS. CMS will then decide if clarification is needed. If so, the answer will be posted on the official CMS website. The act of posting clarification will set policy. The website is http://www.cms.hhs.gov/medicaid/mds20. This site should be closely monitored for these clarifications. The manual goes on to explain that there are plans for a new process to update the RAI manual with these new clarifications. That new process will probably be posted at this site when it is solidified.
       There is another site, http://cms.hhs.gov/medicaid/mds20/default.asp, where you will find directions at the bottom of the web page directing you to e-mail questions to ppsmds@cms.hhs.gov. We think these questions are mainly for Medicare Prospective Payment System (PPS) assessments.
       Actually, there are several other sites you may find helpful. Here are a few.
* http://www.cms.hhs.gov/providers/nursinghomes/nhi/NH20021029.pdf: This download, in Adobe Portable Document Format (PDF), provides language to assist consumers in interpreting the quality measures. This information can be made into a booklet to give to potential residents and their families.
* http://www.cms.hhs.gov/providers/nursinghomes/nhi/NatlUserMan_v1_1.pdf: You can download the user manual of quality measures that was written for providers, versus consumers. Of course, we think every facility should have a copy of this. It just makes good sense and it is free, except for the cost of ink and paper.
* http://www.cms.hhs.gov/medicaid/mds20/man-form.asp: The new RAI manual can be downloaded from this site. Again, this is free to download, save the cost of ink and paper.
* http://www.cms.hhs.gov/reports/hcimu/hcimu_04292002.pdf: This is a government report. It is sort of dry and uninteresting but could yield some juicy fragments if you have the stamina to wade through it all.
* http://www.cms.hhs.gov/providers/snfpps/snfpps_swingbed.asp: This site has information about completing the MDS for swingbeds in the acute care setting.
* http://www.cms.hhs.gov/medlearn/SNFFRManual.pdf: A manual explaining regulations for Medicare Part A SNF PPS can be found here.
* http://www.cms.hhs.gov/medicaid/ltcsp/default.asp: This is a storage and distribution website for long-term care survey protocols. Not all areas are open to the public, but this is a good place to access names and e-mail addresses for contacts.
* http://www.cms.gov/manuals/memos/comm_date_dsc.asp: Found here is a listing of agency transmittals for comments, reminders, and requests for action or information--"CMS 2003 Program memos."
* http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php: With a web address like this you would expect big things, and this site delivers. It directs questions to the appropriate agency or policy, which includes Medicare, Medicaid, Clinical Laboratory Improvement Amendments (CLIA), the Health Insurance Portability and Accountability Act of 1996 (HIPPA), the State Children's Health Insurance Program (SCHIP), PPS, etc. Several of the sites contain phone numbers, names, and, of course, e-mail addresses. Also included here is a site to apply for a job with CMS.
* http://www.chsra.wisc.edu/CHSRA_Home.htm: This website gives you access to the individuals who actually analyzed the MDS data and generated the quality indicators. The Center for Health Systems Research and Analysis (CHSRA) performs a lot of data analysis, research, and policy development. Marking this with a bookmark would be great idea.
* http://www.alliedtech.com/: The website proclaims this company is a "leader" in information technology. These are the people who determine whether a quality measure is a valid statistic (i.e., can the data support the claim?). A good place to know about, but there is not a lot of information here.
* http://www.amda.com: This is the American Medical Directors Association site. It contains good clinical information with access to several educational presentations. The "news" area contains updates on long-term care issues including new federal policies. While several areas are free, some of the areas require joining the association.
* http://pioneernetwork.net/: This is a grass roots group of progressive thinkers trying to change the culture of aging--an inspiring, mind-opening, creative site offering hope for the future of long-term care.
* http://cms.internetstreaming.com/: Free educational courses are offered online here from CMS. What more could you ask for?
* http://aanac.com: This is the American Association of Nurse Assessment Coordinators site. The home page offers several areas of interest. However, to get most of the information, it is necessary to join. There is a free listserv that is quite useful.
       "Dear Mabel: Any advice on the new manual? It seems so much bigger. Do I need to read it all?" (nurse, Arizona)
       Answer: First, just let us say, hip, hip, hooray! The new manual is out, and it is grand. It has been about seven years in the making. Second, our advice is to read it, read it, read it all. We have copies we take with us to read whenever and wherever we can. We know it seems like Mt. McKinley, but we have been astonished at how quickly it goes. Most of the changes are in chapter three. The changes through the entire manual are explained and clarified well. New case studies are offered to reduce some of the confusion in critical areas. The "Index of the RAI Version 2.0 Manual" makes it easier for beginners to look up definitions for individual MDS entries. CMS has added several new appendices that are excellent sources of information. CMS has outdone themselves with this new manual. The information is clear, concise, plentiful, and easy to access. It is an immense improvement over the previous manual. In the future, we will be addressing some of the changes. Until then, have fun reading and rereading. If you have a question for Mabel, you can e-mail us at MabelMDS@aol.com.
The publisher, HMP Communications, and the authors disclaim responsibility for any injury to persons or property resulting from any ideas or products referred to in this article.