R414-516-6. Direct Resident Services

  A program may earn QI points by providing Direct Resident Services as follows:

  (1) Providing a denture replacement policy. A program may earn one QI point by providing a denture replacement policy where the program will replace lost or damaged dentures for residents within 90 days of the loss or damage.

  (2) Providing optional dining services. A program may earn up to three QI points for dining service options provided in the categories below:

  (a) A program may earn one QI point for providing a menu option of at least five meal choices outside of the planned meal;

  (b) A program may earn one QI point for providing a cook-to-order menu;

  (c) A program may earn three QI points for providing a five-meal program for the entire calendar year; or

  (d) A program may earn one QI point for providing a four-meal program for the entire calendar year.

  (3) Providing a Preferred Snack Program with 80 percent compliance. A program may earn two QI points by providing distinct resident preferences for snacks.

  (a) A program shall provide a snack survey including food and beverage options, snack time options, the date of the survey, and the name of the person completing the survey.

  (b) The program shall complete the survey within two weeks of admission or by March 31, 2018, whichever is later.

  (c) A program shall provide the snack and beverage at each resident's preferred time.

  (d) If a resident requires assistance for feeding, the facility shall provide a dining assistant during the snack.

  (e) A program shall complete a snack survey for each distinct resident quarterly or as requested by the resident.

  (f) The program shall calculate compliance by dividing the number of distinct residents who complete a preferred snack survey (numerator) by the number of distinct residents during the quarter, who desired to complete a snack survey (denominator).

  (4) Providing a Preferred Bedtime Program with 80 percent compliance. A program may earn two QI points by providing resident preferences for bedtime.

  (a) The program shall provide a bedtime survey, in which the resident was asked about preferred bedtime options and preferred rituals. The program must include the date of the survey and the name of the person who completed it.

  (b) The program shall complete the survey within two weeks of admission or by March 31, 2018, whichever is later.

  (c) The program shall provide each resident their preferred bedtime options and rituals.

  (d) The program shall complete a bedtime survey annually or as requested by the resident.

  (e) The program shall calculate compliance by dividing the number of distinct residents who complete a bedtime survey (numerator) by the number of distinct residents during the calendar year, subtracted by the distinct residents who declined to complete a bedtime survey (difference is denominator).

  (5) Providing consistent CNA or nursing staff assignments to residents with 80 percent compliance. A program may earn up to five QI points by providing consistent CNA or nursing staff assignments to residents. The points may be earned by providing the same CNA or nurse for a distinct resident for 32 waking hours during a standard Sunday through Saturday week.

  (a) A program may earn one QI point for having a staffing schedule providing consistent CNA's and nurses for the entire program.

  (b) The program may earn one QI point for providing consistent CNA assignment to a distinct hall containing at least 10 residents.

  (c) The program may earn two QI points for providing consistent CNA assignment to an entire program.

  (d) The program may earn one point for providing consistent nurse assignment to a hall containing at least 10 residents.

  (e) A program may earn two QI points for providing consistent nurse assignment to an entire program.

  (f) The program shall provide the consistent assignment for 40 of 52 weeks during the calendar year.

  (g) The program shall calculate compliance by dividing the number of distinct residents who have consistent assignment in the hall or program (numerator) by the number of distinct residents during the calendar year in the hall or program (denominator).

  (6) Providing a Range of Motion (ROM) program to residents with 80 percent compliance. A program may earn four QI points by providing a ROM program to residents semi-annually by a qualified clinician; or, may earn two QI points by providing a ROM program to residents semi-annually by a restorative nurse aid under the direct supervision of a qualified clinician.

  (a) The program shall include a ROM assessment, completed by a qualified clinician, for passive range of motion (PROM) or active range of motion (AROM) for shoulder, elbow, wrist, digits of the hand, hip, knee, and ankle joints. The program shall also include a ROM assessment of which joint has limitations, the reduced anatomical motion to the joint, how the restriction limits function, the title and name of the person completing the plan of care (POC), and the date of the POC.

  (b) If a reduction in ROM is found and the clinician recommends a ROM POC, the POC shall include:

  (i) a goal to return the resident to the highest practicable level of function;

  (ii) the frequency and duration of the POC;

  (iii) the title and name of the person completing the POC; and

  (iv) the date of the POC.

  (c) If the program develops a POC for a resident, a qualified clinician or another qualified professional shall complete the POC under the supervision of a qualified clinician.

  (d) If a resident qualifies for a ROM POC, but desires not to participate, the qualified clinician shall document the refusal and provide a ROM assessment semi-annually.

  (e) The program shall calculate compliance by dividing the number of distinct residents who received a ROM assessment semi-annually plus the number of residents refusing to complete a ROM assessment semi-annually (sum is numerator) by the number of distinct residents during the calendar year (denominator).

  (7) Providing a One-on-One Activity program with 80% compliance. A program may earn up to four QI points by providing a one-on-one activity program. A one-on-one activity program shall provide a 30-minute minimum individual activity onsite or within the community each month for each resident; and

  (a) A program may earn one QI point by providing a schedule for one-on-one activity participation for residents desiring to participate;

  (b) A program may earn three QI points if compliant with providing one-on-one activities;

  (c) A qualified activity professional shall complete an activity interest (AI) survey for each resident including recreational, educational, physical, arts and crafts, and any additional activity options preferred by the resident. The AI survey shall include the name and title of the surveyor and the date the survey was completed;

  (d) For each resident who desires to participate in a one-on-one activity program:

  (e) A qualified activity professional shall develop a POC including the preferred list of activities and a method of grading the importance of the activities to the resident. The activity POC shall include:

  (i) the activities to be completed during the one-on-one activity;

  (ii) the goal of the activity;

  (iii) what the activity is promoting

  (iv) the date the POC was completed; and

  (v) the title and name of the person completing the POC.

  (f) The person who completes the activity with the resident shall document:

  (i) the preferred activity completed;

  (ii) the duration of the activity;

  (iii) the goal of the activity;

  (iv) which quality of life measures were promoted; and

  (v) any relevant comments made by the resident.

  (g) The qualified activity professional shall modify the POC as appropriate or when requested by the resident.

  (h) If a resident who desires to participate in the one-on-one activity program cannot participate in a given month, the nursing facility program shall document the refusal.

  (i) If a resident refuses to participate in the one-on-one activity program, the qualified activity professional shall document the refusal and continue to complete an AI survey with the resident and offer the one-on-one activity program annually.

  (j) If a resident who initially refuses to participate in a one-on-one activity program and desires to participate before the annual AI survey, the qualified activity professional shall complete the steps noted for residents desiring to participate in a one-on-one activity program.

  (k) The program shall calculate compliance by adding the number of distinct residents who participated in but declined a monthly one-on-one activity, the number of distinct residents who completed the program, and the number of distinct residents who declined to complete the program (distinct sum is numerator) divided by the number of distinct residents during the calendar year (denominator).

  (8) Providing a Mobility Program to qualifying residents with 80 percent compliance. A program may earn four QI points by providing a mobility program to qualifying residents. The nursing facility program shall offer residents who qualify for a walking program a walking activity five of seven days in a standard week for 40 out of 52 weeks during the calendar year.

  (a) A nurse or qualified physician shall complete Section GG0170 Mobility of the MDS Version 3.0 for each Medicaid resident.

  (b) A resident who achieves a score of 04, 05, or 06 on Sections D and J qualifies to participate in a walking program.

  (c) The nurse or qualified physician who completes the mobility section shall establish a POC for the walking program to determine:

  (i) the distance of the walk;

  (ii) duration of the walk; and

  (iii) the amount of assistance required by the resident, including mobility devices to be provided by the staff.

  (d) The nursing facility program shall provide weekly documentation to illustrate program completion, including modifications to a residents walking program.

  (e) If a resident qualifies for but refuses to participate in a walking program, the nurse shall document the refusal and complete the mobility, sit-stand, and one-step command surveys annually.

  (f) If a resident initially declines to participate in a walking program and then requests to engage in a walking program before the annual follow-up surveys, the program shall complete the survey and develop a walking POC for the resident.

  (g) The nursing facility program shall calculate compliance by adding the number of distinct residents who completed the walking program with the distinct residents who qualified for but requested limited participation in the program, and residents who qualified for but declined participation in the walking program (distinct sum is numerator) by the number of distinct residents who qualified for a walking program during the calendar year (denominator).