[Federal Register Volume 68, Number 95 (Friday, May 16, 2003)]
[Notices]
[Pages 26621-26622]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-12229]



[[Page 26621]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4060-N]


Medicare Program; Town Hall Meeting on the Refinement of the 
Minimum Data Set (MDS), Version 3.0

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of meeting.

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SUMMARY: This notice announces a town hall meeting to allow the public 
to discuss and give general comments about the revisions to the Minimum 
Data Set, version 3.0. Specifically, the meeting will attempt to elicit 
the individual comments and experiences of nursing home providers, 
consumers, resident advocates, and provider groups related to proposed 
revisions to the Minimum Data Set; to solicit recommendations on how to 
continue to improve the instrument and to seek ideas to reduce burden. 
Beneficiaries, providers, physicians, nursing home staff and industry 
representatives, MDS specialists, and other interested parties are 
invited to this meeting to present their individual views about the 
instrument and to learn about plans for revision of the instrument, the 
user's manual, care planning protocols and accompanying software. The 
meeting is open to the public.

DATES: Meeting Date: The town hall meeting announced in this notice 
will be held on Monday, June 2, 2003, from 12:30 p.m. to 4 p.m. eastern 
daylight saving time.

ADDRESSES: The town hall meeting will be held in the auditorium at the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, MD 21244. Directions are available at http://www.cms.hhs.gov.

FOR FURTHER INFORMATION CONTACT: Bob Connolly 410-786-6882 or Rita 
Shapiro 410-786-2177. You may also send comments or inquiries about 
this meeting via e-mail to [email protected].

SUPPLEMENTARY INFORMATION:

I. Background

    Amidst growing interest and concern about quality in nursing homes 
during the early 1980s, the Congress and the Department of Health and 
Human Services (DHHS), in 1983, commissioned an important study on 
nursing home quality to be conducted by the Institute of Medicine 
(IoM). The IoM study, ``Improving the Quality of Care in Nursing 
Homes'' (1986), reported widespread quality of care problems and 
recommended the strengthening of Federal regulations for nursing homes. 
Shortly thereafter, the Congress passed the Omnibus Reconciliation Act 
of 1987, which required the Secretary to develop a standardized 
instrument to provide information on resident status that would assist 
facilities in assessing resident needs and strengths and in developing 
appropriate care planning. In 1990, we developed the Resident 
Assessment Instrument (RAI), a standardized assessment instrument 
required for all residents in Medicare and Medicaid certified nursing 
homes. The RAI includes the Minimum Data Set (MDS), a set of resident 
status information collected periodically on every resident living in 
certified nursing homes. In 1995, we released a second-generation 
instrument, known as the MDS version 2.0. Version 2.0 was implemented 
in most homes in 1996. Our longstanding intention to computerize the 
MDS was fulfilled in 1998 when we funded the development of an 
infrastructure for automating the transmission of MDS data. Beginning 
on June 22, 1998, all certified long term care facilities were required 
to begin transmitting encoded MDS 2.0 data to States. States are also 
required to transmit these MDS records to a central repository we 
established.
    The original MDS and its subsequent enhanced versions (for example, 
the quarterly MDS, the Medicare Prospective Payment Assessment Form, 
and the discharge tracking form) have been integral to the development 
and implementation of the Medicare prospective payment system as well 
as approaches to the measurement and improvement of health care 
outcomes (quality of care) in nursing homes. For example, the Nursing 
Home Public Reporting Quality Initiative relies on quality measures 
derived from information submitted by every nursing home using the MDS. 
In addition, State survey and certification of nursing homes has been 
refined through the use of MDS-derived quality indicators which can 
flag resident outcomes that require further investigation by the State 
surveyor which helps focus the onsite review process to better identify 
quality of care problems.
    While the MDS has revolutionized the way we assess and monitor 
nursing home care, the MDS was developed over a decade ago and, 
therefore, requires some revisions to incorporate advances in care. In 
addition, the MDS tool was originally designed for a long-stay, 
custodial care population and some items are also relevant to short 
stay residents. Since its development, the nursing home industry has 
experienced an increase in the number of short-stay, rehabilitation-
intensive admissions as well as a number of homes that specialize in 
distinct populations such as pediatrics residents whose unique care 
needs are not perfectly captured by the MDS 2.0. Finally, we have 
expanded our relationship with external groups with the goal of 
creating an instrument that can be used to complement current nursing 
home paper work rather than duplicating efforts already undertaken by 
nursing home staff in their effort to properly assess and manage their 
population.
    We have contracted to complete validation testing of the MDS 3.0 
items by December 2004. Feedback from the Town Hall meeting will be 
used to advise the validation process and provide us with important 
information regarding clinical improvements and provider burden. To be 
considered to make formal comments, commenters must follow the 
registration procedures described in the DATES, ADDRESSES, and 
Registration Instructions sections of this notice.

II. Meeting Format

    The meeting will begin with an overview of the goals of the 
meeting, a review of the feedback received to date and how this 
feedback has been translated into changes to the draft MDS version 3.0. 
The timeline for revisions to the MDS 3.0 and plans for implementation 
will be discussed as well as the plans for evaluating the new 
instrument prior to its release. The implications of the revised 
instrument on various CMS operations, including survey and 
certification of nursing homes, public reporting of quality measures, 
the resource utilization groups and prospective payment system, 
software and data transmission, and care planning using the Resident 
Assessment Protocols (RAPs) will be discussed. The validation 
contractor will be introduced and a formal moderator will facilitate 
the meeting. We request written comments prior to the meeting and will 
entertain public comments from consumers, providers, provider and 
professional organizations from the Baltimore audience and Regional 
Office teleconferencing participants. Comments are requested about MDS 
3.0, its content, and ways to further reduce the burden of MDS data 
collection. Comments can address the implications of the revised 
instrument such as impacts on payment, survey processes, quality 
indicators, publicly reported quality measures, resident

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assessment protocols, RAVEN and information technologies, item-by-item 
comments on new MDS 3.0 items or deletions of current MDS 2.0 items. 
Information from this Town Hall Meeting will be used to advise the work 
of the validation contractor.
    On April 3, 2003, a draft version of the MDS 3.0 instrument was 
posted to the following Web site: http://www.cms.hhs.gov/providers/nursinghomes/nhi. Beginning on or about May 19, 2003 information about 
the MDS 3.0 town hall meeting will be posted at the same Web site 
address and interested parties will find an agenda for the meeting and 
handouts to be used during the discussions.
    We will limit the time for participants to make formal statements 
according to the number of registered participants and the number of 
written comments. Individuals who wish to make formal statements must 
contact Bob Connolly or Rita Shapiro as soon as possible. Those 
individuals must subsequently submit their formal statement in writing 
no later than 5 p.m., Friday, May 23, 2003. Send written submissions 
to: Rita Shapiro, Division of Ambulatory and Post Acute Care (DAPAC), 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail 
Stop S3-02-01, Baltimore, Maryland 21244 or [email protected]. 
Open microphone town hall segments will provide opportunities for 
comments from individuals not registered to speak on the day of the 
meeting.

III. Registration Instructions

    The Division of Acute and Post Acute Care is coordinating meeting 
registration. While there is no registration fee, all individuals must 
register to attend. Because this meeting will be located on Federal 
property, for security reasons, any persons wishing to attend this 
meeting must call Bob Connolly or Rita Shapiro or e-mail 
[email protected] to register by close of business on May 27, 
2003. Attendees must show photographic identification to the Federal 
Protective Service or Guard Service personnel before they will be 
permitted to enter the building. Individuals who have not registered in 
advance will not be allowed to enter the building to attend the 
meeting. Seating capacity is limited to the first 250 registrants. Our 
Atlanta, Boston, Chicago, Dallas, Denver, Kansas City, New York, 
Philadelphia, San Francisco, and Seattle, regional offices will host a 
Satellite Broadcast of the meeting for participants wanting to 
participate at these locations. These teleconference lines will be 
allotted on a first come, first serve basis.
    Individuals requiring sign language interpretation for the hearing 
impaired or other special accommodations should contact Bob Connolly or 
Rita Shapiro at least 10 days before the meeting.

    Authority: Sections 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh)

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: May 12, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 03-12229 Filed 5-15-03; 8:45 am]
BILLING CODE 4120-01-P