Manual - Maryland State Archivesmsa.maryland.gov/megafile/msa/speccol/sc5300/sc...In the MSACS...

MARYLAND SUBACUTE CARE SURVEYC O M A R 1 0 . 2 4 . 0 5P A T I E N T L E V E L D A T A R E P O R T I N G R E Q U I R E M E N T S

USER MANUALFor version 5.0

Division of Data Systems and Analysis4160 Patterson Avenue

Baltimore, Maryland 21215Telephone No. - 410-764-3460 or

1 (877) 245-1762Fax: 410-358-1236

!

Donald E. Wilson, M.D.Chairman

Barbara G. McLeanExecutive Director

Document Issue Date: September 18, 2002

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Table of Contents

I. INTRODUCTIONA. Welcome and Important Telephone Numbers......................................................................... 1B. Purpose of the Subacute Care Survey ........................................................................................ 2C. History of the Subacute Care Survey.......................................................................................... 3D. Facilities Required to Report in the Subacute Care Survey..................................................... 3E. How Long to Retain the Data ..................................................................................................... 5F. How to Use the Manual ............................................................................................................... 6

II. GENERAL INSTRUCTIONS FOR COMPLETING THE SUBACUTE CARESURVEYA. Instructions for Submitting Data in an Automated Format ................................................... 9B. Survey Submission Date............................................................................................................. 11C. Patients To Be Surveyed............................................................................................................. 11D. Penalties for Non-Reporting ..................................................................................................... 11E. Requesting an Extension to the Survey Submission Date .................................................... 11

III. INSTALLATION AND SETUPA. Minimum Configuration............................................................................................................. 13B. “Pre-Installation” Instructions .................................................................................................. 13C. “Pre-Network Installation” Instructions ................................................................................. 14D. Installation Instructions for Single Facility.............................................................................. 14E. Software Configuration Instructions ........................................................................................ 15F. Keys to the System Setup Screen .............................................................................................. 17G. Keys to the Utilities Menu.......................................................................................................... 17H. Icon for the Maryland Subacute Care Survey Software (optional)....................................... 20

IV. GETTING STARTEDA. Keys to Know.............................................................................................................................. 21B. Types of Screens.......................................................................................................................... 22C. Screen Layout............................................................................................................................... 22

V. USING YOUR SOFTWAREA. Opening the program ................................................................................................................. 25B. Data Entry .................................................................................................................................... 26

Table of ContentsVI. PATIENT INFORMATION – KEYS TO DATA COLLECTION

A. Subacute Care Survey Patient Level Data Set ......................................................................... 29B. Data Set Elements ....................................................................................................................... 29

1. Identification Information .................................................................................................. 30A. Facility Identification Number................................................................................. 30B. Patient Identification Number ................................................................................. 30C. Bed License Type....................................................................................................... 31

2. Length of Stay....................................................................................................................... 31A. Admission Date ........................................................................................................ 31B. Discharge Date ......................................................................................................... 32

3. Demographic Information.................................................................................................. 32A. Gender ....................................................................................................................... 32B. Race ............................................................................................................................ 33C. Date of Birth ............................................................................................................. 33D. Estimated Age in Years ........................................................................................... 34E. Ethnicity .................................................................................................................... 34F. ZIP Code of Residence ........................................................................................... 35G. Area of Residence..................................................................................................... 35H. Marital Status ............................................................................................................ 36I. Living Situation Prior to Current Referral............................................................ 37

4. Admission Information....................................................................................................... 38A. Source of Admission................................................................................................ 38

5. Discharge Information ........................................................................................................ 41A. Patient Outcome ...................................................................................................... 41B. Early or Unplanned Discharge............................................................................... 41C. Reason for Early or Unplanned Discharge .......................................................... 42D. Discharge Destination ............................................................................................. 42

6. Cognitive Patterns ................................................................................................................ 45A. Comatose................................................................................................................... 45B. Memory/Orientation............................................................................................... 46C. Cognitive Skills for Daily Decision Making ......................................................... 47

7. Activities of Daily Living .................................................................................................... 488. Behavioral Symptoms.......................................................................................................... 529. Skin Condition on Admission ............................................................................................ 5310. Principal and Other Diagnoses .......................................................................................... 55

A. Principal and Other ICD-9 Diagnoses on Admission for Care ........................ 5511. Additional ICD-9 Diagnoses Identified During Stay ..................................................... 5712. Therapies Provided .............................................................................................................. 57

Table of Contents13. Special Treatments and Procedures................................................................................... 58

A. Medication Administration ..................................................................................... 58B. Administration of Nutrients/Fluids ...................................................................... 59C. Monitoring................................................................................................................. 59D. Care of Tubes/Catheters (Frequency of Treatment).......................................... 60E. Other Treatments (Frequency and Total Number of Days) ............................. 61

14. Financial Information.......................................................................................................... 63A. Primary and Secondary Payment Source .............................................................. 63

VII. REPORTSA. Report Types................................................................................................................................ 67B. Viewing and Printing Reports ................................................................................................... 69

VIII. PREPARE AND TRANSMIT THE SUBACUTE CARE SURVEY VIA THEBULLETIN BOARD SERVICE (WORLDGROUP MANAGER)A. Run the Error Report and Zip the File for Transmission..................................................... 71B. The WorldGroup Manager ....................................................................................................... 75

1. To Install the WorldGroup Manager ................................................................................ 752. To Logon to the WorldGroup Manager the First Time ................................................ 793. When You Logon to the WorldGroup Manager for the Second Time ....................... 814. To Register for the Maryland Subacute Care Survey ...................................................... 835. Transmission of the Automated Survey Data.................................................................. 846. Special Notes ........................................................................................................................... 87

IX. UTILITIESA. Backup Files ................................................................................................................................. 90B. Password Maintenance ............................................................................................................... 90C. Printer Setup................................................................................................................................. 92D. Reindex Files ................................................................................................................................ 93E. System Setup ............................................................................................................................... 93F. Purge Data Files........................................................................................................................... 94G. Delete Individual Patient............................................................................................................ 95H. Change Patient ID Number....................................................................................................... 95I. Print Audit Log............................................................................................................................ 95

X. TROUBLE-SHOOTINGA. Possible Error Messages............................................................................................................. 96

Table of ContentsXI. APPENDICES

A. Subacute Care Survey Hard Copy of Data Collection FormB. Subacute Care Survey Questions and Answers (including Data Set Completion

Timetable)C. Samples of Some of the ReportsD. Summary of Interdependent Data Items & Consistency ChecksE. Recommended Backup Procedures

M A R Y L A N D H E A L T H C A R E C O M M I S S I O N

User Manual – Subacute Care Survey- 1 -

I. INTRODUCTION

A. WELCOME AND IMPORTANT TELEPHONE NUMBERS

Welcome to the Maryland Subacute Care Survey (MSACS) software. The software was specificallydesigned to meet all the requirements established by the Maryland Health Care Commission(MHCC) for completing the Maryland Subacute Care Survey. This User's Manual was designed tohelp the user with installation of the software through transmission of required files. It includeshelp with setup configurations, getting acquainted with the layout of the software, reportexplanations, utilities, problems you may encounter, and back-up procedures. We hope thissoftware makes submitting your file as easy as possible.

There are two (2) software packages you will use. The first package, the Maryland Subacute CareSurvey software, collects the data and prepares the file for transmission to MHCC by zipping thefile. The second package, called WorldGroup Manager, transmits the zipped file to the MHCC viatelephone lines to the WorldGroup Manager (Health Data Connect) Bulletin Board Service.

In the MSACS software, all data entry fields contain "pop-up" screens to assist the user whennecessary. To see the “pop-up” screen, click inside the field and press the function key [F10]. On-Line Help [Fl] is available throughout the system as well. There also is field-by-field help located atthe bottom of the screen. The user may use the Enter key to access menu items and to move fromfield to field. The system also has built-in error and consistency checks to assist the user in enteringaccurate data.

Have questions? Look for these icons throughout this manual.

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Policies, Clinical Help, WorldGroup Manager Support:Questions regarding data reporting policies, rules and regulations, clinical issues and theWorldGroup Manager software should be directed to:

Maryland Health Care CommissionDonna Bullen4160 Patterson AvenueBaltimore, MD 21215

Telephone No.: (410) 764-3460 or 1 (877) 245-1762Facsimile: (410) 358-1236Email: [email protected]

Installation & Software Support:Problems with installation, errors or technical questions with the actual Maryland Subacute CareSurvey software should be directed to:

Metro Data, Inc.10534 York Road, Suite 202Hunt Valley, Maryland 21030

Telephone: (410) 667-3600Facsimile: (410) 667-3655Email: [email protected]

B. PURPOSE OF THE SUBACUTE CARE SURVEY

In March 1995, the Commission’s predecessor, the Maryland Health Resources PlanningCommission (MHRPC) adopted as emergency and proposed permanent regulations a new chapter,COMAR 10.24.05 Development of Subacute Care Units. Those regulations became finaleffective July 31, 1995. One of the purposes of these regulations is to conduct a Subacute CareSurvey (Regulation .07). This survey is designed to collect information from both existing and newsubacute care units to:

• be able to identify distinguishing program and patient characteristics;• compare program similarities;• analyze the system impact of subacute care on cost, quality, and access; and• improve the Commission's decision-making with respect to this type of care.



C. HISTORY OF THE SUBACUTE CARE SURVEY

To assist staff in designing the Subacute Care Survey, the MHRPC established a nine-memberTechnical Advisory Committee on Subacute Care Data Reporting in April 1995. The TechnicalAdvisory Committee, which included individuals with a wide range of expertise in the delivery,organization, and financing of subacute care, was appointed with the assistance of the MarylandHospital Association, the Health Facilities Association of Maryland, the Maryland Association ofNon-Profit Homes for the Aging, the Maryland Medical Directors Association, the Health ServicesCost Review Commission, the Maryland Medical Assistance Program, the Johns Hopkins UniversitySchool of Public Health, and the Office of Licensing and Certification (now the Office of HealthCare Quality) Programs. The Technical Advisory Committee held a series of six meetings to definethe scope and content of the patient-specific data set that will be collected for patients dischargedfrom subacute care in participating facilities

Survey participants are required to provide patient-specific data on all discharged patients as well asprogram-specific information. The patient-specific data, which is to be reported in a machine-readable format according to specifications provided by the Commission, will include: a patientidentifier which shall be the last six digits of each patient's social security number; diagnostic data byICD-9 code, frequency and intensity of special treatments provided, patient status, and outcomeinformation, including readmissions; other relevant medical, demographic, and functional status datathat can be used to describe an episode of illness across both acute and long term care facilities.Program-specific information will include: specific information on the programmatic design of thesubacute care unit; and aggregate information on staffing, interdisciplinary team approach, and careplans.

Revisions have been made since 1995 to simplify the data collection, leaving the most critical dataitems that can not be obtained through other sources in the survey. In 1998, approximately 70 dataitems were removed from the survey, including information on levels of cognition, types andnumbers of medications, and measures of functional independence, and one data item was added,the total number of informal caregivers. In 2002, 138 additional data items were removed from thesurvey, including sections on nursing rehabilitation and restorative care, nursing diagnosisinformation, and costs and charges. With the release of version 5.0, the survey now collects the 116data items on each discharged patient which best describe the patient’s functional status at the timeof discharge or death.

Effective October 1, 1999, the Maryland Health Resources Planning Commission (MHRPC) mergedwith the Maryland Health Care Access and Cost Commission (HCACC) to become the MarylandHealth Care Commission (MHCC).

D. FACILITIES REQUIRED TO REPORT IN THE SUBACUTE CARE SURVEY

Under Regulation .07A(1), of COMAR 10.24.05 (Subacute Care Bed Pool and Other CONApproved/Exempt Subacute Care Projects), all new facilities that were approved to providesubacute care services under Regulations .03-.06 will be required to provide data to the Commissionupon initiation of the service. Over the years the actual facilities participating in the survey have



changed. In the initial years, facilities were required to provide data on the full range of settings, asdesignated by Regulation .07A(2), serving the needs of post-acute patients. Those settings includedfacilities licensed for comprehensive care, extended care, and chronic hospital care located in bothacute care and freestanding facilities. In designating the survey participants, the Commissionconsulted with trade associations to identify facilities with subacute care units and the Office ofHealth Care Quality Programs to identify facilities licensed for Special Care Units under COMAR10.07.02.

Effective January 1, 2001, the non-hospital based acute care and freestanding facilities were droppedfrom the Subacute Care Survey. Currently the hospital-based comprehensive care units, chronichospitals and the three (3) facilities licensed to provide extended care participate in the survey. TheCommission has designated the following hospital-based facilities licensed to providecomprehensive care to report data.

For your reference the Facility ID numbers, unique numbers assigned byMHCC to each reporting facility, are listed next to each facility’s name.

(a) Hospital-Based Comprehensive Care Facilities

Facility ID Facility Name

3051999 Bayview Nursing Facility0481501 Calvert Memorial Hospital0881605 Civista (formerly Physician’s Memorial) Hospital1081606 Frederick Memorial Hospital1102117 Garrett Memorial Hospital3051998 Good Samaritan Hospital0358904 Greater Baltimore Medical Center (GBMC)1212001 Harford Memorial Hospital1581701 Holy Cross Hospital3081603 James L. Kernan Rehabilitation Hospital2078710 Memorial Hospital at Easton – Skilled Nursing Facility3081601 Mercy Hospital1581702 Montgomery General Hospital0202037 North Arundel Hospital0381501 Northwest Hospital2289110 Peninsula Regional Medical Center1681802 Southern Maryland Hospital Center3058905 St. Agnes Health Care0358902 St. Joseph’s Hospital1515140 Suburban Hospital Skilled Nursing Facility (The Pavilion)

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(b) Extended Care Facilities


0101202 Sacred Heart Hospital/St. Catherine’s Extended Care Unit(Western Maryland Health Systems)

3051111 Union Memorial Hospital Extended Care Facility21224333 Washington County Hospital Extended Care Facility

(c) Chronic Hospitals


3013963 University of Maryland Specialty Hospital - Deaton2235001 Deer's Head Center1613964 Gladys Spellman Nursing Center3081604 James L. Kernan Rehabilitation Hospital*3037149 Johns Hopkins Geriatric Center3013962 Levindale Hebrew Geriatric Center and Hospital2135002 Western Maryland Center

* Effective Quarter 3, 2002

The facilities designated in (a) and (b) above are required to report data reflecting the utilization ofbeds licensed for comprehensive/extended care. The facilities designated in (c) above are requiredto report data reflecting the utilization of beds licensed for chronic hospital care.

The Commission notifies all new acute-care facilities approved to provide subacute care services(Subacute Care Bed Pool and other CON/Approved Exempt Subacute Care Projects) of thereporting requirements of COMAR 10.24.05. Those facilities begin collecting and reporting the dataitems included in the Subacute Care Survey upon initiation of their subacute care program.

E. HOW LONG TO RETAIN THE DATA

There are situations in which the Commission may need to have the facility verify data which has beentransmitted for a resident from a past submission. The data needs to be retained in a manner for easyretrieval for the facility for five (5) years from the submission date. You may choose to keep either theelectronic data files or the hard copies of the data collection tool. Each facility must also retain a list withthe resident names, with the associated the Patient ID numbers used on the survey, and the facility’sPatient ID number. If you have questions about what should be retained, please contact the SubacuteSurvey Coordinator at (410) 764-3460 or 1 (877) 245-1762.



F. HOW TO USE THE MANUAL

The User Manual for the Maryland Subacute Care Survey: COMAR 10.24.05 Patient-Level DataReporting Requirements is designed to provide detailed instructions to survey participants. Themanual is organized in eleven major sections: 1) Introduction, 2) General Instructions forCompleting the Subacute Care Survey, 3) Installation and Setup, 4) Getting Started, 5) Using YourSoftware, 6) Patient Information Sections, 7) Reports, 8) Prepare and Transmit the Subacute CareSurvey via the Bulletin Board Service (WorldGroup Manager), 9) Utilities, 10) Trouble-shooting, and11) the Appendices. Prior to responding to the survey, this manual should be reviewed in detail.The contents of the ten sections that follow the Introduction are described below:

General Instructions for Completing the Subacute Care Survey (Section II)

This section of the manual provides directions for transmitting the Subacute Care Survey in therequired machine-readable format. Information on the survey submission date as specified inCOMAR 10.24.05, penalties for non-reporting, and procedures for requesting an extension to thesurvey submission date, also are provided in this section of the manual.

Installation and Setup (Section III)

This section of the manual provides directions for installing and setting up the software on yourcomputer. Information on the hardware configurations needed, password maintenance, how to setyour system parameters, and how to set up your computer for a printer are included in this section.

Getting Started (Section IV)

This section of the manual provides information on the keys to know, the screen layout, and screentypes.

Using Your Software (Section V)

This section of the manual provides directions to get into the program, and to enter data.

Patient Information Sections (Section VI)

This section of the manual provides detailed specifications for completing the survey for eachdischarged patient. The section also includes definitions, reporting requirements, and codingspecifications for each data set element included on the Subacute Care Survey.

Reports (Section VII)

This section of the manual contains detailed instructions for generating facility-specific reports fromthe Subacute Care Survey. This does not include reports that compare your facility to all of thefacilities reporting in the Subacute Care Survey.



Prepare and Transmit the Subacute Care Survey via the Bulletin Board Service -WorldGroup Manager (Section VIII)

This section of the manual contains detailed specifications for transmitting the survey to MHCCusing the Health Data Connect Bulletin Board Service (BBS). The Commission’s BBS softwarepackage is WorldGroup Manager.

Utilities (Section IX)

This section of the manual provides directions for processes that are not used in the day-to-dayentry of survey information. They help you to customize, protect, and fix your program when youchoose to do it.

Trouble-shooting (Section X)

This section of the manual provides common error messages the user may encounter while usingthis program. Each error message is accompanied by the action the user must take to resolve theproblem or the user is instructed to call technical support.

Appendices

This section of the manual provides a hard copy of the survey for data entry, questions & answers,sample reports, consistency checks, and recommended backup procedures.



II. GENERAL INSTRUCTIONS FOR COMPLETINGTHE SUBACUTE SURVEY______________________________________

A. INSTRUCTIONS FOR TRANSMITTING DATA IN AN AUTOMATED FORMAT

To assist facilities in reporting data in the required machine-readable format, the Commission hasdeveloped the Maryland Subacute Care Survey Data Collection, Verification, and TransmissionSoftware. This software is available to all participating facilities at no cost. The Commission'sBulletin Board System (BBS) provides a way to transmit the data files generated by the surveysoftware and enables the Commission to communicate information about the survey to all facilities.All participants are provided with a copy of WorldGroup Manager software enabling them totransmit the subacute care data to the Health Data Connect BBS.

1. The survey is due to MHCC by the Close of Business on the 45th day following the end of thequarter:

Quarter Due Date

1 May 15th

2 August 15th

3 November 15th 4 February 15th

If you are unable to meet these deadlines, you may request a 30-day extension. Please follow theinstructions in Section E below to request an extension.

2. The data file that you create will have a unique name every time you create the file. The firstseven positions will always be the same. They are your facility ID. The eighth (8th) position isthe number of times the file for a specific quarter has been created for transmission. The first(1st) position after the dot (.) is the letter “e” which reports that this is an electronic file forSubacute. The second (2nd) position after the dot (.) is the last digit of the calendar year of thedata being submitted. The third (3rd) position after the dot (.) is the quarter of the data being

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submitted. For example, in the case that the datafile is named 88888882.e24 - The first sevendigits are 8888888, the facility ID; the eighth digit, 2, reports that the facility generated the filetwo times for this quarter; e reports that this is the electronic file, 2 is for year of the data(2002), and 4 is for the fourth quarter of 2002. In the case of the file for Record 7 (R7) the lastposition will always be a 7 (88888882.027).

3. Surveys must be transmitted on a quarterly basis. Please transmit data files one file at a time.Do not send us two data files in one transmission. Label the transmission accurately (forinstructions see #5 below). This enables us to process the files correctly.

4. Surveys should be transmitted via WorldGroup Manager to the Health Data Connect BBS. Ifyour facility requires an alternate media type for submission of its data, please contact theCommission for permission and instructions. In the case of technical difficulties, the data maybe transmitted on 3½ diskettes or via e-mail.

5. Label your transmission (or diskette) with the following information:

Facility NameContact Person’s NameDate the data was sentQuarter # and Year of the DataNumber of Diskettes in Submission (i.e., 1 of 2, 2 of 2)File Name(s)Fax Number for a receipt to be sent toImportant - Tell us whether you experienced technical problems during the

data collection and transmission process, or no problems at all. Theevents to advise us of include: a computer crash during the datacollection, you switched to a new computer, the computer did notclose properly, or other technical problems.

6. When diskettes are transmitted by mail, be sure to use diskette mailers to protect them.

For additional information concerning the automated submission ofsurvey data, please contact:

Donna Bullen, Subacute Care Survey CoordinatorDivision of Information Systems

Maryland Health Care Commission4160 Patterson AvenueBaltimore, MD 21215

Telephone Number: (410) 764-3460 orToll-free: 1 (877) 245-1762

Fax: (410) 358-1236Email: [email protected]

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B. SURVEY SUBMISSION DATE

Survey participants shall report the patient-level data set to the Commission within 45 days followingthe last day of the calendar year quarter during which the patient was discharged or died.

C. PATIENTS TO BE SURVEYED

The Subacute Care Survey must be completed for each patient discharged from the program whowas admitted after September 30, 1995, including patients formally discharged from the programand patients who died while under treatment.

D. PENALTIES FOR NON-REPORTING

If a facility fails to provide accurate, timely, and complete data as required under COMAR 10.24.05,the Commission may:

1. Impose a penalty of not more than $100.00 per day for each day the violationcontinues after consideration of the willfulness and seriousness of the withholding aswell as any past history of withholding of information;

2. Issue an administrative order that requires the facility to provide the information; or

3. Apply to the circuit court in the county in which the facility is located for legal reliefconsidered appropriate by the Commission.

E. PROCEDURES FOR REQUESTING AN EXTENSION TO THESURVEY SUBMISSION DATE

A facility may request an extension of its submission date by letter to the Subacute Care SurveyCoordinator if the request:

1. is submitted not later than 15 days before the submission is due;

2. explains the reason for the extension; and

3. provides a requested due date.

See the address on the next page for submitting an extension.



A written request for an extension should be submitted to:

Donna BullenSubacute Care Survey CoordinatorMaryland Health Care Commission

4160 Patterson Avenue Baltimore, Maryland 21215

A request may also be sent to Ms. Bullen by facsimile to (410) 358-1236. The Subacute Care SurveyCoordinator shall send a response to the request for an extension to a provider within 10 days ofreceiving the request.

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III. INSTALLATION AND SETUP______________________________________

Please Note:

If you have a system administrator or dedicated computer support personnel at your facility, pleasecontact them and give them these instructions. Please read these instructions before proceedingwith the installation. Be sure to follow the instructions that correspond to the type of computerconfiguration used by your facility. If data from multiple facilities is to be entered on one PC, or aNetwork, please contact us immediately for different instructions.

A. MINIMUM COMPUTER CONFIGURATIONto run the Subacute Care Survey Software:

Microsoft Windows compatible Personal Computer with Pentium class processor32 MBs RAM2 Gigabyte Hard Disk (15 MB for the program and up to 5-10 MB for data each year)Color Super VGA Color Monitor and Video CardOperating System: Windows 95/98/ME/XP/2000 or DOS 6.PC Anywhere (Version 9.x or higher)Modem 56000 Baud, Analog phone lineDiskette Drive 3.5 inch, back-up Software and Back-up ProceduresMedia for Back-up (diskettes or tape)Printer (Dot matrix, Laser)

B. “PRE-INSTALLATION” INSTRUCTIONS

Please follow the instructions listed below before you attempt to install thesoftware diskette.

Each computer that will be running the Subacute Care Survey software on Windows95 or 98 it willneed to have the “config.sys” checked to ensure that it includes a “files=80” and “buffers=40”

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statement. If the computer is running on WindowsNT or 2000 it will need to have the“config.NT” checked to ensure that it includes three (3) statements: 1) “dos=high, umb”; 2)“device=%SystemRoot%\system32\himem.sys”, and 3) “files=150”.

If any changes are made to the config.sys or the config.NT files, the computer must be rebootedbefore you proceed with the installation. For further instructions on how to make changes to theconfig.sys or config.NT files, please contact your computer support personnel.

C. “PRE-NETWORK INSTALLATION” INSTRUCTIONS

Please follow the instructions listed below before you attempt to install thesoftware on a network.

When installing the software on a network, the installation must be done to a mapped driveletter. If you plan to install this program in a subdirectory (for example I: \APPS), pleasepermanently "map" a drive to the directory. For example, the software is installed in I:\APPS\MSACS, "map" this to be M: \MSACS and follow the instructions below.

D. INSTALLATION INSTRUCTIONS FOR SINGLE FACILITY (STAND ALONEPC OR NETWORK)

Note: These instructions presume that your 3.5 inch floppy drive is assignedas drive letter “A:”

If your 3.5 inch floppy drive has a different drive designation, you must substitute your driveletter during the installation for any instances referring to drive letter “A:” in these instructions.

1. Insert the Maryland Subacute Care Survey Software Installation diskette into your A: floppydrive.

2. If you access software from a menu or through Windows, please exit out of these programsto the DOS prompt C:\ >. Check with computer support personnel if you need assistancewith this step, or the installation process.

3. From the DOS prompt type “A: <enter>”

4. From the prompt (A: \ >) type the following:

INSTALL A: Z: [Where A: = Floppy Drive and z:= Hard Drive or networkdrive where the software will reside, C:\ F:\ etc.]

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Example for programs loaded from an A: (floppy drive) to a C: (hard drive)

A:\> Install A: C: [Drive letters depend on your computer system setup]

5. You will be prompted to put the Installation Diskette in the appropriate drive, and to enterC to Continue. (The floppy should already be in the appropriate floppy drive).

6. After you enter C to confirm and “Continue”, you will receive the following messages:

“Please wait, copying files...”

7. After files have been copied, you will be prompted to insert the second Installation disketteand press C to Continue. You will again receive the “Please wait” message.After the message displays, Installation Complete, the Installation is finished. A reminderscreen will appear after installation of the software to confirm that you have made changesto the system files. It also describes how to use this program under Windows.

8. The Maryland Subacute Care Survey software can be accessed by running the file:

Z:\msacs\msacs.bat <enter>[z:=Hard Drive or network drive where Subacute software was installed.]

E. SOFTWARE CONFIGURATION INSTRUCTIONS

This MUST be completed before you add any records.

1. From the Main Menu of the program, select “4. Utilities”. The Main Menu screen is listedbelow.

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2. Please select 5. SYSTEM SETUP, from the Utilities Menu screen depicted below.

3. After you select “System Setup”, you will be presented with the screen below.

Be sure to fill in all the facility information including Facility name, address, city,state, zip code, phone number, county code, MHCC assigned facility ID number andMA provider number. This information is automatically included with yourtransmissions to identify your facility to MHCC. If you are not sure of your countycode, use the first two digits of your facility ID number.

Important! Make sure your system parameters are set up correctly.



F. KEYS TO THE SYSTEM SETUP SCREEN

The following descriptions will help you to understand the various “SetupScreen” options.

COLOR TYPE - If you are using a color monitor, mark a "C" for the COLOR TYPE. Ifyour monitor is monochrome, mark this field with a "B".

COLOR LOGO - If the color MHCC logo causes problems with starting the program, or ifit takes too long to load, COLOR LOGO can be marked with "N" to turn this feature off.

PASSWORDS - MHCC recommends using passwords. If you decide to use passwords toprotect the confidentiality of the information entered into the Maryland Subacute CareSurvey software, you can turn passwords on by putting a "Y" in this field. If you decide it isnot necessary to use passwords, you can put an "N" in this field.

NOTE: If you wish to track who is using this program (user name, date, time) youmust have passwords turned on. Users will then be tracked and an Audit Log can beprinted from the Utilities Menu. Since MHCC does not have access to thesepasswords you must keep them in a place for easy retrieval by the facility’s SystemsAdministrator.

DEFAULT PRINTER - This will show the kind of printer that was selected from thePRINTER SETUP option on the Utilities Menu.

VERSION - This will show the current version of the Maryland Subacute Care Surveysoftware on your system.

COMMUNICATIONS - This feature is currently not available. Skip to the next field.

SYSTEM BACKUP - This field contains the start-up command for your backup software.This field should include drive and path (if necessary). The default backup command isshown above for MSBACKUP. Refer to your MS-DOS users guide for the exact commandfor your system. See Appendix E for Recommended Backup Procedures.

G. KEYS TO THE UTILITES MENU:

Note: For more detailed information on each of these keys see Section IX. of this UserManual.

BACKUP FILES - This option can be chosen to begin the backup session specified in theSYSTEM SETUP. If you do not already have this capability at your facility, you must takeaction to backup the Maryland Subacute Care Survey data. It is extremely important tobackup your data to protect your organization from loss of data. The Maryland Subacute

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Care Survey software comes defaulted with the command for the MS-DOS backup todiskette.

PASSWORD MAINTENANCE - This option is used to control access to the varioussystem functions. Each option on the Main Menu, as well as PASSWORDMAINTENANCE and PURGE DATA FILES on the Utilities Menu, can be protected.Users have the ability to assign different levels of security as shown below. A "Y" under anarea indicates the user has rights to all aspects of that particular program feature. An "N"under an area indicates that particular user would not have access to that feature.

Upon entering this screen, the first user will be displayed in the NAME field alongwith the PASSWORD. Options at the bottom of the screen will allow you tomanipulate the information as you choose. To choose the option you want, enterthe first letter of the option you choose and press [↵Enter]. The options are:

<N>EXT - Shows the next user and password in the file.

<P>REVIOUS - Shows the previous user and password in the file.

<L>AST - Shows the last user and password in the file.

<F>IRST - Shows the first user and password in the file.

<E>DIT - Allows you to edit currently selected user and password shown atthe top of the screen.

<D>ELETE - Deletes currently selected user and password shown at thetop of the screen.

<A>DD - Adds new user and password to the file.

The Areas you are able to password protect by marking an "N" (for No Access)under the section are as follows:

PURGE - Prevents user access from 3 options on the Utilities Menu -PURGE DATA FILES, DELETE INDIVIDUAL PATIENT, andCHANGE PATIENT ID NUMBER.

ENTER DATA - Prevents user access to the ENTER SURVEYINFORMATION option on the Main Menu.

REPORTS - Prevents user access to the REPORTS option on the MainMenu.



DATA XFER - Prevents user access to the RUN ERROR CHECKS ANDZIP FILE FOR TRANSMISSION option on the Main Menu.

UTILITIES - Prevents user access to the UTILITIES option on the MainMenu.

PASSWORDS – Prevents user access to the PASSWORDMAINTENANCE option on the Utilities Menu.

PRINTER SETUP - This section is used to choose a printer as yourdefault printer type. This option will identify the kind of printer used. Thisoption will not select the printer in your facility to which you want to sendthe report. That will have to be set up by your computer staff. To select aprinter type, highlight the printer you want and press [↵ENTER] as shownon the next page.

The printer you choose, or the currently defaulted printer, will be displayedin the System Setup.

Printing Locally – Choose the printer that most closely matches theprinter connected to your PC.

Printing on a Network - You will have access to printers set up byyour system administrator. The Maryland Subacute Care Surveysoftware will send the reports to your default printer (LPTl:).Highlight the printer from the list that most closely matches thisprinter. If printing to a network printer, you must capture port LPT1to redirect the print job to the network. If you have problems, pleasecall your system administrator.



REINDEX FILES - Should be used whenever a "corrupted index" errormessage is received. Reindex Files should be run to correct the problem. Ifthis does not work, call for technical support.

SYSTEM SETUP - Used to set system control parameters. It should onlybe updated by management personnel. Detailed information is provided in“Software Configurations Instructions” Section E. above.

PURGE DATA FILES - Used to remove old data which has been sent toMHCC. Data should be retained for at least two years. Detailed informationis provided in Section IX. - Utilities of this manual.

DELETE INDIVIDUAL PATIENT – Used to completely delete apatient and admission date for a patient that was erroneously entered.Detailed information is provided in Section IX. - Utilities of this manual.

CHANGE PATIENT ID NUMBER - Used to correct a patient's IDnumber and/or admission date that were entered incorrectly. Detailedinformation is provided in Section IX. - Utilities of this manual.

PRINT AUDIT LOG - This option will print a log of users and timesconnected to the system. This report is only available to those usingpasswords. Detailed information is provided in Section IX. - Utilities of thismanual.

H. ICON FOR SUBACUTE CARE SOFTWARE - Optional:

If running under Windows, the icon for this software, hrpc-col. ico, can be found on thedrive (z:) chosen for installation (See Section D step 4 of this Section) in the subdirectoryMSACS. This icon may be used when a new program icon or group is setup for thisapplication. Please reference your Windows manual for instruction on creating a new icon.

If you have ANY problems installing this software, DO NOT try toreinstall. Please call for Technical Support from Metro Data, Inc. 9:00a.m. to 5:00 p.m., Monday through Friday at (410) 667-3600.

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IV. GETTING STARTED______________________________________

A. KEYS TO KNOW

[Caps Lock] - Located on the left side of the keyboard. When [CAPS LOCK] is on, a light in theupper right corner of the keyboard will be On. This is a toggle key to allow you to type in ALLCAPS (On) or lower case (Off).

[Num Lock] - Located in the upper right portion of the keyboard. When [NUM LOCK] is on, alight in the upper right corner of the keyboard will be On. This is a toggle key to allow you to typenumbers using the keypad on the right side of your keyboard.

[Esc] - Used to exit a menu or a screen.

[PgDn] - Used to advance to the next screen or "page".

[PgUp] - Used to return to the previous screen or "page".

[F10] - Used to call "Pop-Up" Windows, where available.

[F1] - Used to call up the On-line Help.

[↵Enter] - Located on the right side of the keyboard. Used to move forward from one field to thenext.

[Delete] - Used to delete one character at a time in a field.

ARROW Keys - Used to move left, right, up, and down the screen.

[Home] - Used to go to the beginning of a line or field.

[End] - Used to go to the end of a line or field.

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[Tab] - Used to move from one field to the next.

[CTRL] [Tab] – Used to move backwards from one field to the previous field.

[←Backspace] - Used to delete one character to the left of the curser.

[Alt] [↵ENTER] – Used to enlarge the survey screen to fill the whole computer screen. Whenthe screen is enlarged, you may move between the survey screen and other open programs byclicking on [Alt] and [Tab] together.

B. TYPES OF SCREENS

This software was designed to make data entry and submission as easy as possible. The software isbroken down into two main types of screens - Menu screens and Data Entry Screens. There arefour (4) Menu screens that will direct you into general areas for data entry or report options. Theyare the Main Menu, the Utilities Menu, the Reports Menu, and the Survey Menu.

Data entry screens are screens that will allow you to enter information with the keyboard or from"pop-up" lists. The most important data entry screens are the patient information screens that areaccessed from the Patient Information Menu. These screens are similar to the hard copy paperforms provided by the Maryland Health Care Commission.

C. SCREEN LAYOUTS

Menu Screens contain a list of options you can choose by pressing the arrow keys up or down tohighlight the selection you would like to choose. Shown below is the “Main Menu” of the softwarewith the Utilities section highlighted. You can also move to any selection on menu screens or pop-up windows by pressing the first letter or number of the selection you choose.



In this case, pressing the “4” key will take you directly to the 4. UTILITIES option. Once yourselection is highlighted, press [↵ENTER] to enter that section.

Data Entry Screens contain descriptions of data requested and Data Boxes for entering theinformation. Data boxes (for users with color screens) are the red boxes on your screen. This is thearea used to enter the information for a variable.

Data Entry Screens for patient information will be set up with the following areas:

1. Patient information is displayed at the top of each Patient Data Entry screen. Thisinformation includes the facility assigned Medical Record Number and the name of thepatient.

2. The next area is the Data Entry area where patient information is entered. You may find thefield-by-field help with a brief description of the current field by clicking on [F10] frominside the data entry field.

3. At the bottom of the screen are “hot keys.” They are keys that can be used to performspecific functions.

The program “hot keys” are as follows:

[Fl] ONLINE HELP – This key will give a detailed description of the informationrequired in the area on which you are working. Scrolling through this informationwith the [Page Down] key will give further information.



[F10] Valid Codes - This key will provide a "pop-up" box with a list of valid codes,if available. When [F10] is pressed, a box will appear on the screen with all availablecode options. A message will be shown in the field-by-field help or at the bottom ofthe screen as shown below. The list of options may be larger than can be listed inthe limited space the box provides. Pressing the up or down arrow keys or the[PgUp] or [PgDn] keys will scroll through the list and show options that were notpreviously listed. If you know the first letter of the option you would like, you canpress that letter and the highlight bar will go to the first option in the list that beginswith that letter. To choose a selection from the list, highlight the selection youwould like and press [↵Enter]. Your selection will be entered automatically into thedata field where your curser resides.

[Esc] EXIT - This key will return to the previous menu.

[PgDn] or [Page Down] NEXT PAGE - This key will take you to the next "page"or screen.

[PgUp] or [Page Up] PREV PAGE - This key will take you to the previous "page"or screen.



V. USING YOUR SOFTWARE______________________________________

A. OPENING THE PROGRAM

The command to start the Maryland Subacute Care Survey software is “msacs”. From the DOSprompt where the program was loaded, type msacs then press [↵Enter]. Press any key to bypass thesplash page. A screen will now appear that looks like the screen shown below.

If passwords are turned on in the System Setup, the next screen that will appear is the PasswordEntry Screen. If passwords are not turned on, you will go directly to the Main Menu.

At the password screen:

• Enter name• Enter password - Make sure [Caps Lock] is on. Passwords are only accepted if

they are entered in capital letters.

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This will access the Main Menu Screen shown below. From the Main Menu the user can access theData Entry screens, run Reports, Run Error Checks and Zip Transmission File, and Run Utilities.Use the arrow keys to highlight the option and press [↵Enter] which will access the data entry screenand the sub-menus.

B. DATA ENTRY

The patient information screens are accessed by:

• Choosing 1. Enter Survey Information from the Main Menu• Then Entering Patient Number• Entering Admission Date

After choosing 1. ENTER SURVEY INFORMATION from the Main Menu, the program will askfor a patient number (the last 6 digits of the social security number) and the admission date. Thepatient ID number can be entered by hand. By pressing the [F10] key, all residents previouslyentered will appear in a "pop-up" box as shown below. When you type the first letter of a resident’sname the list will automatically go to the first person whose name starts with that letter.



Once the patient ID number is entered, the admission dates can also be accessed with an [F10]“pop-up" box as shown below. If the Social Security Number is not known for the patient, enter an“N" + the last 5 (or less) digits of the Medical Record Number.

Note: On rare occasions a facility has two patients with the same last 6 digits of their SocialSecurity Number. In that case you can still enter that number as long as their periods of stay do notoverlap. The second person entered with the duplicate Patient ID Number will show the Name andMedical Record Number of the first person. Simply write correct information in place of incorrectinformation and data will be entered properly. If periods of stay do overlap, please call MHCC foran assigned Patient ID Number for the patient in question.

After both the Patient ID Number and the Admission Date have been entered, the program will askif the information entered is correct.

If it is correct, enter “Y" for yes, otherwise enter “N" for no and enter the correct information.

This will access personal information for first time patients (who have not been entered into thesoftware) and then take you to the Patient Information Menu for Patients. This screen is shownafter the “Note” below.

The software will go directly to the Survey Menu for Patients who already have information entered.

NOTE: An Admission Date cannot be entered for a previously admittedpatient unless a Discharge Date was entered for previous stay. An AdmissionDate cannot be entered that falls during a previous stay.

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Each of the sections can then be entered by highlighting the section desired and pressing [↵Enter].Certain sections can only be entered when specific conditions are met.

Notes:

The following sections can only be entered if the DISCHARGE DATE in the DEMOGRAPHICsection is greater than two days. (The calculation of two days is 48 hours between the AdmissionDate and the Discharge Date.)

• DISCHARGE INFORMATION (V)• ACTIVITES OF DAILY LIVING ON DISCHARGE (VII)• BEHAVIORAL SYMPTOMS (VIII)• SKIN CONDITION (IX)• ADDITIONAL DIAGNOSES IDENTIFIED DURING STAY (XI)• THERAPIES PROVIDED (XII)• SPECIAL TREATMENTS AND PROCEDURES (XIII)• FINANCIAL INFORMATION (XIV)

If the information in these sections was filled out and the DISCHARGE DATE is later changed tobe less than two days away from the ADMISSION DATE, these sections will be cleared of theirinformation.

If the patient is marked to be Comatose in the COGNITIVE section, BEHAVIORALSYMPTOMS cannot be entered. If the information in the COGNITIVE section was filled out andthe COMATOSE field is later changed to be "1” for Yes, this section will be cleared of theinformation.

There are also options at the bottom of the screen to ADD/SELECT PATIENT and EXITMARYLAND SUBACUTE CARE SURVEY MENU.



VI. PATIENT INFORMATION – KEYS TO DATACOLLECTION______________________________________

A. SUBACUTE CARE SURVEY: PATIENT-LEVEL DATA SET

The Subacute Care Survey must be completed for each patient discharged from the program, whowas admitted after September 30, 1995, including patients formally discharged from the programand patients who died while under treatment.

A patient should be reported as discharged if:

(1) transferred from one bed licensure category to another bed licensure category within thesame facility (e.g., chronic hospital bed to comprehensive care bed);

(2) transferred from the designated subacute care unit or service to another area of the facility;

(3) transferred to an acute care hospital or other health care facility and subsequentlyreadmitted, regardless of whether or not a bed was held for the patient during the absencefrom the facility.

Many of these fields within the information screens have standardized responses that can beaccessed with a [F10] “pop-up” window.

B. DATA SET ELEMENTS

Definitions and coding instructions for the data elements included on the Subacute Care Survey areprovided in this section. Appendix A provides a hard copy of the data collection tool for theMaryland Subacute Care Survey. Appendix B provides specific answers to questions that a facilitymay have for unique situations.

Section

VI



1. IDENTIFICATION INFORMATION

A. FACILITY IDENTIFICATION NUMBER

Definition: The Facility Identification Number is a unique, seven-digit numeric identifierassigned by the Maryland Health Care Commission to each facility required to report dataunder COMAR 10.24.05, Development of Subacute Care Units. The first two digits of theIdentification Number refer to the jurisdiction in which the facility is located. The remainingdigits are assigned by MHCC.

Reporting Requirements: The Facility Identification Number is required to be reported forall specified discharges from the facility.

Coding Specifications: The Facility Identification Number is automatically coded in theHeader for each Record Type.

Other Comments: If you have questions about your Facility Identification Number, pleasecontact the MHCC Division of Data Systems & Analysis at (410) 764-3460 or 1 (877) 245-1762.

B. PATIENT IDENTIFICATION NUMBER

Definition: The Patient Identification Number is the last six digits of the patient's SocialSecurity Number.

Reporting Requirements: The Patient Identification Number is required to be reported forall specified discharges from the facility.

Coding Specifications: The Patient Identification Number is automatically coded in theHeader for each Record Type.

Other Comments:

1. Each facility should retain for five years a list of Patient Identification Numbers usedin responding to the Subacute Care Survey that can be traced back to the patient'smedical record to clarify unclear responses and/or obtain missing data.

2. If your records do not indicate the patient's Social Security Number, you may be ableto determine the number from the patient's Medicare Number. The numeric part ofa Medicare Number is the Social Security Number; however, if the MedicareNumber is followed by a "D", it is not the patient's Social Security Number. In thiscase it is the spouse's Social Security Number and should not be used as the PatientID in this survey. If the Medicare Number is followed by an "A", "M", or a "T",then the numeric part is the patient's Social Security Number and may be used asthe Patient ID in this survey.



3. If the patient's Social Security Number is unknown, use your facility's assignedpatient ID number preceded with the letter "N". This response should be leftjustified. For example, if your facility uses a 4-digit patient identifier, the correctresponse for this data item is as follows:

C. BED LICENSE TYPE

Definition: Bed License Type refers to the licensure category of the bed to which the patientis admitted as determined by the Office of Health Care Quality (OHCQ). Special Care Unitsare specifically designated as such by the OHCQ on the license or the licensing letter.If you have questions regarding your bed license type please contact the Office ofHealth Care Quality.

Reporting Requirements: The Bed License Type is required to be coded for all specifieddischarges from the facility in the Header of each Record Type.

Coding Specifications: The coding for Bed License Type is as follows:

Code Bed License Type

1 Comprehensive Care2 Comprehensive Care: Special Care Unit3 Extended Care4 Chronic Hospital

Other Comments: To confirm if your Bed License Type is Comprehensive Care, ExtendedCare or Chronic, go to Section I. Section D. of this manual. To confirm if your Bed LicenseType is Comprehensive Care: Special Care, go to your facility license or an attached licensingletter to verify any special criteria.

2. LENGTH OF STAY

A. ADMISSION DATE

Definition: The Admission Date refers to the month, day, and year on which the patient wasaccepted for care in the subacute program. In the case of a patient transferred to an acute carehospital or other location who subsequently returns to the program, the Admission Dateshould reflect the month, day, and year on which the patient was readmitted to the program.



Reporting Requirements: The Admission Date is required to be coded for all specifieddischarges from the program in the Header of each Record Type.

Coding Specifications: The Admission Date should be coded using two digits to identify themonth and day, and four digits to identify the century and year. For months and days with onlyone digit, place a zero in the first column.

For example, a patient admitted to the program on July 3, 2002 would be coded as follows:

B. DISCHARGE DATE

Definition: The Discharge Date refers to the month, day, and year on which the patient wasdischarged from the subacute program.

Reporting Requirements: The Discharge Date is required to be reported for all specifieddischarges from the program in the Header of each Record Type.

Coding Specifications: The Discharge Date should be coded using two digits to identify themonth and day, and four digits to identify the century and year. Use all columns provided torecord the date. For months and days with only one digit, place a zero in the first column.

For example, a patient discharged from the program on July 10, 2002 would be coded asfollows:

3. DEMOGRAPHIC INFORMATION

A. GENDER

Definition: Gender refers to the sex (i.e., male or female) of the patient.

Reporting Requirements: Gender is required to be reported for all specified discharges fromthe program in the Header of each Record Type.



Coding Specifications: The Gender should be coded by selecting one of the following single-digit codes:

Code Gender

1 Male2 Female

B. RACE

Definition: Race refers to the racial/ethnic background of the patient as observed by thefacility staff, based on the major classifications used by the Bureau of the Census.

Reporting Requirements: Race is required to be reported for all specified discharges fromthe program in the Header of each Record Type.

Coding Specifications: The Race should be coded by selecting one of the following single-digit codes:

Code Race

1 White2 African American3 Asian/Pacific Islander4 American Indian/Eskimo/Aleutian5 Other9 Unknown

C. DATE OF BIRTH

Definition: The Date of Birth refers to the month, day, and year on which the patient wasborn.

Reporting Requirements: The Date of Birth is required to be reported for all specifieddischarges from the program in the Header of each Record Type.

Coding Specifications: The Date of Birth should be coded using two digits to identify themonth and day and four digits to identify the year. For months and days with only one digit,place a zero in the first column. Residents must be at least two years old at the time ofdischarge.



For example, a patient born on January 2, 1901 would be coded as follows:

NOTE: If the exact month, day, and year of the Date of Birth are unknown or if only the month and day areknown, leave the Date of Birth field empty and code an Estimated Age (in years).

D. ESTIMATED AGE IN YEARS

Definition: The Estimated Age refers to the approximate age in years as of the date ofadmission to the program for those patients whose exact date of birth is unknown.

Reporting Requirements: The Estimated Age in Years is required to be reported for allspecified discharges from the program for whom the exact date of birth is unknown.

Coding Specifications: You may use all three (3) columns provided to record the EstimatedAge. For patients whose exact Date of Birth is known and reported, the Estimated Agewill automatically be coded "777" (Not Applicable). The Estimated Age must be atleast two (2) years old.

E. ETHNICITY

Definition: Ethnicity refers to Hispanic origin (persons of Mexican, Puerto Rican, Cuban,Central or South American, or other Spanish culture or origin), regardless of race, as observedby the facility staff.

Reporting Requirements: Ethnicity is required to be reported for all specified dischargesfrom the program.

Coding Specifications: Ethnicity should be coded by selecting one of the following single-digit codes:

Code Ethnicity

1 Spanish/Hispanic Origin2 Not of Spanish/Hispanic Origin9 Unknown



F. ZIP CODE OF RESIDENCE

Definition: The ZIP Code of Residence refers to the five-digit code assigned by the U.S. PostOffice to the patient's permanent, legal address prior to admission for services.

Reporting Requirements: The ZIP Code of Residence is required to be reported for allspecified discharges from the program with the exception of patient coded "Homeless" (Code6) for Living Situation Prior to Current Referral.

Coding Specifications: Use all columns provided to record the five-digit ZIP code. The ZIPCode of Residence should be coded using the following format:

If the ZIP Code is unknown, enter "99999" in the columns provided.

NOTE: If you click on [F10] in the Zip Code field you will pull up a listing of the cities inMaryland in alphabetical order and the corresponding Areas of Residences.

G. AREA OF RESIDENCE

Definition: The Area of Residence refers to the political subdivision (State and County/City)of the patient's permanent, legal address prior to admission for services.

Reporting Requirements: The Area of Residence is required to be reported for all specifieddischarges from the program with the exception of patients coded "Homeless" (code 6) forLiving Situation Prior to Current Referral.

Coding Specifications: The Area of Residence should be coded by selecting one of thefollowing two-digit codes:

Maryland01 Allegany 13 Howard02 Anne Arundel 14 Kent03 Baltimore County 15 Montgomery04 Calvert 16 Prince George's05 Caroline 17 Queen Anne's06 Carroll 18 St. Mary's07 Cecil 19 Somerset08 Charles 20 Talbot09 Dorchester 21 Washington10 Frederick 22 Wicomico11 Garrett 23 Worcester



12 Harford 30 Baltimore City

Delaware40 Kent 42 Sussex41 New Castle 43 Unidentified Delaware

Pennsylvania44 Adams 50 Greene45 Bedford 51 Lancaster46 Chester 52 Somerset47 Fayette 53 York48 Franklin 54 Other PA County49 Fulton 55 Unidentified Pennsylvania

West Virginia56 Berkeley 61 Morgan57 Grant 62 Preston58 Hampshire 63 Tucker59 Jefferson 64 Other WV County60 Mineral 65 Unidentified West Virginia

Virginia66 Alexandria 71 Prince William67 Arlington 72 Stafford68 Fairfax 73 Westmoreland69 King George 74 Other VA County70 Loudoun 75 Unidentified Virginia

79 District of Columbia

88 Other States/Foreign Countries

99 Unknown

Other Notes: If the wrong Area of Residence is entered for a ZIP Code in Maryland, theprogram will not let you continue until it is corrected.

H. MARITAL STATUS

Definition: Marital Status refers to the legal state of matrimony as of the date of admission tothe subacute program.

Reporting Requirements: Marital Status is required to be reported for all specified dischargesfrom the program.



Coding Specifications: Marital Status should be coded by selecting one of the followingsingle-digit codes:

Code Marital Status

1 Never Married2 Married3 Separated4 Divorced5 Widowed9 Unknown

Never Married - Patients classified as Never Married have remained single. Patientswhose only marriage had been annulled are also classified as Never Married.

Married - Patients classified as Married include those who have been married onlyonce as well as those who have remarried after being widowed or divorced. Patientsin common-law marriages are also classified as Married.

Separated - Patients classified as Separated include those who are legally separatedor otherwise absent from their spouse because of marital discord. Separation due tothe need for institutionalization should be recorded as Married.

Divorced - Patients classified as Divorced include those who are legally divorcedand have not remarried.

Widowed - Patients classified as Widowed include those whose spouse is no longerliving but who have not remarried.

I. LIVING SITUATION PRIOR TO CURRENT REFERRAL

Definition: The Living Situation Prior to Current Referral refers to the householdcomposition at the patient's permanent, legal address prior to admission for services.

Reporting Requirements: The Living Situation Prior to Current Referral is required to bereported for all specified discharges from the program.

Coding Specifications: The Living Situation Prior to Current Referral should be coded byselecting one of the following:

Code Living Situation Prior to Admission

1 With Spouse2 With Children3 With Other Relatives



4 With Unrelated Persons in Institutional Setting5 Lived Alone6 Homeless8 Other Living Situation9 Unknown

Other Comments: Determining the individual who owns or maintains the patient's place ofresidence may help in deciding which category to code. For instance, if the patient lives with achild who owns the premises, the appropriate code would be "2."

4. ADMISSION INFORMATION

A. SOURCE OF ADMISSION

Definition: The Source of Admission refers to the type of housing or health care facilitywhere the patient was staying immediately prior to entering this program. This may or may notcoincide with the patient's Living Situation Prior to Current Referral.

Reporting Requirements: The Source of Admission is required to be reported for allspecified discharges from the program.

Coding Specifications: The Source of Admission should be coded by selecting one of thefollowing two-digit codes:

Code Source of Admission

01 Private Residence10 Adult Foster Care/Project HOME11 Senior Assisted Housing12 Boarding Home13 Continuing Care Retirement Community (CCRC) -Independent Living Unit14 Continuing Care Retirement Community (CCRC) - Assisted Living15 Assisted Living16 ICF-Mentally Retarded20 Comprehensive Care Facility21 Extended Care Facility30 Rehabilitation Hospital31 Chronic Hospital32 Psychiatric Hospital33 Acute Care Hospital (Medical-Surgical Unit)34 Acute Care Hospital (Psychiatric Unit)35 Veterans Administration Hospital (Medical-Surgical Unit)36 Veterans Administration Hospital (Psychiatric Unit)37 Veterans Administration Hospital (Other Services)38 Acute Care Hospital (Rehabilitation Unit)



88 Other99 Unknown

Private Residence - Patients in this classification were admitted to the programfrom a private residence owned by themselves or a family member.

Adult Foster Care/Project HOME - Patients in this classification were admittedto the program from adult foster care or Project HOME programs. Adult fostercare programs are operated by some local departments of social services and providea protective living environment in a group home setting for adults usually sufferingfrom head injury or dementia. Project HOME provides Certified Adult ResidentialEnvironment (CARE) homes operated by the Department of Human Resourceswhere persons (usually suffering from chronic mental illness or AIDS) receivesupervision and are taught independence skills.

Senior Assisted Housing - Patients in this classification were admitted to theprogram from Group Senior Assisted Housing or Multi-Family Senior AssistedHousing programs administered by the Maryland Office on Aging. Senior assistedhousing is a level of housing between independent living and institutionalizationwhich combines shelter with meals, housekeeping, and assistance with activities ofdaily living for elderly persons who require support to maintain independentfunctioning.

Boarding Home - Patients in this classification were admitted to the program fromregistered assisted living facilities and other boarding homes providing personal careservices for the elderly. Registered assisted living facilities provide care for two tofour persons.

CCRC-Independent Living Unit - Patients in this classification were admitted tothe program from an independent living unit located in a Continuing CareRetirement Community (CCRC) identified by the Maryland Office on Aging.

CCRC-Assisted Living - Patients in this classification were admitted to theprogram from a licensed assisted living facility located in a Continuing CareRetirement Community (CCRC) identified by the Maryland Office on Aging.

Assisted Living - Patients in this classification were admitted to the program from alicensed assisted living facility, excluding assisted living facilities located in CCRCs.

ICF-Mentally Retarded - Patients in this classification were admitted to theprogram from a licensed intermediate care facility for the mentally retarded.



Comprehensive Care Facility - Patients in this classification were admitted to theprogram from a licensed comprehensive care facility.

Extended Care Facility - Patients in this classification were admitted to theprogram from a licensed Extended Care Facility (ECF) unit at Union MemorialHospital, Washington County Hospital, or Sacred Heart Hospital.

Rehabilitation Hospital - Patients in this classification were admitted to theprogram from a licensed special hospital-rehabilitation facility. This classificationincludes free-standing rehabilitation hospitals and excludes distinct-part rehabilitationunits located in acute care hospitals.

Chronic Hospital - Patients in this classification were admitted to the programfrom a licensed chronic hospital facility.

Psychiatric Hospital - Patients in this classification were admitted to the programfrom a licensed special psychiatric hospital.

Acute Care Hospital (Medical-Surgical Unit) - Patients in this classification wereadmitted to the program from the medical-surgical unit of a licensed acute carehospital. This category excludes patients admitted from a distinct-part rehabilitationunit located in an acute care hospital (Code 30) and patients admitted from apsychiatric unit located in an acute care hospital (Code 34).

Acute Care Hospital (Psychiatric Unit) - Patients in this classification wereadmitted to the program from a psychiatric unit located in a licensed acute carehospital. This category excludes patients admitted from licensed special psychiatrichospitals (Code 32).

Veterans Administration Hospital (Medical-Surgical Unit) - Patients in thisclassification were admitted to the program from the medical-surgical unit of aVeterans Administration Hospital.

Veterans Administration Hospital (Psychiatric Unit) - Patients in thisclassification were admitted to the program from the psychiatric unit of a VeteransAdministration Hospital.

Veterans Administration Hospital (Other Services) - Patients in thisclassification were admitted to the program from units of a Veterans AdministrationHospital other than a medical-surgical or psychiatric unit.



Acute Care Hospital (Rehabilitation Unit) - Patients in this classification wereadmitted to the program from the distinct-part rehabilitation unit located in an acutecare hospital.

5. DISCHARGE INFORMATION

A. PATIENT OUTCOME

Definition: This refers to the patient's disposition at the end of his or her stay. Whenevaluating the Patient Outcome, consider the patient's condition relative to his/her primarydiagnosis. For instance, did the patient show improvement relative to his/her primarydiagnosis? Did the patient show partial improvement relative to his/her primary diagnosis?Did the patient demonstrate no change relative to his/her primary diagnosis?

Reporting Requirements: Patient Outcome is required to be reported for all specifieddischarges from the program.

Coding Specifications: Patient Outcome should be coded by selecting one of the followingsingle-digit codes (see “Other Comments” below):

Code Patient Outcome

1 Improvement to same or greater level of Health/Function2 Partial Improvement in Health/Function3 Stabilization of Vital Functions (Prevent Decline/Death)4 No Change5 Patient Decline6 Patient Death

Other Comments: If “6” is selected for Patient Death, no other fields need to be completedin the Discharge Information section.

B. EARLY OR UNPLANNED DISCHARGE

Definition: This refers to whether or not the patient was discharged unexpectedly or earlierthan the program staff had originally planned.

Reporting Requirements: Early or Unplanned Discharge is required to be reported for allspecified discharges from the program.



Coding Specifications: The following coding scheme should be used:

Code Early or Unplanned Discharge

0 No1 Yes7 Not Applicable

C. REASON FOR EARLY OR UNPLANNED DISCHARGE

Definition: If the patient was discharged unexpectedly or earlier than planned, the reasonmust be indicated. Early discharge may be due to a variety of reasons, including those listedunder "Coding Specifications." If the patient was discharged as expected, or the patient died, acode of "7" (Not Applicable) should be assigned.

Reporting Requirements: Reason for Early Or Unplanned Discharge is required to bereported for all specified discharges from the program.

Coding Specifications: The following coding scheme should be used:

Code Discharge Prior to Treatment Plan Completion

1 Left Against Medical Advice2 Condition Required Admission to Other Health Care Facility3 No Longer Qualified by Third Party Payer4 Patient Recovered Earlier Than Expected7 Not Applicable8 Other

D. DISCHARGE DESTINATION

Definition: Discharge Destination refers to patient destination following formal dischargefrom the subacute program, including the type of housing or health care facility to which thepatient was referred immediately after leaving the program.

Reporting Requirements: Discharge Destination is required to be reported for all specifieddischarges from the program.



Coding Specifications: Discharge Destination should be coded by selecting one of thefollowing two-digit codes:

Code Discharge Destination

01 Private Residence10 Adult Foster Care/Project HOME11 Senior Assisted Housing12 Boarding Home13 Continuing Care Retirement Community (CCRC) - Independent Living Unit14 Continuing Care Retirement Community (CCRC) - Assisted Living15 Assisted Living16 Intermediate Care Facility (ICF) - Mentally Retarded20 Comprehensive Care Facility21 Extended Care Facility30 Rehabilitation Hospital31 Chronic Hospital32 Psychiatric Hospital33 Acute Care Hospital (Medical-Surgical Unit)34 Acute Care Hospital (Psychiatric Unit)35 Veterans Administration Hospital (Medical-Surgical Unit)36 Veterans Administration Hospital (Psychiatric Unit)37 Veterans Administration Hospital (Other Services)38 Acute Care Hospital (Rehabilitation Unit)77 Not Applicable88 Other99 Unknown

Private Residence - Patients in this classification were discharged from the facilityto a private residence owned by themselves or a family member.

Adult Foster Care/Project HOME - Patients in this classification were admittedto the program from adult foster care or Project HOME programs. Adult fostercare programs are operated by some local departments of social services and providea protective living environment in a group home for adults usually suffering fromhead injury or dementia. Project HOME provides Certified Adult ResidentialEnvironment (CARE) homes operated by the Department of Human Resourceswhere persons (usually suffering from chronic mental illness or AIDS) receivesupervision and are taught independence skills.

Senior Assisted Housing - Patients in this classification were discharged from thefacility to Group Senior Assisted Housing or Multi-Family Senior Assisted Housingprograms administered by the Maryland Office on Aging. Senior assisted housing is



a level of housing between independent living and institutionalization whichcombines shelter with meals, housekeeping, and assistance with activities of dailyliving for elderly persons who require support to maintain independent functioning.

Boarding Home - Patients in this classification were discharged from the facility toregistered assisted living facilities or boarding homes providing personal care servicesfor the elderly. Registered assisted living facilities provide care for two to fourpersons.

CCRC-Independent Living Unit - Patients in this classification were dischargedfrom the facility to an independent living unit located in a Continuing CareRetirement Community (CCRC) identified by the Maryland Office on Aging.

CCRC-Assisted Living - Patients in this classification were discharged from thefacility to a licensed assisted living facility located in a Continuing Care RetirementCommunity (CCRC) identified by the Maryland Office on Aging.

Assisted Living - Patients in this classification were discharged from the facility to alicensed assisted living facility, excluding assisted living facilities located in CCRCs.

ICF-Mentally Retarded - Patients in this classification were discharged from thefacility to a licensed intermediate care facility for the mentally retarded.

Comprehensive Care Facility - Patients in this classification were discharged fromthe facility to a licensed comprehensive care facility.

Extended Care Facility - Patients in this classification were discharged from thefacility to a licensed Extended Care Facility (ECF) unit at Union Memorial Hospital,Washington County Hospital, or Sacred Heart Hospital.

Rehabilitation Hospital - Patients in this classification were discharged from thefacility to a licensed special hospital-rehabilitation facility. This classification includesfree-standing rehabilitation hospitals and excludes distinct-part rehabilitation unitslocated in acute care hospitals.

Chronic Hospital - Patients in this classification were discharged from the facilityto a licensed chronic hospital facility.

Psychiatric Hospital - Patients in this classification were discharged from thefacility to a licensed special psychiatric hospital.

Acute Care Hospital (Medical-Surgical Unit) - Patients in this classification weredischarged from the facility to the medical-surgical unit of a licensed acute care



hospital. This category excludes patients discharged to a distinct-part rehabilitationunit located in an acute care hospital (Code 30) and patients discharged to apsychiatric unit located in an acute care hospital (Code 34).

Acute Care Hospital (Psychiatric Unit) - Patients in this classification weredischarged from the facility to a psychiatric unit located in a licensed acute carehospital. This category excludes patients discharged to licensed special psychiatrichospitals (Code 32).

Veterans Administration Hospital (Medical-Surgical Unit) - Patients in thisclassification were admitted to the program from the medical-surgical unit of aVeterans Administration Hospital.

Veterans Administration Hospital (Psychiatric Unit) - Patients in thisclassification were admitted to the program from the psychiatric unit of a VeteransAdministration Hospital.

Veterans Administration Hospital (Other Services) - Patients in thisclassification were admitted to the program from units of a Veterans AdministrationHospital other than a medical-surgical or psychiatric unit.

Acute Care Hospital (Rehabilitation Unit) - Patients in this classification weredischarged from the program to a distinct-part rehabilitation unit located in an acutecare hospital.

Other Comments: If a patient died, then the appropriate code is "77" (N/A).

6. COGNITIVE PATTERNS

A. COMATOSE

Definition: If the patient is Comatose, he/she has a recorded neurological diagnosis of"coma" or is in a "persistent vegetative state."

Reporting Requirements: Comatose is required to be reported on admission for all specifieddischarges from the program.

Coding Specifications: Record the appropriate number in the box. If the patient isComatose, enter "1" (Yes). If the patient is not Comatose, or is semi-comatose, enter "0" (No).



B. MEMORY/ORIENTATION

Definition: The Memory/Orientation section of the survey includes items designed tomeasure the patient's short-term memory, long-term memory, and general mental orientation.Short-Term Memory refers to the patient's ability to recall information a short interval after ithas been presented. Long-Term Memory refers to the patient's ability to recall informationafter a longer period of time has elapsed.

Reporting Requirements: Memory/Orientation on admission is required to be reported forall discharges from the program who are not coded "Comatose."

Coding Specifications: Assign the most appropriate code, using the codes listed below:

Code Memory

0 No1 Yes

Other Comments:

a) Can Recall After Five Minutes: Ask the patient to describe a recent event that both ofyou had the opportunity to remember. You could also use a more structured short-termmemory test.

Examples

Ask the patient to describe the breakfast meal OR an activity just completed.

Ask the patient to remember three items (e.g., book, watch, table) for a few minutes. AfterYOU have stated all three items, ask the patient to repeat them (to verify that you were heardand understood). In five minutes, ask the patient to repeat the name of each item. If the patientis unable to recall all three items, code "0" for no.

b) Current Season - Able to name the current season (e.g., correctly refers to weather for thetime of year, legal holidays, religious celebrations).

c) Knows Own Name - Able to recall own name.

d) Can Recall Long Past Events: Engage in conversation that is meaningful to the patient.Ask questions for which you already know the answers (from your review of the medicalrecord, general knowledge, or family).



Examples

Ask "Where did you live just before you came here?" If at home, ask "What was you address?"If from another facility, ask "What was the name of the place?" "Are you married?" "What isyour spouse's name?" "Do you have any children?" "How many?" "When is your birthday?""In what year were you born?"

e) Knows Present Location - Able to locate and recognize own room; not required to knowthe room number, but can at least find the way to the room. Knows that he/she is in a hospitalor nursing home.

f) Knows Family/Caretaker - Able to distinguish staff members from family members,strangers, visitors, and other patients. It is not necessary for patient to know staffmember's name, but patient should recognize that the person is a staff member.

Validate the information obtained from medical records or from staff members by asking thepatient each item directly. For example, "What is the current season?" "What is the name ofthis place?" "What kind of place is this?" If the patient is not in his/her room, ask questionslike, "Will you show me to your room?" Observe the patient's ability to find the way.

C. COGNITIVE SKILLS FOR DAILY DECISION-MAKING

Definition: Cognitive Skills For Daily Decision-Making refer to the patient's ability to makeeveryday decisions about the tasks or activities of daily living.

Reporting Requirements: Cognitive Skills For Daily Decision-Making on admission arerequired to be reported for all specified discharges from the program who are not coded"Comatose."

Coding Specifications: Code one of the following responses:

Code Cognitive Skills for Daily Decision-Making

0 Independent1 Modified Independence2 Moderately Impaired3 Severely Impaired

Independent - Patient's decisions are consistent and reasonable (reflecting lifestyle,culture, values); patient organizes daily routine and makes decisions in a consistent,reasonable, and organized fashion.



Modified Independence - Patient organizes daily routine and makes safe decisionsin familiar situations but experiences some difficulty in decision-making when facedwith new tasks or situations.

Moderately Impaired - Patient's decisions are poor; patient requires reminders,cues, supervision in planning, organizing, and correcting daily routines.

Severely Impaired - Patient's decision-making is severely impaired; patient never (orrarely) makes decisions.

Other Comments:

1. Review records; consult family and direct caregiver; observe patient.

2. Examples of skills include: choosing items of clothing; determining mealtimes; usingenvironmental cues to organize and plan (e.g., clocks, calendars, posted listings ofupcoming events); using awareness of one's own strengths and limitations in regulatingthe day's events (e.g., asks for help when necessary); making the correct decisionconcerning how to get to the lunchroom.

7. ACTIVITIES OF DAILY LIVING

Definition: Activities of Daily Living (ADLs) Self-Performance measure the resident’s actualself-care performance level in activities of daily living over the last seven (7) days according to aperformance-based scale. Activities of Daily Living (ADLs) Staff Support measure the patient'shighest level of support provided by the staff for mobility, transfer, eating, and toiletingactivities over the last seven (7) days.

Reporting Requirements: The ADL data items are required to be reported on admission andon discharge for all specified discharges from the program.

Coding Specifications: Coding for the ADL data items are identical to the comparable itemsfrom the MDS Versions 1.0/2.0.

Activities of Daily Living should be coded to reflect Self Performance (SP) and Support for thefollowing: Bed Mobility; Transfer; Eating; and Toileting. Self Performance (SP) indicates the highestdegree to which a patient performed certain activities without assistance over the last seven (7)days, with codes ranging from 0-4, and 8 for Bed Mobility and Transfer. Staff Supportindicates the highest level of physical assistance provided over the last seven (7) days, withcodes ranging from 0-3, and 8 for Bed Mobility and Transfer. If no help was provided or the



activity did not occur (for Bed Mobility and Transfer) at all during the entire seven (7) days usecode 8. The code “8” may not be used for Eating or Toileting.

Self-Performance (SP) Codes: Staff Support Codes:

0 Independent 0 No Setup or Physical Help From Staff1 Supervision 1 Setup Help Only2 Limited Assistance 2 One-Person Physical Assistance3 Extensive Assistance 3 Two-Person + Physical Assistance4 Total Dependence 8 Activity Did Not Occur*8 Activity Did Not Occur* 9 Unknown (on Admission only)9 Unknown (on Admission only)

NOTES: 1) The coding of “8” should be used only in exceptional cases; for example, when a patient'sactivities are unable to be observed. The coding of "8" may not be used for Eating or Toileting. Also, whena patient is completely bed-ridden, meaning he/she is not transferred from bed for any reason, "8" may becoded for the Bed Mobility or Transfer. The code "8" should not be used for Toileting for a catheterizedpatient or for a patient using a bedpan. For those patients who are incontinent and did not use a bathroomfor their toilet usage, and were never catheterized nor using a bedpan, a "4" (Total Dependence) should becoded for Self-Performance and the number of people required to provide care should be reflected in theSupport code. 2) The coding of “9” is only allowed on Admission only. A determination of the self-performance and the staff support must be made for the seven days prior to Discharge.

ADL Self-Performance Categories - Measure what the patient actually did withoutassistance, indicating balance between patient self-performance and assistance staff membersprovided for each activity. For each ADL category, code the appropriate response for thepatient's actual performance during the past seven days. Enter the code in the line labeled SP.[NOTE: Consider the patient's performance during all shifts; function may vary.]

Independent - No help or staff oversight -OR- Staff help/oversight provided only1 or 2 times during the last 7 days.

Supervision - Oversight, encouragement, or cueing provided 3 or more times duringthe last 7 days -OR- Supervision (3 or more times) plus physical assistance providedonly 1 or 2 times during the last 7 days.

Limited Assistance - Patient highly involved in activity, received physical help inguided maneuvering of limbs or other nonweight-bearing assistance on 3 or moreoccasions -OR- limited assistance (3 or more times) plus more help provided only 1or 2 times during the last 7 days.



Extensive Assistance - While patient performed part of the activity over the last 7days, help of the following types(s) was provided 3 or more times:

• Weight-bearing support provided 3 or more times;• Full staff performance of activity (3 or more times) during part (but not all)

of the last 7 days

Total Dependence - Full staff performance of the activity during the entire 7-dayperiod. [NOTE: This must include all subtasks of more complex ADL activities. Ifpatient is totally dependent for only some subtasks, do not code "4".]

Activity Did Not Occur During the Entire 7-Day Period - The use of this codeis limited to situations where the ADL activity was not performed by the patient orstaff and is primarily applicable to fully bed-bound patients who neither transferredfrom bed nor moved between locations over the entire 7-day period. [NOTE:When an "8" code is entered for Self-Performance, also enter an "8" code forSupport. A resident who has not been out of bed in the past 7 days could be coded“8.”]

ADL Staff Support Provided- The highest level of support actually provided to the patient bystaff over the last 7 days for each ADL, even if that level of support only occurred once.. Foreach ADL category, code the maximum amount of support given during the last seven days onthe Staff Support line labeled “Staff Support" - irrespective of the frequency over the 7-dayperiod. Code regardless of patient's Self-Performance classification (e.g., if someone wasindependent but received a 1-person physical assist one or two times during the 7-day period,the ADL Support item is coded "2")

No Setup or Physical Help From Staff

Setup Help Only - Patient is provided with materials or devices necessary toperform the activity of daily living independently.

One Person Physical Assist

Two+ Persons Physical Assist

Activity Did Not Occur During the Entire 7-Day Period - This code is limited tosituations where the ADL activity was not performed and is primarily applicable tofully bed-bound patients who neither transferred from bed nor moved betweenlocations over the entire 7-day period. [Note: When an "8" code is entered forSupport, also enter an "8" code for Self Performance. A resident who has not beenout of bed in the past 7 days could be coded “8.”]



The examples below clarify coding for both Self-Performance and Staff Support. Theanswers appear to the right of the patient descriptions. Cover the answers, read and scorethe example, and then compare your answers with those provided.

Examples: ADL Self-Performance and ADL Staff Support Self-Perf.

StaffSupport

Bed Mobility

Patient was physically able to reposition self in bed but had a tendency tofavor and remain on left side; needed frequent reminders and monitoringto reposition self while in bed.

Received supervision and verbal cueing for using a trapeze for all bedmobility. On two occasions when arms were fatigued, patient receivedheavier physical assistance of two persons.

Because of severe, painful joint deformities, patient was totally dependenton two persons for all bed mobility. Although unable to contributephysically to positioning process, patient was able to cue staff for theposition she wanted to assume and at what point she felt comfortable.

1

1

4

0

3

3

Transfer

Despite bilateral above-the-knee amputations, patient always movedindependently from bed to wheelchair (and back to bed) using a transferboard he retrieves independently from his bedside table.

Patient moved independently in and out of armchairs but always receivedlight physical guidance of one person to get in and out of bed safely.

Transferring ability varied throughout each day; received no assistance atsome times and heavy weight-bearing assistance of one person at othertimes.

0

2

3

0

2

2



Examples: ADL Self-Performance and ADL Staff Support Self-Perf.

StaffSupport

Eating

Patient arose daily after 9 am preferring to skip breakfast and just munchon fresh fruit later in the morning. She ate lunch and dinnerindependently in the facility's main dining room.

Patient is blind and confused. He ate independently once staff orientedhim to the types and whereabouts of food on his tray and instructed himto eat.

Patient fed self with staff monitoring at breakfast and lunch but tired laterin day; was fed totally by nursing assistant at supper meal.

0

1

3

0

1

2

Toileting

Patient used bathroom independently once up in a wheelchair; usedbedpan independently at night after it was set up on bedside table.

When awake, patient was toileted every two hours with minor assistanceof one person for all toileting activities (e.g., contact guard for transfersto/from toilet, drying hands, zipping/buttoning pants); required total careof one person several times each night after incontinence episodes.

Patient received heavy assistance of two persons to transfer on/off toilet;able to bear weight partially; required only standby assistance with hygiene(e.g., being handed toilet tissue or incontinence pads).

0

3

3

1

2

3

8. BEHAVIORAL SYMPTOMS

Definition: Behavioral Symptoms cause disruption to program patients or staff members,including those that are potentially harmful to the patient or disruptive in the environment,even though staff and patients appear to have adjusted to them. (e.g., Mrs. R's calling out isn'tmuch different than others on the unit; there are many noisy patients.) Identify the presence ofBehavioral Symptoms during the patient's stay. Wandering is movement with no identifiedrational purpose; patient appears oblivious to needs or safety. This behavior must bedifferentiated from purposeful movement - e.g., a hungry person moving about the unitin search of food; or pacing.



Reporting Requirements: Behavioral Symptoms on admission are required to be reportedfor all specified discharges from the program who are not coded "Comatose."

Coding Specifications: Code the frequency of each descriptive behavior. Code "0" if patientdid not exhibit that type of behavior during his/her stay. [Note: This code applies topatients who have never exhibited the behavior or who have exhibited the behavior butno longer exhibit it, including those whose behavior is fully managed by psychotropicdrugs, restraints, or a behavior-management program.] Report on the most disruptivepatient behavior across all three shifts.

Code Frequency

0 Behavior Not Exhibited1 Behavior of this Type Occurred Occasionally2 Behavior of this Type Occurred Often, But NOT Daily3 Behavior of this Type Occurred Daily

Other Comments: Review the clinical/medical record and the current care plan; consult withunit staff to complete this data item.

9. SKIN CONDITION ON ADMISSION

Definitions: Skin condition includes the number of ulcer sites, the types of ulcers, theexistence of other skin conditions (i.e., burns, open lesions or wounds, skin tears or cuts,surgical wounds).

Reporting Requirements: The Skin Condition data items are required to be reported onadmission for all specified discharges from the program.

Coding Specifications:

(1) Record the number of sites for each stage of ulcer on the patient's body. Consider bothpressure and stasis ulcers. If none are present at the stages stated, code "0."

(2) Next, record the highest stage of pressure ulcer and the highest stage of stasis ulceron the patient's body. Assign the appropriate code. If the patient does not have a pressureulcer or a stasis ulcer, code a "0" (No Ulcers of this type).

Code Ulcer Type0 No Ulcers of this type1 Stage 1



2 Stage 23 Stage 34 Stage 4

(3) If the patient has any burns (second or third degree), an open wound/lesion, a skin tear orcut (other than surgical), or a surgical wound code a "1" (Yes) in the appropriate boxes;otherwise, code a "0" (No).

Types of Ulcers:

Pressure Ulcers- Ischemic ulceration or necrotic tissues overlying a bony prominence thathas been subjected to pressure or friction. Other terms used to indicate this conditioninclude bed sores and decubitus ulcers.

Stasis Ulcer- An open lesion, usually in the lower extremities, caused by decreased bloodflow from chronic venous insufficiency; also referred to as a venous ulcer or ulcer related toperipheral vascular disease (PVD).

Stage 1 Ulcer - Nonblanchable erythema of intact skin; the heralding lesion of skinulceration. Note: Reactive hyperemia can normally be expected to be present for one-halfto three-fourths as long as the pressure occluded blood flow to the area. This should not beconfused with a Stage 1 pressure ulcer.

Stage 2 Ulcer - Partial thickness skin loss involving epidermis and/or dermis. The ulcer issuperficial and presents clinically as an abrasion, blister, or shallow crater.

Stage 3 Ulcer - Full thickness skin loss involving damage or necrosis of subcutaneous tissuethat may extend down to, but not through, underlying fascia. The ulcer presents clinically asa deep crater with or without undermining of adjacent tissue.

Stage 4 Ulcer - Full thickness skin loss with extensive destruction, tissue necrosis, ordamage to muscle, bone or supporting structures (for example, tendon or joint capsule).Note: Undermining and sinus tracts may also be associated with Stage 4 pressure ulcers.

Other Skin Conditions:

Burns - Includes burns from any cause, in any stage of healing. This category does notinclude first degree burns (changes in skin color only).

Surgical Wounds - Includes healing and non-healing, open or closed surgical incisions, skingrafts, or drainage sites on any part of the body.



Other Comments: Review clinical/medical record and current care plan to code theseitems. Ask nursing assistant. Examine the patient. Without a full body check, theseconditions can be missed.

Note: When eschar is present, accurate staging of the ulcer is not possible until the eschar hassloughed or the wound has been debrided.

Assessing a Stage 1 pressure ulcer requires a specially focused assessment for patientswith darker skin tones to take into account variations in ebony-colored skin. Based onone set of recommendations for recognizing Stage 1 pressure ulcers in ebony complexions,look for: (1) any change in the feel of the tissue in a high-risk area, (2) any change in theappearance of the skin in high-risk areas, such as the orange-peel look; (3) a subtle purplish hue;and (4) extremely dry, crust-like areas that actually cover a tissue break when examined closely.

10. PRINCIPAL AND OTHER DIAGNOSES

A. PRINCIPAL AND OTHER ICD-9 DIAGNOSES ON ADMISSION FOR CARE

Definition: The Principal Diagnosis is the one medical condition, disease, or injury categorythat directly resulted in the patient's admission to the program. The Principal Diagnosis isnot necessarily the reason for the patient's initial illness or medical problems. For example, anindividual who has been diagnosed with Parkinson's Disease is admitted to the programbecause she has fractured her hip. The Principal Diagnosis in this case is the hip fracture, notParkinson's Disease. The Principal Diagnosis does not include the treatment or serviceprovided to the patient. For instance, ventilation would not be appropriate as a PrincipalDiagnosis. Other diagnoses are any other diagnoses or disease categories that may or may notbe closely associated with, but contribute to, the patient's reason for admission, ADL status,cognition, behavior, medical treatments, and/or risk of death. In the example mentionedabove, Parkinson's Disease would be considered one of the patient’s other diagnoses.

Reporting Requirements: The Principal Diagnosis and up to nine Other Diagnoses at thetime of admission are required to be reported for all specified discharges from the program.All patients must have a Principal Diagnosis coded.

Coding Specifications: The Principal Diagnosis and Other Diagnoses should be coded toreflect the status on the day of admission to the program. Principal and other diagnoses shouldbe coded using ICD-9 codes. Space is provided for up to 2 decimal places. This data item isleft-justified. There are three formats of ICD-9 codes:

• 3 digits with no decimal places;• 4 digits, including 1 decimal place;• 5 digits, including 2 decimal places.



When codes contain only one decimal, left-justify the decimal, and leave the second decimalbox blank. Please refer to the following examples for coding this field.

Example Number 1 - 769 (3 digits with no decimal places)

Example Number 2 - 286.9 (4 digits, including 1 decimal place)

Example Number 3 - 574.21 (5 digits, including 2 decimal places)

NOTE: Do not add or delete zeros from ICD-9 Diagnosis Codes. Complete the codes exactly as indicated inthe ICD-9 Coding Manual, including preceding zeros (e.g., 044.9); and trailing zeros (e.g., 807.00).

Other Comments:

1. If the patient has less than nine other diagnoses on admission, leave the otherspaces blank. If the patient has more than nine other diagnoses, use your bestclinical judgement to determine which most closely meets the definition listedabove.

2. Do not use ICD-9 procedure codes, E-codes, or V-codes. Procedure codes, from Volume3 of the International Classification of Diseases, 9th Revision, Clinical Modification arecodes consisting of no more than 4 digits, including two decimal places (e.g., 84.10) andrefer to therapeutic or diagnostic procedures performed. The condition that necessitatedthe performance of the procedure and not the procedure itself should be coded on theSubacute Care Survey. E-codes, which refer to External Causes of Injury and Poisoning,are distinguished by an initial "E" followed by three digits before the decimal.



3. Use the most specific ICD-9 Diagnosis Code available when coding Principal and OtherDiagnoses. ICD-9 codes that are too general will not be accepted as valid diagnosis codes.Where sub-categories are available, specify with as much detail as provided in the medicalrecord chart, even if it means specifying a condition as "unspecified".

11. ADDITIONAL ICD-9 DIAGNOSES IDENTIFIED DURING STAY

Definition: Additional Diagnoses are those medical conditions or diseases that developedduring the patient's stay or that were identified after his/her admission. Only note thesediagnoses if they are different from the diagnoses assigned to the patient at admission.

Reporting Requirements: Up to five Additional Diagnoses Identified During the Stay arerequired to be reported for all specified discharges from the program.

Coding Specifications: Additional Diagnoses should be coded using ICD-9 codes. Space isprovided for up to five additional diagnoses. If the patient has no additional diagnoses atdischarge, leave the space blank.

12. THERAPIES PROVIDED

Definition: Record the number of days each therapy type was administered during thepatient's stay for at least 10 minutes during a day. Record services provided inside theprogram only. If the therapy was not administered during the patient's stay, or if it was notgiven for at least 10 minutes during any one day, record "0" for both days and minutes. To becounted, a therapy must meet all of the following:

1. Therapies must be ordered by the physician.

2. Therapy must be based on the therapist's assessment and treatment plandocumented in the medical record.

3. Therapies must be provided/supervised by the appropriate licensed/certifiedindividual.

Reporting Requirements: Therapies provided during the entire stay are required to bereported for all specified discharges from the program.

Coding Specifications: Code number of days and total minutes each therapy type wasprovided in each category. (Exclude documentation and care planning time.)

Speech Therapy - Services that are provided by a Speech/Language Pathologistwho has a Certificate of Clinical Competence (CCC) or is in his/her ClinicalFellowship Year (CFY).



Occupational Therapy - Therapy services that are provided or directly supervisedby a Licensed/Registered Occupational Therapist (OTR). Licensed/CertifiedOccupational Therapy Assistant (COTA) may provide therapy but not superviseothers (aides or volunteers) giving therapy. Include services provided by a COTAwho is employed by the nursing facility only if they are under the direction of anOTR.

Physical Therapy - Therapy services that are provided or directly supervised by aLicensed Physical Therapist (LPT). A Licensed Physical Therapist Assistant (LPTA)may provide therapy but not supervise others (aides or volunteers) giving therapy.Include services provided by a LPTA who is employed by the program only if theyare under the direction of an LPT.

Respiratory Therapy - Included are coughing, deep breathing, chest PT, heatednebulizers, aerosol treatments, and mechanical ventilation, etc., which must beprovided by a licensed/certified professional. Respiratory therapy does not includepulse oxymetry.

Other Comments: Identify the number of days that the patient received such treatment.

13. SPECIAL TREATMENTS AND PROCEDURES

Definition: Special Treatments refer to selected types of care and procedures provided to thepatient during the stay. Frequency of administration refers to how often the physician's orderrequires the treatment to be administered. Days administered refers to the total of days duringthe resident’s visit the treatment was administered.

Reporting Requirements: Special Treatments are required to be reported for all specifieddischarges from the program.

Coding Specifications: Frequency of Special Treatments should be coded to reflect thetreatment frequency ordered by the physician, as reflected on the patient's medical record, fortreatments that were provided during the stay. If the frequency changed during the stay, codethe highest frequency that occurred during the stay.

A. MEDICATION ADMINISTRATION

Coding Specifications: If the patient received medication through any of these methods,indicate so by recording a code of "1" (Yes); otherwise, record a code of "0" (No).

IV Chemotherapy - Specialized care involving chemotherapy (antineoplastic drug)given intravenously to treat various types of neoplasms.

Intravenous Medication Administration (IV Push) - The administration ofmedications intravenously without combining them with a fluid solution.



PO Medication Administration - The administration of medications orally asordered by the physician.

IM/SQ Medication Administration - The administration of medications via anintramuscular route or sub-cutaneously.

B. ADMINISTRATION OF NUTRIENTS/FLUIDS

Coding Specifications: If the patient received nutrients/fluids through any of thesemethods, indicate so by recording a code of "1" (Yes); otherwise, record a code of "0" (No).

Hyperalimentation (TPN) - The continuous administration of nutrients viapercutaneous catheter to persons who are unable to eat or absorb food.

Intravenous Fluid Administration - The intravenous administration of fluids.

Tube Feeding - The use of naso-gastric or gastric tube as the primary method offeeding.

C. MONITORING

Coding Specifications: If the patient was monitored using any of these methods, pleaseindicate so by recording a code of "1" (Yes); otherwise, record a code of "0" (No).

Anticoagulation Monitoring - Monitoring the effects of administeringanticoagulants on the clotting and coagulation mechanisms (PT, PTT).

Blood Sugar/Pulse Oxymetry Monitoring - Frequent or recurrent supervisingand observing of blood sugar levels of patients who have diabetes.

Apnea Monitoring- Frequent supervision/observation of the breathing patterns ofpatients with predisposing diseases or conditions. This is a combination of humanand machine monitoring.

Blood Gas Monitoring - The drawing of arterial blood to screen for abnormalblood gas values in persons experiencing respiratory decompensation.

Cardiac Monitoring - The use of specialized equipment, including telemetry, tocontinuously assess heart rate rhythm and inform the staff of any potentially seriousvariations.



D. CARE OF TUBES/CATHETERS (FREQUENCY OF TREATMENT)

Coding Specifications: Indicate the frequency of administration of the special treatmentslisted above by selecting the frequency response code that reflects how often the physicianordered the treatment to be administered. If the patient was not treated with tubes or catheters,code "77".

Treatment Frequency Codes:1H = (qh) every hour2H = (q2h) every two hours3H = (q3h) every three hours4H = (q4h) every four hours6H = (q6h) every six hours8H = (q8h) every eight hours/shift

1D = (qd or hs) once daily2D = (BID) two times daily (Includes every 12 hours)3D = (TID) three times daily4D = (QID) four times daily5D = five times daily

1W = (QWeek) once every week2W = twice every week3W = three times every week4W = four times every week5W = five times every week6W = six times every weekQO = every other day

1M = (QMonth) once every month2M = Twice every month

PR = As necessaryCC = Continuous

77 = Not applicable88 = Other99 = Unknown

Chest Tube Drainage - The introduction of a catheter into the chest to removeexcess fluids.

Other Drainage Tube - A tube, catheter or surgical drain into a body cavity ortissue compartment for the purpose of draining, decompressing, evacuating, orirrigating excess fluids/ and or fluids caused by infection. (e.g., penrose drains, NG



tubes connected to Gomco suction) This type of specialized care does not includechest tubes or Foley catheters.

Percutaneous Catheters - Specialized care in which a catheter is inserted into thebody for the administration of medications, and the care given to maintain thepatency of the line on days when infusions are not administered.

Tracheostomy Care - Specialized care directed toward the maintenance of airwaypatency and prevention of infection of a tracheostomy site. This includestracheostomy tube cleansing and/or changes and wound site care.

Indwelling Urinary Catheter/Irrigation - A permanent catheter designed to bepassed through the urethra into the bladder to drain it of retained urine.

Peripheral IV, PICC, or Central IV Line - The insertion of an intravenous lineinto a peripheral vein and extending into the central circulatory system. ExcludesPICC lines inserted at an acute general hospital.

E. OTHER TREATMENTS (FREQUENCY AND TOTAL NUMBER OF DAYS)

Coding Specifications: Indicate the number of days that the patient has received each of thetreatments listed above. Frequency of administration of these special treatments should becoded by selecting the frequency response code that reflects how often the physician orderedthe treatment to be administered. If the patient was not treated with a particular treatment,code a "0" for days and a "77" for frequency.

Treatment Frequency Codes:1H = (qh) every hour2H = (q2h) every two hours3H = (q3h) every three hours4H = (q4h) every four hours6H = (q6h) every six hours8H = (q8h) every eight hours/shift

1D = (qd or hs) once daily2D = (BID) two times daily (Includes every 12 hours)3D = (TID) three times daily4D = (QID) four times daily5D = five times daily

1W = (QWeek) once every week2W = twice every week3W = three times every week4W = four times every week5W = five times every week



6W = six times every week

QO = every other day

1M = (QMonth) once every month2M = Twice every month

PR = As necessaryCC = Continuous

77 = Not applicable88 = Other99 = Unknown

Blood Transfusion - Specialized care that involves transfusions of blood or anyblood products (e.g., platelets).

Hemodialysis Dialysis - Specialized care involving the removal of wastes from theblood of persons whose kidney function has ceased or is inadequate. This includesshort-term and chronic, long-term treatment.

Oxygen Therapy - The administration of oxygen by inhalation for some cardiacand pulmonary conditions. This does not include patients who administer their ownoxygen nebulizers, vaporizers, or atomizers or one-time STAT emergencyadministration of oxygen.

Peritoneal Dialysis - Specialized care involving the removal of wastes from theblood, via the peritoneum, of persons whose kidney function has ceased or isinadequate. This includes short-term and chronic, long-term treatment.

Suctioning - Specialized care involving removal of secretions from the upperand/or lower airway to maintain the airway. This does not include a one-time STATemergency use of suction, but rather ongoing intermittent suctioning.

Surgical Wound Care - The management of wounds by dressing change andapplication of topical substances and cleansing of the area. This includes chemicaldebridement.

Ulcer Care - Specialized care of stasis and pressure ulcers which may involvedebridement, wound cleansing, the application of dressings, or adjunctive therapy.

Ventilator Care - Specialized care involving the use of a mechanical device toperform the function of respiration.

Ventilator Weaning - The process of gradually reducing ventilatory support with agoal of eventual discontinuation of the ventilatory and/or tracheostomy support.



This involves the monitoring of patients that are being permitted to breathe on theirown for gradually increasing periods of time. Requires close nurse, physician andrespiratory staff monitoring along with assistive devices such as apnea and pulseoximetry monitors, and laboratory monitoring of blood gases.

Radiation Therapy - Specialized care involving the use of radiation therapy or aradiation implant to treat various types of neoplasms.

14. FINANCIAL INFORMATION

A. PRIMARY AND SECONDARY PAYMENT SOURCE

Definition: The Primary Payment Source refers to the one funding source that paid or wasexpected to pay for the greatest amount of the charges incurred by the patient. The SecondaryPayment Source refers to the funding source that paid for additional charges incurred by thepatient.

Reporting Requirements: The Primary and Secondary Payment Sources are required to bereported for all specified discharges from the program.

Coding Specifications: The Primary Payment Source should be coded using the followingscheme:

Code Primary Payment Source

01 Private (Self) Pay02 Medicare03 Maryland Medical Assistance04 D.C. Medicaid05 Other State Medicaid06 Private Insurance07 VA Contract10 Health Maintenance Organization12 CHAMPUS88 Other99 Unknown

The Secondary Payment Source should be coded using the following scheme. If the patientdoes not have a Secondary Payment Source, use a code of "77" for Not Applicable.



Code Secondary Payment Source

01 Private (Self) Pay02 Medicare03 Maryland Medical Assistance04 D.C. Medicaid05 Other State Medicaid06 Private Insurance07 VA Contract10 Health Maintenance Organization12 CHAMPUS77 Not Applicable88 Other99 Unknown

Private (Self) Pay - Patients in this classification had the greatest amount of theircharges paid for by their own or family income, including Social Security, pensionsand annuities, property income (interest, dividends, rents) and earning, but excludingprivate insurance and Supplemental Security Income (SSI).

Medicare - Patients in this classification had the greatest amount of their skillednursing facility charges paid for under Title XVIII of the Social Security Act.

Maryland Medical Assistance Program - Patients in this classification had thegreatest amount of their charges paid for by the State of Maryland MedicalAssistance (Medicaid) Program.

D.C. Medicaid Program - Patients in this classification had the greatest amount oftheir charges paid for by the District of Columbia Medicaid Program.

Other State Medicaid Program - Patients in this classification had the greatestamount of their charges paid for by Medicaid programs other than the MarylandMedical Assistance Program and the D.C. Medicaid Program.

Private Insurance - Patients in this classification had the greatest amount of theircharges paid for by non-governmental insurance policies.

VA Contract - Patients in this classification had the greatest amount of their chargespaid for under contracts with the Veterans Administration.

Health Maintenance Organization - Patients in this classification had the greatestamount of their charges paid for by the Health Maintenance Organization to whichthey belong.



CHAMPUS - Patients in this classification had the greatest amount of their chargespaid for by the Office of Civilian Health and Medical Programs of the UniformedServices.



VII. REPORTS______________________________________

Reports are what make the Maryland Subacute Care Survey softwareimmediately useful to your facility. These reports can show who was in yourfacility during a particular time period. You may print hard copy forms of thecompleted data collection tools for the survey and identify trends accordingto age, length of stay, outcome, and more. Samples of some of the reportsare provided in Appendix C.

A. REPORTS TYPES (WITH DESCRIPTIONS)

Survey Forms

• PATIENT SURVEY FORMS BY LIST OF PATIENTS - This report will produce hardcopies of the Maryland Subacute Care Survey for up to 10 patients at a time.

• PATIENT SURVEY FORMS BY DATE RANGE - This report will produce hard copiesof the Maryland Subacute Care Survey for a specified date range.

Trend Reports

• AGE GROUP REPORTS - This report will show the number of discharges your facilityhad during a range of dates for 8 age brackets. These discharges will also be broken downby specific criteria you select.

• LENGTH OF STAY REPORTS - This report will show the number of discharges fromyour facility by criteria that you select during a range of dates and the length of time theywere in your facility.

• OUTCOME REPORTS - This report will show the number of discharges your facility hadduring a range of dates and the outcome of their stay by your selected criteria.

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• DISCHARGE PERCENTAGE REPORTS - This report will show the number ofdischarges your facility had during a range of dates according to criteria you select, and theirpercentage of total discharges.

• COGNITIVE SKILLS FREQUENCY REPORT - This report shows the distribution ofthe discharges that your facility had in "Cognitive Skills for Daily Living" during a selectedrange of dates.

• BEHAVIORAL SYMPTOMS FREQUENCY REPORT - This report will show thedistribution of the discharges that your facility had in each area of Behavioral Symptomsduring a range of selected dates. The areas of Behavioral Symptoms are: Wandering, VerballyAbusive Behavior, Socially Inappropriate, and Resists Care.

• ACTIVITIES OF DAILY LIVING FREQUENCY REPORT (ADL) - This report willshow the distribution of the discharges that your facility had in each area of ADLs during aselected range of dates. The ADLs are: Bed Mobility, Transfer, Eating, and Toilet Use. Thisreport only includes the Self Performance on Admission for each ADL.

General Information

• PATIENT LISTING BY QUARTER - This report will show all the patients that were inyour facility during a range of dates. Included on this report is the Patient ID #, full name,admission date and discharge date.

• ERROR LOG REPORT - This report will run consistency checks on survey data for aspecified date range. Any information that is not an acceptable answer for a question will belisted on this report. All errors must be corrected before data can be submitted to MHCC.The consistency checks are automatically run prior to submitting information to MHCC bydiskette or via modem.



B. VIEWING AND PRINTING REPORTS

1. Select “2. REPORTS” from the Main Menu. This will display the screen shown below.

2. To send the report to your printer, highlight PRINT REPORTS and press [↵Enter]. Tosend the report to your monitor, highlight VIEW REPORTS and press [↵Enter].

3. The Reports Menu, listing the reports available, will be displayed next. Highlight the nameof the report you would like and press [↵Enter].

4. Trend Reports allow you to customize the reports by identifying criteria for the report.Select the criteria you would like for your report and press [↵Enter].

5. The Patient Survey Forms by List of Patients Report will display a Patient List Screen for alist of patients with their respective admission dates to be printed. NOTE: It will print all ofthe page 1’s first for the group and then all of the page 2’s.



The screen, shown below, uses [F10] "pop-up" screens for easyaccess to patient names and admission dates. (For informationabout [F10] "pop-up" screens, see section IV. Getting Started).You may choose up to 10 patients at a time.

Once all patients you wish to print are entered in the spaces, leave the next space blank andpress [↵Enter] to start printing the report.

6. All other reports ask the quarter for which you would like the information provided. Youcan enter the quarter number and the year, or you can enter “O” for “Other” and select anydate range you would like.

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VIII. TRANSMITTING THE SUBACUTE CARESURVEY VIA THE BULLETIN BOARDSERVICE (WORLDGROUP MANAGER)______________________________________

A. RUN ERROR CHECKS AND ZIP THE FILE FOR TRANSMISSION

After all of the information has been entered into the survey screens, you are ready to submit theinformation to MHCC. The information should be sent to a Bulletin Board System using amodem. The Bulletin Board System is simply a computer set up at MHCC to collectinformation. The Subacute Care data is transmitted to the BBS using WorldGroup Manager.

1. Before any information can be sent to MHCC, all of the data must pass consistencychecks. The checks verify that the mandatory fields have been entered and certainanswers make sense in relation to other answers. The consistency checks are listedin Appendix D. From the Main menu, click on “3. Run Error Checks and ZipTransmission File.

2. If there are any errors, an Error Log will be generated. You can print the ERRORLOG from the Reports Menu. If there are any errors, they will be listed for yourreview.

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VIII



The Error Log will show all unacceptable answers for the quarter specified. ThePatient ID Number and Admission Date are provided to identify the exact record.The section where the error lies and a description of the error are also provided. Allerrors must be corrected before you will be able to zip the file that will be sent toMHCC.

3. After all errors have been corrected, you are able to submit your information byclicking on “3. RUN ERROR CHECKS AND ZIP TRANSMISSION FILE” optionfrom the Main Menu and pressing [↵Enter]. The screen shown below will then bedisplayed.

4. Enter the Quarter and the Year of the information you wish to submit. Theappropriate dates will automatically be displayed in the box provided. If you wish tosubmit a date range other than the specified quarters, choose “O” for other, the year,then specify the exact date range you wish to submit. (This should only be donewhen requested by MHCC.)

5. If the information for this date range had previously been prepared for transmission,then the following screen will appear.



6. If you are certain that this information is for the correct date range, answer "Y" foryes; otherwise answer "N" for no.

7. If you answer yes, you will be asked if you would like to TRANSMIT VIAMODEM TO MHCC. You can answer "Y" for yes. Answering yes will zip yourzip the file for your facility for transmission to MHCC.

8. If you answer no, the software will give you the option to CREATE A DISKETTEFOR MHCC. If you are sending your data on a diskette, acknowledge the messageby selecting Y for yes. You will be prompted with the following screen. Continuewith step number 10 below.

9. If you decide that you do not wish to send any information, select N for no. Youwill return to the Main Menu.

10. Highlight the drive on your PC to which you would like to write the information. Ifyou have any questions about which drive you should choose, ask your computerstaff. (If there is only one floppy drive, A: is usually the appropriate response.)



11. You will then be asked to insert a diskette into the floppy drive that you specified inthe previous step. The screen below will appear. When ready, press any key to startcreating the file for MHCC.

12. The message will tell you the number of records being submitted to MHCC, thename of the file that was created, and the Quarter and Year you chose to send. Thefile name should be: Your MHCC assigned facility number + number of attempts tocreate the information + .E + the last number of the year + quarter number. Writethis down. You will need this when you go to WorldGroup Manager. When youhave the file name click on [Enter↵] to close the screen.

Example: If facility number 1234567 attempted to submit the information 3 times forthe first quarter of 2002, the file name should be: 12345673.E21

13. If the file name does not follow this naming convention, call technical support forassistance. After you have verified the file name and the number of recordsprovided, you can press any key to return to the Main Menu.

14. This file is password protected to ensure the confidentiality of the informationprovided to MHCC.



B. THE WORLDGROUP MANAGER

The WorldGroup Manager is the software application that provides access toHealth Data Connect, the MHCC Bulletin Board System. MHCC providesthis software free. It enables facilities to electronically communicate withMHCC and to send the data file created by the Subacute software to MHCC.This software MUST be installed on a computer that is connected to a

modem and a phone line.

You will also use the Bulletin Board to update the registry information on your facility as yourinformation changes. Before installing this application, CLOSE ALL open applications on yourcomputer.

1. TO INSTALL THE WORLDGROUP MANAGER:

If your computer already has the WorldGroup Manager, Do not re-install it. ContactMHCC if you need the diskettes for WorldGroup Manager.

a. Insert disk #1 in the A:\ drive.

b. Single click on Start.

c. Single click on Run.

d. Click on Browse.

e. Click on A:\setup.exe as shown below.

f. Click on OK to start the installation. (Install WGM in C:\WGMAN) NOTE:NEVER CHANGE THE INSTALLATION FOLDER. When prompted, clickOK.

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g. This will take a minute or so, then you will be prompted to insert Disks #2 through#4. Follow the prompts to switch the disks, and click on OK after each disk isswitched.

h. When the World Group Plug-in Installation screen appears that describes the plug-inprocess, click on Cancel.

i. Single click on All Done.

j. Click on Yes at “Restart Windows.”

k. The World Group Manager screen comes up after Windows has started again. Withthe mouse, left click on the World Group Manager icon and drag it to the desktop.

l. When you click on the WorldGroup Manager icon, marked Health Data Connect, itwill appear like the screen shown below.

m. From the Health Data Connect screen click on File.

n. Click on Properties.

o. Please verify that the section labeled “How to Connect” is set up correctly. If youare using a modem, be sure that the circle next to “Modem” is selected.



p. Be sure that the telephone number is “4103581973”. If your modem requires thatyou use “9” to dial out, insert a “9” in front of the telephone number. If you havetrouble dialing out with your modem you may need to insert one or two commasafter the “9”, and before the first number of the area code as shown in the screenbelow.

Ex. – 94103581973 or 9,4103581973 or 9,,4103581973

q. If calling Baltimore from your facility is long distance, be sure that “1” is inserted infront of our area code, but after the “9” or any commas that have been put in place.

Ex. – 914103581973 or 9,14103581973 or 9,,14103581973

r. Click on Settings to verify that the software is setup for your modem. Be sure thatthe correct “COM” Port is set up. You may confirm the COM Port by clicking onStart in the lower left portion of your screen, clicking on Settings, then ControlPanel and Phone and Modem Options. Look at the General Diagnostics tab orthe Modems tab to see the COM Port to which your modem is set.



s. Next, confirm that the correct modem has been selected on the Settings screen. Ifyour modem is not listed, we recommend that you use “28800 Generic” as thedefault, as shown:

t. Click OK on the Modem Setting screen to record your changes.

u. Each time you install WorldGroup Manager, the program will automatically insert acheck in the box next to “Log on as new user.” If you are a new user and have nottransmitted before, this is correct. Click on OK to go to step “w” below.

NOTE: If you are installing this software on a new computer, but yourfacility has been successfully submitting data on another, go to the “How toLogon” section of the Properties screen.

v. If you have successfully transmitted before, remove the check in the box marked“Log on as new user” and type in the User-ID for your facility. If you do not knowyour User-ID or password, contact MHCC at (410) 764-3460 or1 (877) 245-1762.

NOTE: We recommend that you do not enter your password in the box labeled“Password” for security.

w. Double click on the telephone icon. You will begin to hear the modem dialing toour BBS.

x. When you have connected successfully, you will be asked to type in your passwordand then go into the Health Data Connect software.

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2. TO LOGON TO THE WORLDGROUP MANAGER (WGM) THE FIRST TIME:

NOTE: You will need to apply for a HEALTH DATA CONNECT account.If you have used WorldGroup Manager previously and it is still loadedon your machine, you do not have to apply to Health Data Connect asecond time.

If you are using WGM on a new machine and have transmitted the survey previously, youdo not have to apply again. Please contact our office to walk you through the process to setup the new machine and use the old User-ID and password.

**** Because the application process may take a week, or five (5) working days, please applyto connect to Health Data Connect at least one week before attempting to submit your surveyto the Bulletin Board. ****

a) From the WorldGroup Manager screen, the HDC icon will appear. Before clickingon the icon, single click on File at the top of the screen.

b) Single click on Properties.

c) Locate “Log on as new user” in the large box at the bottom of the Online ServiceProperties screen. Single click to place a check in the box.

d) Single click on OK.

e) Double click on the WorldGroup Manager icon. The following screen will appear.

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f) You will need to complete the application by providing the following information:

Name: (Use the facility name. This will become your User-ID.)Company Name: (Use the contact person’s name. This will become the

first line of your facility’s address)

NOTE: Although this may seem odd, it is the correct way to complete the applicationas a new user.

Street Address: (Type in the street address, including City, State & Zip Code.)Country: (Type in the Country.)Voice Phone: (Type in the contact person’s voice telephone number.)Password: (Use a facility-specific password, not a personal password.)

g) The name and password in the application will be used as your User-ID when youaccess the system in the future. Because the information submitted to theCommission is confidential, the security of Health Data Connect is extremelyimportant.

Please use a password with a length of 6-9 characters including at least one number.For example: LILACLA2. Please be careful not to leave your password where otherscan find it and please remember your User-ID and password. You will then beasked to answer questions about yourself and your company. Please answer thosequestions completely so the Commission will be able to send information back toyou later.

h) Single click on Re-prompt at logon.

i) Single click on OK.

j) At the password verification screen, re-enter the password, then click OK. See thescreen below.



k) The “Thank You” screen shown below will appear. Click OK to acknowledge.

l) The next time you logon to the HDC you will then be prompted to complete theHDC Registry. The application process may take a week, or five (5) working days.

m) Your application will then be processed by MHCC and it will be upgraded to aHealth Data Connect User. You will be contacted via fax once this has occurred, oryou may try to logon the next day to see if your status has been upgraded.

If you have not received a response within five (5) working days, please call DonnaBullen at (410) 764-3324.

3. WHEN YOU LOGON TO WORLDGROUP MANAGER THE SECOND TIME:

a) After you have applied to HEALTH DATA CONNECT, and your applicationhas been upgraded to ‘User’ status, you may logon to Health Data Connect.

b) You may see a gray screen when you actually enter the WorldGroup Managersoftware for the first time. This means the software in your computer isautomatically downloading new files for WorldGroup Manager from the BulletinBoard. When the download is completed, the screen below will appear. The grayscreen may also appear at other times.



c) Upon connecting to Health Data Connect you will be taken to a message marked“Health Data Connect – Announcements.” Click Close to continue.

d) If you are entering the survey for the first time you will automatically a message thatyou have not filled out your Registry entry yet. Click on the message “You haven’tfilled out your Registry entry yet…” and you will be taken to the ‘Registry’ screen.

e) Be sure to complete the ‘Registry’. Failure to do this will delay the processing of thetransmission of your survey. It is your responsibility to maintain the ‘Registry’ withthe most current information for your facility. MHCC issues the receipt for the



transmission to the Contact Name and Fax Number on file in the ‘Registry’. Forinstructions, see #4 below in this section.

f) You will also have two e-mail messages – “Welcome new user” and “Class SwitchNotification.” You may find it very helpful to read both of them.

g) If you have previously transmitted your survey to MHCC, you will be taken directlyto the “Home” page (first screen) as shown below, labeled “Electronic DataSubmission.” Here you will be able to use options for e-mail, downloadingprograms from the library, or select the Subacute Care Survey. Available options canbe identified when the mouse arrow changes to a pointing hand symbol.

Home Page

4. TO REGISTER FOR THE MARYLAND SUBACUTE CARE SURVEY:

Please be sure to complete the Subacute Care Survey Registry in the Health Data Connect. This Registry isseparate from the application and the information will be used to generate receipts from the Commission whenyour file is transmitted.

Each facility that will be transmitting the survey should be listed with the World Group Manager in theRegistry by the facility name. It is your responsibility to maintain your information on the Subacute CareSurvey Registry whenever your facility information changes. Be sure to keep the Contact Person’s name andtelephone numbers up to date.



a) From the Main Menu, click on Subacute Care Survey.

b) Click on Registry.

c) Click on File.

d) Click on Edit your Entry. The screen below will appear.

Registry

e) The following information will be requested:Facility NameContact nameJob Title of the contact personPhone Number of the contact personFax number of the contact personSurvey(s) to be submitted (by the facility)Summary (Type in the Contact Person’s name)

f) Click on Save.

5. TRANSMISSION OF THE AUTOMATED SURVEY DATA:

***NOTE: Each time you transmit the data be sure to let MHCC know whether ornot you experienced technical problems during the data collection and transmissionprocess or no problems at all. Particular events to advise the Commission of include:



a computer crash during the data collection, you switched to a new computer, thecomputer did not close properly, or other technical problems. ***

a) For instructions on how to create the data file, see section VIII-A. of this UserManual. You can proceed only after the file has been created and zipped, andWorldGroup Manager software has been installed.

b) Click on the telephone icon for Health Data Connect in the WorldGroup Managergroup.

c) Enter your password when the software requests it.

d) You will see a “Health Data Connect” announcement when you enter the software.Click OK.

e) Click on the Maryland Subacute Care Survey icon.

f) Click on Data Submission.

g) You will be asked to choose the file you want to send. To find that file, go to theroot directory of the drive on which you installed the Subacute Care Survey. Fromthat root directory, go to the “msacs” folder. Click on the file that was created andzipped in the Subacute Care Survey software, then single click on OK.

File to Transmit

h) If you are unable to locate the name of the file, return to the Subacute Care Surveysoftware and zip the file again, this time noting the name and location of the filelisted at the end of the process.

i) The data file that you created when you ran error reports and zipped the file fortransmission (for instructions see section VIII.A.) will have a unique name everytime you create the file.



The name of the file:

The first seven positions will always be the same. They are your Facility ID Number.The eighth position is the number of times the file has been created for transmission.

The first (1st) position after the dot (.) is always the letter “e”, which reports that thisis an electronic file for Subacute.

The second (2nd) position after the dot (.) is the last digit of the calendar year of thedata being submitted.

The third (3rd) position after the dot (.) is the quarter of the data being submitted.

For example in the case that the data file is named 88888882.e24 - The first sevendigits are 8888888, the facility ID; the eighth digit, 2, reports that the facilitygenerated the file two times for this quarter; e reports that this is the electronic file, 2is for year of the data (2002), and 4 is for the fourth quarter of 2002. In the case ofthe file for Record 7 (R7) the last position will always be a 7 (88888882.027).

j) You will then be prompted to enter a description of the file. Be sure to include thename of the staff person to receive the FAX receipt, your current fax number, yourfacility name, and any special comments. NOTE: Be sure to include a statementabout whether you experienced technical problems during the data collectionand transmission process, or no problems at all. Particular events to advisethe Commission of include: a computer crash during the data collection, youswitched to a new computer, the computer did not close properly, or othertechnical problems. When this information is complete, single click on OK.

Description



k) NOTE: When you upload a file to Health Data Connect, a progress bar will appearin the background that will show how much of the file has been sent. If the Mainscreen of Health Data Connect is covering your entire screen, you will not see thisprogress bar. In that case, you may see this bar when part of the right hand side ofyour screen showing. You can do this by dragging the main screen to the left or byincreasing the resolution of your screen (600 dpi X 800 dpi works well), or byminimizing the Main Menu. After the message says 100%, it will take a couple ofminutes to complete processing the task. When completed, that small screen willclose automatically.

l) To return to the home page, single click on File from the menu. Single click onExit from the drop down menu. If you do not receive a receipt via facsimile withinfive (5) working days, please call Donna Bullen at (410) 764-3324.

6. SPECIAL NOTES:

1) The MHCC server is checked for viruses each night with a virus checker andis updated frequently with the latest virus signature files.

2) You should be able to dial in any day (including holidays) between the hoursof 7:00 a.m. and 11:00 p.m.

3) Please be sure that you register with Health Data Connect well before youare ready to transmit your survey data. This will decrease the traffic on theBBS when other facilities will be trying to transmit their survey data, and toprevent delays in transmitting your survey data.



4) Problems and questions regarding the submission of the zipped survey datafile to the BBS should be addressed to:

Donna BullenSubacute Care Survey CoordinatorMaryland Health Care Commission

4160 Patterson AvenueBaltimore, MD 21215

Telephone: (410) 764-3460 or1 (877) 245-1762

FAX: (410) 358-1236E-mail: [email protected]

mailto:[email protected]

User Manual - Subacute Care Survey- 90 -

IX. UTILITIES______________________________________

Utilities are those processes that are not used in the day-to-day entryof survey information. These sections will help you customize,protect, and fix your program when you choose to do so. There arenine (9) utilities to help you with your software. To access the utility

section, select option 4 “Utilities” from the Main Menu. The screen below will appear.

A. BACKUP FILES – Choose this option to begin the backup session specified inthe “System Setup.” If you do not already have this capability at your facility, you musttake action to backup the Maryland Subacute Care Survey data. It is extremely importantto backup your data to protect your organization from data loss. The Maryland SubacuteCare Survey software will allow itself to backup by way of a MS-DOS backup command,but we strongly recommend that you assess your own unique backup needs based on yourhardware, operating system, and computing environment. Refer to Appendix E. forrecommended backup procedures.

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User Manual - Subacute Care Survey- 91 -

B. PASSWORD MAINTENANCE – Use this option to control access to thevarious system functions. Each option on the Main Menu, as well as “PasswordMaintenance” and “Purge Data Files” on the Utilities Menu, can be protected. Users havethe ability to assign different levels of security as shown below. The "Y" in each columnindicates that the user has rights to all aspects of that particular program feature. An "N"in any of the columns indicates that the particular user would not have access to thatfeature. Passwords are not active unless that option is chosen in the System Setup.MHCC recommends password protecting these files to maintain the confidentiality of thisinformation.

Upon entering this screen, the first user will be displayed in the Name field along with thePassword. Options at the bottom of the screen will allow you to manipulate theinformation as you choose. To choose the option you want, enter the first letter of theoption you choose and press [↵Enter]. The options are:

<N>EXT - Shows the next user and password in the file.

<P>REVIOUS - Shows the previous user and password in the file.

<L>AST - Shows the last user and password in the file.

<F>IRST - Shows the first user and password in the file.

<E>DIT - Allows you to edit the currently selected user and password shown atthe top of the screen.

<D>ELETE - Deletes the currently selected user and password shown at the topof the screen.

<A>DD - Adds a new user and password to the file.



You are able to password protect the following areas by marking an "N" (for No Access)as follows:

Purge - Prevents user access to 3 options on the Utilities Menu: Purge Data Files,Delete Individual Patient, and Change Patient ID Number.

Enter Data - Prevents user access to the “Enter Survey Information” option onthe Main Menu.

Reports - Prevents user access to the “Reports” option on the Main Menu.

Data Xfer - Prevents user access to the “Run Error Checks And Zip TransmissionFile” option on the Main Menu.

Utilities - Prevents user access to the “Utilities” option on the Main Menu.

Passwords - Prevents user access to the “Password Maintenance” option on theUtilities Menu.

C. PRINTER SETUP - Use this to choose your default printer type. This optionwill identify what kind of printer is being used. This option will not select the printer inyour facility to which you want to send the report; that must be set up by your IT staff.The printer you choose, or the currently defaulted printer, will be displayed in the “SystemSetup.” Choosing this option will give you the screen shown below. Simply highlight theprinter you would like and press [↵Enter].



When Printing Locally - Choose the printer that most closely matches theprinter connected to your PC.

When Printing on a Network - You will have access to printers set up by yourIT system administrator. The Maryland Subacute Care Survey softwarewill send the reports to your default printer (LPT1:). Highlight the printerfrom the list that most closely matches this printer. If you have problems,please call your IT system administrator.

D. REINDEX FILES - Use this whenever a "corrupted index" error message isreceived. “Reindex Files” should be run to correct the problem. If this does not work,call for technical support.

E. SYSTEM SETUP – This step should have been taken upon completing thesoftware installation. Changes at your facility may require you to make updates from timeto time. It is your responsibility to keep this data updated.

The top of the System Setup screen contains information to identify your facility,including facility name, street address, city, state, zip code, phone number, county code,MHCC assigned Facility ID Number, and MA Provider Number. This information isautomatically included with your submissions to identify your facility.

COLOR TYPE - If you are using a color monitor, mark a "C" for the “ColorType”, if your monitor is monochrome, mark this field with a"B".

COLOR LOGO - If the color MHCC logo causes problems with starting theprogram, or if it takes too long to load, “Color Logo” can bemarked with “N" to turn this feature off.



PASSWORDS - If you decide to use passwords to protect the confidentiality ofthe information entered into the Maryland Subacute CareSurvey software, you can turn passwords on by putting a "Y" inthis field. MHCC recommends using passwords. If you decideit is not necessary to use passwords, you can put an "N" in thisfield.

NOTE: If you wish to track who is using this program (username, date, time) you must have passwords turned on. Userswill then be tracked and an Audit Log can be printed from theUtilities Menu.

DEFAULT PRINTER - This will show the kind of printer that was selectedfrom the “Printer Setup” option on the Utilities Menu.

VERSION - This will show the current version of the software. It will changeeach time a new software version is installed.

COMMUNICATIONS – This field is currently not available. Skip to the nextfield. The field contains the start-up command for thecommunications software that will be used to send surveyinformation to MHCC via a modem. This command shouldinclude the drive and path of the communications software.

SYSTEM BACKUP - This field contains the start-up command for your backupsoftware. This field should include drive and path (ifnecessary). The default backup command is MSBACKUP.

F. PURGE DATA FILES - Removes old data on your computer that has been sentto MHCC.

This option can be used to delete old patient records as well as clear out audit loginformation. Simply choose which information you would like to delete, and the datethrough which you would like to purge, and that information will be deleted. Yourelectronic datafiles should be retained for at least two years.



You will be prompted prior to executing the “Purge” option. You must confirm yourintention prior to purging. Select “Y” (yes) to purge data; select “N” (no) to abort.

G. DELETE INDIVIDUAL PATIENT - Completely deletes a patient andadmission date from the file that was erroneously entered. To delete patient information,enter the incorrect Patient ID Number and Admission Date and press [↵Enter].

H. CHANGE PATIENT ID NUMBER - This option is used to correct a Patient'sID Number and/or an Admission Date that was entered incorrectly. To change thisinformation, enter the incorrect Patient ID Number and Admission Date under Old Dataand enter the correct Patient ID Number and Admission Date under New Data. All fileswill be automatically updated with new information.

I. PRINT AUDIT LOG - This option is used to print a log of users and timesconnected to the system. The audit file collects the date and time when a user logs in, logsout, or purges any data. This information is only collected when passwords are activatedin the System Setup. If this file gets too large, it can be purged with the “Purge DataFiles” option from the Utilities Menu.



X. TROUBLESHOOTING______________________________________

The following are common error messages the user may encounter while using thisprogram. Each error message is accompanied by the action the user must take to resolvethe problem, or the user is instructed to call technical support at Metro Data, Inc. Pleaseremember: when you encounter an error message, the first thing you must do is write itdown. If you do not see the error message in this list, then call technical support and readthe error message to them.

Note: Technical support is provided by Metro Data, Inc., Mondaythrough Friday from 9:00 AM to 5:00 PM. They can be reached at(410) 667-3600 or via email at “[email protected].” MetroData, Inc. does not recommend that you make any changes to yoursystem without contacting them first. If any changes need to be

made, you may want to contact your computer support person or network administrator,so that they may consult directly with Metro Data, Inc.

POSSIBLE ERROR MESSAGES:___________________________________________________________________________________

"File does not exist" - Call technical support.

"File is in use by another" - See if another user is in the same program; if not call technicalsupport.

"Record in use by another" - See if another user is in the same program; if not call technicalsupport.

"End of file encountered" - Exit program and try again. If problem persists, call technicalsupport.

"Record is out of range" or "Record is not in index" - This usually means an index has beencorrupted or the data or database was changed without the index active. The affectedindex file must be rebuilt by selecting the REINDEX FILES option from the UtilitiesMenu. If this does not correct the problem, call technical support.

Section

X

L O O K

$ Software Notes

% Very Important



"Cannot open file" - Try again. If the file still does not open, call technical support.

"File access denied" - Wait and try again later. If the error message continues, call technicalsupport.

"Cannot update file" - This is most likely a hardware problem. Contact your computersupport personnel.

"Invalid printer redirection" - Call technical support for assistance.

"Printer not ready" - Make sure all the printer cables are connected properly. See if you canprint from other programs first. If the error message persists, call your IT systemsadministrator or technical support.

"There is a problem with your printer" – First, check to see if your printer is turned On.Second, is your printer on-line? Third, check to see if the printer cables are tight betweenthe computer and the printer. If you still get this message, call your IT systemsadministrator or technical support.

"Too many files open" - The config.sys file needs to be changed, please call your IT systemsadministrator or technical support.

"The record you want is in use by someone else right now. Do you want to try again? (Y/N)" - If yousay "No" the program will discontinue the process it is working on and not all files will beupdated. Check and see if anyone else is in the same program. If not, wait and try again.If the error message persists, call technical support.

"There is a problem with the index(s) needed for this routine. You will be returned to the Main Menu." -From the Main Menu go to the Utility option and click on Reindex Files.

"Something has gone wrong and the system is attempting to write to a read only file." - Call your ITsystems administrator. If unable to resolve the problem, please call technical support forassistance.

"Whoops" - The operating system will not permit creation of a file that is required. Thismay arise for several reasons: 1) You do not have sufficient rights and should call your ITsystems administrator; 2) the disk or subdirectory is full; 3) you are trying to use an invalidname; or 4) A read-only file of the same name exists. If 1 - 4 apply, call your IT sytemsadministrator, otherwise call Metro Data, Inc.

"The system is unable to open the file you need." - One of two things may have happened: 1) youdo not have the correct user rights; or 2) the file has been erased. If 1 or 2 apply, call yourIT systems administrator, otherwise call Metro Data, Inc.



"A hardware error has occurred" - Your disk or directory may be full or there may be a diskfailure. Call your hardware technician or IT systems administrator immediately.

"A database has a problem" - You must restore your database from your most recent backup,or call technical support for assistance.

"Something seems to have corrupted your compiled code file" - Please call technical support forassistance.

"Your hardware and/or operating system returned an error during an attempt to read a file" - Pleasecall technical support for assistance.

"There is a problem writing the file to disk" - Check to make sure that the disk is not writeprotected or full. Call your IT systems administrator for assistance.

"An attempt was made to use an index containing fields not in the database" – Please call technicalsupport for assistance.

"An attempt was made to use an unavailable print device." - Either the printer you want is notsharable or the correct DOS PATH setting has not been made. You must leave thesystem and call your IT systems administrator or technical support.

"Something has scrambled your DOS memory" - Return to the DOS prompt and call technicalsupport.

"Out of disk space" - You have run out of disk space. Leave the system and return to theDOS prompt. Call your IT systems Administrator or technical support.

"Low files" - Your config.sys file needs to be adjusted upwards. This must be done fromDOS. Call your IT systems administrator or technical support for assistance.



“Index Error”When the user encounters an “indexing error” this box will appear on the screen.

The error message will guide the user to correcting the problem. After following theinstructions above, if the user is still receiving this message, call technical supportimmediately.

“The file you need is missing!”

This error message indicates that a crucial file is missing from the program. The screenexplains this and directs the user to call technical support.



“An error has occurred!”

When an error occurs during this program, a text box will appear indicating this. Press"Y" when you see the message and it will display the error message in full. Write down theerror message and call technical support

User Manual - Subacute Care Survey

SUBACUTE CARE SURVEY HARD COPY OFTHE DATA COLLECTION FORM______________________________________

Appendix

A


User Manual – Subacute Care Survey

QUESTIONS & ANSWERS

GENERAL QUESTIONS

______________________________________

(1) Which patients should the Subacute Care Survey be completed for?

A completed Subacute Care Survey must be submitted to the Commission for all patients discharged fromthe designated facility, or unit within the facility, who are admitted after September 30, 1995. If, forexample, a patient is admitted to the facility on October 1, 1995 and discharged on November 2, 1995,the Subacute Care Survey data elements for that patient would be included in the first quarterly submissionto the Commission. A patient admitted to the facility on September 2, 1995 and discharged on October10, 1995 should be excluded from the Subacute Care Survey. A patient who is less than two years oldshould be excluded from the Subacute Care Survey.

(2) Does the survey pertain to the patient’s condition at admission or at discharge?

Please refer to the table provided at the end of this Appendix for the approximate times that each itemshould be completed.

(3) Is a minimum length of stay (LOS) required in order for a patient to beincluded in the Subacute Care Survey?

No. The Subacute Care Survey should be completed for all patients discharged from the designated facility,or unit/service within the facility, who are admitted after September 30, 1995, including patients withlengths of stay of one day or less. See the next question for more details.

(4) Most of the survey items are required to be completed at admission. How is“admission” defined?

The period of time allowed for these items to be completed depends on the anticipated length of stay for thepatient.

(1) If the patient is expected to stay in the program for 14 days or longer, then most of these itemsmust be completed by the seventh day of the patient’s stay. (You may complete these items earlier

Appendix

B



if you desire.) Note: Many facilities complete the survey for all residents to ensure that the datahas been collected for the residents whose stay is longer than originally expected.(2) If the patient is expected to be discharged less than 48 hours after admission, then thefollowing items can be skipped: Cognitive Patterns, Activities of Daily Living, BehavioralSymptoms, Skin Condition on Admission, and Therapies Provided.

(3) A patient who has not been in the program long enough to generate any charges (i.e., theadmission was a “mistake” or the patient died within 48 hours of admission) should not beincluded in the survey.

(5) If a patient died, does the entire survey have to be completed?

Yes, if the patient died stayed in the facility more than 48 hours and subsequently died, complete all items.Discharge Information should be coded as follows: Patient Outcome should be coded as “6”. DischargeDestination should be coded as “77.” Early or Unplanned Discharge, and Reason for Early orUnplanned Discharge should both be coded as “7.” All ADL at Discharge items should be coded as“9”.

No, if the patient died within 48 hours of admission, follow the instructions, in Question 4, part 3 above,for patients expected to be discharged less than 48 hours after admission.

(6) How is the term “discharge” defined for the purposes of reporting data in theSubacute Care Survey?

A discharge is a patient who is formally discharged from the program, a patient who died, or a patient who(1) transferred from one bed licensure category to another bed licensure category within the same facility; (2)transferred from the designated subacute care unit/service to another area/service of the facility; (3)transferred to an acute care hospital or other health care facility and was subsequently readmitted,regardless of whether or not a bed was held for the patient during the absence from the facility. Forfacilities reporting data for Medicare-skilled patients only, a patient should be reported as discharged whenthe criteria for skilled care are no longer met.

(7) Should the survey be completed for patients who are not in a subacute healthcare status but who are placed in the subacute care unit?

No.

(8) Sometimes a patient who is admitted as subacute cannot be placed in anexisting designated subacute care unit because of overflow. This patient may beplaced elsewhere in the facility on a temporary basis until a bed in the designatedunit becomes available. When the patient is finally transferred to the unit, is thistransfer considered a discharge?

No.



(9) If a patient is admitted as subacute, is discharged to another part of the facility,and then readmitted as subacute, does the entire survey have to be completed forthat patient again (e.g., a patient who is transferred to an acute hospital for surgeryand then readmitted to subacute care)?

Yes.

(10) In some facilities, subacute and Medicare skilled patients are placed in thesame unit. If a patient’s status changes from subacute to Medicare skilled, but thepatient remains in the same unit, how should the change in status be recorded?

The change in status from subacute to Medicare skilled is considered a discharge, even if the patientremains in the same unit. The Discharge Destination should be recorded as “Other.”

(11) If a patient leaves the subacute unit but his/her bed is held is the patientconsidered discharged?

Officially, bed hold never affects the definition of discharge. If the patient leaves the subacute unit for 24hours or longer, he/she is always considered discharged. If the patient returns, a new survey must becompleted. (a) A patient who leaves the subacute program temporarily is not considered discharged ifhe/she returns within 24 hours (b) Also, a patient is not considered discharged if he/she has left theprogram for the purposes of family visitation. However, the total number of hours spent visiting the familyshould not exceed 24 hours. In either of these situations, a new survey should not be completed. Continueto record information using the original survey.

(12) How should respite care patients be handled?

A patient is admitted for respite care when the regular caretaker is unable to care for the patient or needstime to rest. Thus, the purpose of respite care is to provide relief for the regular caretaker. Never completea survey for a patient who has been formally admitted for the purposes of respite care. However, if a respitepatient becomes ill and is formally admitted to the subacute unit as a subacute care patient, then he/shemust be included in the survey until his/her status changes again and formal discharge occurs. In the caseof comprehensive care facilities, if a respite patient becomes a permanent resident, then he/she must beincluded in the survey once his/her status changes.

(13) MDS items incorporated in the Maryland Subacute Care Survey must becompleted for all discharges with lengths of stay less than 14 days. Doesn’t thisrequirement conflict with the CMS guidance that the MDS be completed only forpatients with a length of stay of 14 days or more?

The Maryland Subacute Care Survey incorporates several MDS items, but it is not the MDS; therefore,the length of stay requirements for the two surveys are different.



DEMOGRAPHIC INFORMATION

______________________________________

(1) Why does the survey require information on a patient’s Hispanic origin?

The Hispanic population is the fastest growing minority group in the United States. Standardized surveyssuch as the Census are beginning to collect information on this group.

(2) How should Area of Residence be coded for patients who live out-of-state or inforeign countries?

See Section VI. 3-G in this manual.

(3) How should Area of Residence be coded for patients who lived in aninstitution such as a nursing home?

If the patient lived in the institution for many years, then code the area of residence in which the institutionis located. If the patient was only in the institution for a short period of time (less than a year), then codethe area of residence in which the patient lived prior to institutionalization.

(4) What is the appropriate way to code a patient who is admitted as “Homeless”but is not discharged “Homeless?”

If the patient is admitted as Homeless, Living Situation Prior to Current Referral should be coded 6. Thecode for Discharge Destination should reflect the patient’s new place of residence.

(5) How should Living Situation Prior to Current Referral be coded for a patientwho lives in an apartment attached to a residence?

Determining the individual who owns or maintains the patient’s place of residence may help in decidingwhich category to code. For instance, if the patient lives in an apartment that is attached to the residence ofa child, a code of “2” may be most appropriate.

(6) How should Living Situation Prior to Current Referral be coded for:(a) a patient who was a resident of a nursing home;(b) a patient who lived in a boarding home; or(c) a patient who lived in senior assisted housing?

If the patient was a resident in any of the following settings prior to admission to the subacute program,then the appropriate code would be “4” for “With Unrelated Persons in Institutional Setting.” Suchsettings may include: ICF-Mentally Retarded, Comprehensive Care Facility, Extended Care Facility,Rehabilitation Hospital, Chronic Hospital, Psychiatric Hospital, Acute Care Hospital, or VeteransAdministration Hospital.



If the patient was living in a community-based settings, then the appropriate code would be 8 for “OtherLiving Situation.” Such settings may include: Adult Foster Care/Project HOME, Senior AssistedHousing, Boarding Home, CCRC (Independent Living Unit or Assisted Living/Domiciliary Care),Domiciliary Care, or Assisted Living.

DISCHARGE INFORMATION

______________________________________

(1) Sometimes, a patient may be discharged from subacute care but remain 2-3days as private pay in a regular comprehensive care bed for extra care. All along,the intention is for the patient to be discharged home. (a) When is such a patientconsidered discharged from subacute care? (b) If the patient is considereddischarged when his/her treatment has been completed, what is the dischargedestination for the patient who remains in the subacute unit? (c) If the patient’seventual discharge destination is home, won’t the assessment of the program’sefficacy be contaminated if discharge destination is coded any other way?

(a) The patient is considered discharged when he/she is no longer receiving a subacute level of care. (b) Thedischarge destination for the patient should be coded “88” for “Other.” (c) Even though the intent is tosend the patient home, in actuality, the patient is not going home directly after the subacute treatment hasended. Therefore, it would not be valid to code the patient’s discharge destination as “private residence.” Itwould be equally misleading to label the patient’s discharge destination as “comprehensive care.” Since thecurrent version of the survey does not include a code for “respite care,” at this time, the best alternative is“Other.” The purpose of the Subacute Care Survey is not to evaluate the efficacy of individual programs.However, it is important to understand the purposes being served by the programs in general.

COGNITIVE INFORMATION

______________________________________

(1) How are the other survey items coded if the patient is assigned a code of “1”for Comatose?

If the patient is Comatose at Admission, the following Cognitive Pattern items should be skipped: AllMemory/Orientation items, Cognitive Skills for Daily Decision Making, and Behavioral Symptoms.You will need to enter a code other than “7” if the patient is not comatose at discharge.



SKIN CONDITION

______________________________________

(1) A patient may have a skin ulcer that cannot be classified as stasis or pressure.What types of skin ulcers should be included when completing the items thatmention ulcers in general (e.g., “Ulcers: Number of Sites” and “Ulcer Care”)?

For the purposes of the Subacute Care Survey, consider only stasis and pressure ulcers when completingthese items. Other types of “ulcers” may be more accurately categorized as open lesions or skin tears/cuts.Please note that surgical tape may result in several types of skin problems, including pressure ulcers.

PRINCIPAL AND OTHER DIAGNOSES

______________________________________

(1) If a patient is admitted for two equally important reasons, how should“principal diagnosis” be coded?

The principal diagnosis is the medical condition that directly resulted in the patient’s admission to theprogram. If a patient has two equally important diagnoses, consider the effect of each diagnosis on thepatient’s condition as a whole. For instance, a patient may be admitted after a fall during which he/shebroke both an arm and a hip. The broken hip may be the injury that incapacitated the patient because itrestricted mobility. Therefore, the broken hip may be the primary reason for the patient’s admission to thesubacute care program, and should be used as the principal diagnosis. Remember, there can be only oneprincipal diagnosis.

(2) If a patient is admitted for post-hip-replacement therapy, what is the patient’sprincipal diagnosis?

Principal diagnoses may not be V-codes. Always ask yourself why the patient needed hip replacement inthe first place. For instance, the principal diagnosis may be hip fracture or arthritis. The hip replacementitself may be a secondary diagnosis. Secondary diagnoses and other diagnoses identified during the patient’sstay may be V-codes.

THERAPIES PROVIDED

______________________________________

(1) Should respiratory therapy be counted if it is administered by a nurse?

Yes.



(2) Does respiratory therapy include trach masks? Does respiratory therapyinclude nebulizers?

Yes.

(3) If a physical therapist provides surgical wound care, is the care reported as“Physical Therapy” or “Surgical Wound Care?”

Whenever a physical therapist provides care of any sort, the period of treatment should be considered in thetotal number of days of physical therapy. Additionally, if the treatment provided is specifically mentionedin the category labeled “Special Treatments and Procedures,” the number of days and frequency of thetreatment should be recorded here as well. Therefore, if a physical therapist provides surgical wound care,the number of days of physical therapy would include surgical wound care; furthermore, the days andfrequency of treatment would also be recorded under the item “Surgical Wound Care.”

(4) Is whirlpool therapy counted as physical therapy?

If whirlpool therapy is administered by a physical therapist, it is counted as physical therapy.

(5) Where should cognitive therapy be reported?

Cognitive therapy is not reported on the Subacute Care Survey.

SPECIAL TREATMENTS AND PROCEDURES

______________________________________

(1) How should IV antibiotic administration be recorded? This form of IV isalmost always drip rather than push.

For the purpose of the current survey, the item “Intravenous Med. Admin. (IV Push)” (under “SpecialTreatments and Procedures”) should include all forms of IV medication, including IV push and IV drip.Therefore, IV antibiotic administration should be recorded under this item.

(2) Why does the survey ask whether central lines have been inserted in thesubacute care unit? It is common knowledge that the insertion of all central linesis a complicated process that requires equipment usually available in acute carehospitals only.

This assumption is incorrect. Only certain types of central lines must be inserted in a sophisticated settingsuch as that provided by acute care hospitals (i.e., Hickman catheters and Groshong lines). The types ofcentral lines referred to by the survey are internal jugular, external jugular, and subclavian. These types oflines can be inserted in a subacute unit by a physician. They require only an X-ray to ensure that theirinsertion is correct. Peripheral IV and PICC lines can also be inserted in a subacute setting by a nurse



without the aid of a physician. Note: The Maryland Health Care Commission does not advocate theinsertion of central lines by all subacute care programs. Each program must assess its own capability todeliver health care in a safe and effective manner.

(3) The in-house provision of particular treatments (e.g., radiation, dialysis) mustbe indicated on the survey form. (a) What is the definition of in-house? (b) Doesin-house refer to the subacute care unit? (c) If subacute care is administered in aunit of a larger facility (e.g., acute care hospital), is the entire facility considered in-house?

In-house is defined as within the same facility. For instance, certain services may not be available withinthe subacute unit itself (e.g., dialysis); however, these services may be provided in another unit housed withinthe same facility. In such a case, the service is considered to be provided “in-house.” As a rule of thumb, ifa patient receives services in an area that has the same facility number as the subacute unit, the service isconsidered “in-house.” Exceptions may occur. For instance, two parts of a facility may have differentfacility identification numbers solely due to differences in licensure. A comprehensive care patient, forexample, may receive radiation therapy in a chronic hospital. Although both the comprehensive care unitand chronic hospital may be part of the same facility, they may have different facility identification numbers.In this case, the service should still be considered “in-house.”

(4) If a subacute program contracts with another organization to provide a service,such as dialysis, to its patients in the facility that houses the subacute program, isthis service considered to be in-house?

Because the service is provided on the same site as the subacute program the service is considered to be in-house.

(5) There is no Special Treatment option for patients who require ostomy care.How should such treatment be reported?

Ostomy care is not reported on the Subacute Care Survey. However, if a patient had an ostomy, theappropriate ICD-9 V-code should be entered as an Other Diagnosis.

(6) For Other Treatments, such as blood transfusions and hemodialysis, the surveyrequests information on days and frequency. Do we need to record the number ofdays per week that the treatment was given or the number of days for the patient’sentire length of stay?

You should record the total number of days that the treatment was given for the patient’s entire stay. Forinstance, if a patient received suctioning three times a day each day of his/her stay, and the length of staywas five days, then the total number of days of the treatment is five. The frequency of treatment, as orderedby the physician, is 3D (three times a day). If a patient received treatment as needed (PR), then suctioningmay have occurred several times on one particular day and only one time on another day. In this case,record the number of days that suctioning occurred, regardless of the number of times per day. Thefrequency would be PR.



(7) There may be active orders for a patient to receive a certain treatment for threetimes a day for two weeks, but the patient may receive the treatment three times aday for only one week. How should this treatment be coded?

The frequency of the treatment should always be coded according to the doctor’s orders, as recorded in thepatient’s chart. In this case, the frequency would be 3D. However, the total number of days that thetreatment was received should reflect reality. In this case, the patient received 7 days of treatment, not the14 days that were ordered.

(8) What is the best way to code hyperbaric therapy?

Determine the purpose of the therapy. In many cases, the purposes would be surgical wound care.

FINANCIAL INFORMATION

______________________________________

(1) What should be done if a patient’s primary payment source changed betweenadmission and discharge?

The User Manual states that the Primary Payment Source refers to the one funding source that paid orwas expected to pay for the greatest amount (at least 51%) of the total charges incurred by the patient.Therefore, even if a patient expected, upon admission, that a particular source would pay for most ofhis/her care, the actual primary payment source would be determined upon the patient’s discharge.



DATA SET COMPLETION TIMETABLE_____________________________________________________

The following chart indicates the approximate time when each item

should be completed (per patient):

Measurement Period

Data Item On

Admission

On

DischargeDuring

Stay

Reference

MDS 2.0

I. IDENTIFICATION INFORMATION Facility ID# Patient ID#1

Bed License Type

√√√

------AA.5------

II. LENGTH OF STAY Admission Date Discharge Date

√√

AB.1R.4

III. DEMOGRAPHIC INFORMATION Gender Race2

Date of Birth Estimated Age in Years Ethnicity2

Area of Residence ZIP Code Marital Status Living Situation Prior to Current Referral Treatment Plan Goal

√√√√√√√√√√

AA.2AA.4AA.3------AA.4------AB.4A.5------------

IV. ADMISSION INFORMATION Source of Admission √ ------

V. DISCHARGE INFORMATION Patient Outcome Early or Unplanned Discharge Reason for Early or Unplanned Discharge Discharge Destination

√√√√

------------------------

VI. COGNITIVE PATTERNS Comatose Memory/Orientation Cognitive Skills for Daily Decision Making

√√√

B.1B.2B.4



VII. ADLs (Activities of Daily Living) Bed Mobility Transfer Eating Toilet Use

√√√√

√√√√

G.1 aG.1 bG.1 hG.1 i

VIII. BEHAVIORAL SYMPTOMS3

Wandering Verbally Abusive Behavior Physically Abusive Behavior Socially Inappropriate Resists Care

√√√√√

E.4 aE.4 bE.4 cE.4 dE.4 e

IX. SKIN CONDITION Ulcers Stage 2 (Number of Sites) Stage 3 (Number of Sites) Stage 4 (Number of Sites) Type of Ulcer Pressure Ulcer Stasis Ulcer Other Skin Conditions Burns (Second/Third Degree) Open Lesion (Other than Ulcer) Skin Tears or Cuts (Other than Surgery) Surgical Wounds

√√√

√√

√√

√√

M.1 bM.1 cM.1 d

M.2 aM.2 b

M.4 bM.4 cM.4 fM.4 g

X. PRINCIPAL AND OTHERDIAGNOSES Principal (ICD-9) Diagnosis on Admission Other (ICD-9) Diagnoses on Admission

√√

------------

XI. Additional Diagnoses (ICD-9) IdentifiedDuring Stay √ ------

XII. THERAPIES PROVIDED4

Speech-Language Pathology & Audiology Occupational Therapy Physical Therapy Respiratory Therapy

√√√√

P.1 b.aP.1 b.bP.1 b.cP.1 b.d.



XIII. SPECIAL TREATMENTS ANDPROCEDURES5

Medication Administration IV Chemotherapy Intravenous Med. Admin. (IV Push) PO Med. Admin. IM/SQ Med. Admin. Administration of Nutrients/Fluids Hyperalimentation Intravenous Fluid Admin. Tube Feeding Monitoring Anticoagulation Monitoring Blood Sugar Monitoring Apnea Monitoring Blood Gas Monitoring/Pulse Oxymetry Cardiac Monitoring Care of Tubes/Catheters (Frequency of

Treatment) Chest Tube Drainage Other Drainage Tube Percutaneous Catheters Tracheostomy Care Indwelling Urinary Cath/Irrigation Peripheral IV, PICC, or Central IV Line Other Treatments (Frequency & Total

Number of Days) Blood Transfusion Hemodialysis Oxygen Therapy Peritoneal Dialysis Suctioning Surgical Wound Care Ulcer Care Ventilator Care Ventilator Weaning Radiation Therapy

√√√√

√√√

√√√√√

√√√√√√

√√√√√√√√√√

P.1 a. aP.1 a.c------------

K.5 a------K.5 b

------------------------------

------------------P.1 a.j------------

------------P.1 a.g------P.1 a.iM.5 fM.5 eP.1 a.l------P.1 a.h

XIV. FINANCIAL INFORMATION Primary Payment Source6

Secondary Payment Source√√

A.7------



Notes:

1. The Patient ID Number in the Subacute Care Survey consists of the last six digits ofthe Social Security Number. MDS 2.0 includes the full Social Security Number.

2. MDS 2.0 combines Race/Ethnicity in a single data item.

3. The Behavioral Symptoms in the Subacute Care Survey include the categories listed inthe MDS 2.0 and the frequency coding provided in Form 3871. Alterability is not codedin the Subacute Care Survey.

4. The data collected on Therapies in the Subacute Care Survey includes Number of Daysduring entire stay. The therapy must be administered for at least 10 minutes during anyone day to be counted. MDS 2.0 includes only Number of Days in the last 7 calendardays. The therapy must be administered for at least 15 minutes during any one day to becounted.

6. The data collected on Special Treatments and Procedures in the Subacute Care Surveyconsists of Frequency and/or Number of Days for the following items: TracheostomyCare, Oxygen Therapy, Suctioning, Surgical Wound Care, Ulcer Care, Ventilator Care, andRadiation Therapy. MDS 2.0 includes only whether or not these treatments/procedureswere received.

7. The Payment Source/Payment Type data items in the Subacute Care Survey includeresponse categories not used in the MDS 2.0.


SAMPLES OF SOME OF THE REPORTS______________________________________

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SUMMARY OF INTERDEPENDENT DATAITEMS AND CONSISTENCY CHECKS_____________________________________________________

Record/Section

[F10] “pop-up avail? Data Item Interdependent Items Consistency Checks

R1-7 Part I No Facility ID # Required field.R1-7 Part I No Patient ID # Required field - Must be 6-digits, or

if less than 6-digits, start with theletter "N" (field is left-justified).

R1-7 Part I Yes Bed License Type Required field.R1-7 Part II No Admission Date Discharge Date Required field - The Admission

Date coded must be October 1, 1995or later.

First two characters of the year mustbe 19 or 20.

The program automatically checksthe month, day, and year for validvalues.

R1-7 Part II. No Discharge Date Admission Date Required field for submission - TheDischarge Date coded must be equalto or greater than the AdmissionDate.

First two characters of the year mustbe 19 or 20.

The program automatically checksthe month, day, and year for validvalues.

If the Discharge Date is not coded,then the following data entryscreens will NOT appear:

• Discharge Information• Behavioral Symptoms• Skin Condition• Additional Diagnoses

Identified During Stay

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• Therapies Provided• Special Treatments and

Procedures• Financial Information

If the Discharge Date is not coded,then the data entry program willNOT permit entry of dischargevalues for the following items:

• ADLs – on Discharge

If the patient is discharged less than48 hours after admission, then thedata entry program will not permitentry of the following items:

• Cognitive Patterns• ADLs (On Admission/On

Discharge)• Behavioral Symptoms• Skin Condition• Therapies Provided

NOTE: The calculation of less than48 hours is based on the Admissionand Discharge Dates (e.g., a patientadmitted on 10/5/02 and dischargedon 10/7/02 would be counted as atwo-days or less than 48 hr. Lengthof Stay).

R1-7 Part III No Gender Patient Suffix(i.e., Mr. Mrs., Ms.)

Required field - If Patient Suffix =Mrs. or Ms. then Gender must becoded '2' (Female).

If Patient Suffix = Mr. then Gendermust be coded “1” (Male).

R1-7 Part III Yes Race Required field.R1-7Part III

No Date of Birth Admission DateDischarge Date

Estimated Age

Required field – Either Date ofBirth or Estimated Age must becompleted.Date of Birth must be less thanAdmission Date; Greater than orequal to 01/01/1875 and must atleast 730 days prior to the DischargeDate.

Year of Birth cannot be the currentYear.

Date of Birth will be skipped ifEstimated Age is entered with otherthan "777", “1” or blank.



NOTE: Program will calculate ageand automatically enter "777" forEstimated Age when a valid DOB isentered.

R1 Part III No Estimated Age (inyears)

Date of Birth The Estimated Age must be greaterthan 1 and less than 150 years or =777. If the Estimated Age = 777,then a message will appear that“777” is not valid if the DOB isblank.

R1 Part III Yes Ethnicity Required field.R1 Part III Yes ZIP Code of

ResidenceRequired field.

R1 Part III Yes Area of Residence ZIP Code Required field - If the ZIP Code isincluded in the Maryland ZIPCode/County database, then theArea of Residence code must bevalid for the ZIP Code. If the Areaof Residence is greater than 30 andthe ZIP Code is not in the MarylandZip Code/County database or if theArea of Residence = 99, then theprogram will accept the Area ofResidence.

R1 Part III Yes Marital Status Required field.R1 Part III Yes Living Situation

Prior to CurrentReferral

Marital Status Required field - If Marital Status iscoded 1 (Never Married), 4(Divorced), 5 (Widowed), or 9(Unknown), then Living SituationPrior to Current Referral cannot becoded 1 (With Spouse).

R1 Part IV Yes Source ofAdmission

Required field.

R1 Part V Yes Patient Outcome Required field - If Patient Outcomeis coded "6" (Death), then theprogram will automatically enter"7" or ”77” (Not Applicable) in thefollowing items:

• Early or UnplannedDischarge

• Reason for Early orUnplanned Discharge

• Discharge Destination

If Patient Outcome is coded "6"(Death), the program willautomatically enter: "9" (Unknown)for all Activities of Daily LivingItems on Discharge.



R1 Part V No Early orUnplannedDischarge

Patient Outcome Required field - If Patient Outcomeis coded "6" (Death), then theprogram will automatically enter"7" (Not Applicable) in Early orUnplanned Discharge.

R1 Part V Yes Reason for Earlyor UnplannedDischarge

Early or UnplannedDischarge

Patient Outcome

Required field - If Early orUnplanned Discharge is coded "0"(No), then program willautomatically enter "7" (NotApplicable) in Reason for Early orUnplanned Discharge.

If Patient Outcome is coded “4" (NoChange) or “5” (Patient Decline),then Reason for Early or UnplannedDischarge cannot be "4” (PatientImproved).

If Patient Outcome is coded "6"(Death), then the program willautomatically enter "7” (NotApplicable) in Reason for Early orUnplanned Discharge.

R1 Part V Yes DischargeDestination

Patient Outcome

Reason for Early orUnplanned Discharge

Required field - If Patient Outcomeis coded "6" (Death), then theprogram will automatically enter"77" (Not Applicable) in DischargeDestination. The code of “77" inDischarge Destination is only validwhen Patient Outcome is ”6”.

If Reason for Early or UnplannedDischarge is "2" (Conditionrequired admission to other healthfacility) then Discharge Destinationmust be another health facility(codes 20 through 38).

R2 Part VI No Comatose Required field.R2 Part VI No Memory/

OrientationComatose Required field - If Comatose is

coded "1" (Yes), thenMemory/Orientation items are leftblank.

R2 Part VI No Cognitive Skillsfor Daily DecisionMaking

Comatose Required field - If Comatose iscoded "1" (Yes), then CognitiveSkills for Daily Decision Making isleft blank.



Required field - If patient dischargeis within two days of admission,entry of ADL data items notrequired.

Self Performance and Staff Supportare checked for consistency usingthe following standards:

If SelfPerformance:

01234

8*9**

Staff Supportmust be:

0, 1, 20, 1, 2, 30, 1, 22, 32, 38*9**

R2 Part VII Yes Activities ofDaily Living(ADLs)

Admission DateDischarge DatePatient Outcome

* Self Performance and StaffSupport “8” is only valid for BedMobility and Transfer.

** Self-Performance and StaffSupport “9” is only valid for theAdmissions. It is not valid for theevaluations at Discharge.

R2 Part VIII Yes BehavioralSymptoms

Admission DateDischarge DateComatose

Required field - If Comatose iscoded "1" (Yes), then BehavioralSymptom data items are left blank.

If patient discharge is within twodays of admission, entry ofBehavioral Symptom data items isnot required.

R3 Part IX No Ulcers: Numberof Sites

Admission DateDischarge Date

Required field - If patient dischargeis within two days of admissionentry of Number of Ulcer Sites isnot required.

Number of Sites must be > 0 or <=99.

"77” and “99" are invalid number ofsites. These numbers are reservedfor Not Applicable and Unknown,which are not valid answers for thisdata item.



R3 Part IX No Types of Ulcer(Highest Stage)

Ulcers: Number ofSites (By Stage)Admission DateDischarge Date

Required field - If Number of Sites= 0, Type of Ulcer (Highest Stage)must = 0 for both Pressure andStasis Ulcers. If there are UlcerSites, the Type of Ulcer must begreater than “0” for at least onetype. If Stage 2 (Number of sites) isgreater than “0”, then Type of Ulcer(Highest Stage) must be “2” forStasis or Pressure. (NOTE: Thissame edit applies to Stage 3 and 4(Number of Sites.)

If patient discharge is within twodays of admission, entry of Type ofUlcer is not required.

R3 Part IX No Other SkinConditions


Required field -If patient dischargeis within two days of admission,entry of Other Skin Conditions isnot required.

R3 Part X Yes Principal/OtherICD-9 Diagnoseson Admission forCare

Principal Diagnosis - Requiredfield. V-codes and E-codes cannotbe used for Principal Diagnosis.

The Principal Diagnosis codecannot be repeated in coding OtherICD-9 Diagnoses on Admission.

A code entered once under OtherICD-9 Diagnoses on Admissioncannot be repeated.

All codes are validated usingInternational Classification ofDiseases - Ninth Revision, ClinicalModification (ICD-9-CM), Sixthedition. (2002)

R3 Part XI No Additional ICD-9 DiagnosesIdentified DuringStay

Principal DiagnosisOther Diagnoses

A Diagnosis Code entered asPrincipal or Other Diagnosis 1-9cannot be repeated in AdditionalICD-9 Diagnoses Identified DuringStay.

R5 Part XII No TherapiesProvided


Required field - The number of dayscoded for Therapies Provided mustbe less than or equal to Length ofStay or coded "0" for None.

If patient discharge is within twodays of admission, entry ofTherapies Provided is not required.



R5 Part XIII Yes SpecialTreatments andProcedures

Admission DateDischarge DateNumber of Days

Required field - The number of dayscoded for Special Treatments/Procedures must be less than orequal to the Length of Stay or coded"0" for None.

If Days = 0, then data entry programwill assign "77" (Not Applicable) toFrequency.

If Days > 0, then frequency cannotbe “77” (Not Applicable)

R6 Part XI Yes Primary PaymentSource

Required field.

R6 Part XI SecondaryPayment Source

Primary PaymentSource

Required field - The Primary andSecondary Payment Sources cannotbe the same.



RECOMMENDED BACKUP PROCEDURES_______________________________In today's technological working environment, almost everyone relies on a computer tostore documents, correspondence, financial reports, and many other invaluable resources.

Imagine working for weeks or months on something and then it is all lost because acomputer file is deleted or damaged. While hardware can be replaced and applicationsoftware reloaded from original media, recovery of data files relies on regular backupprocedures.

MHCC strongly urges you to make routine backups of yourSubacute Survey program and data files.

These questions can help you identify the adequacy of your current backup procedure:

• Are faculty and staff aware of their personal computer backup options? Dothey have instructions for the options and recommended backup cycles?

• Do we regularly backup department servers?• Does our server backup procedure include secure off-site storage?• Do we periodically test restoration of personal and server files?• Do users store all local data in a single directory to simplify backup of personal

data and ensure that all data is captured?• Do we prohibit the use of e-mail folders for document storage?• Do we periodically review our backup needs?

An answer of "No" to any of the above questionsindicates a risk for which remedial steps should beconsidered.

It should be a top technology priority for every computer user to ensure that the data onfaculty and staff machines is backed up on a regular basis to a secure place. There aremany ways to do this. If your facility owns a fileserver, such as a Novell NetWare,Windows NT, Windows 2000, Macintosh, Unix or Linux server, system users can save all

Appendix

E



their data to their server accounts. This approach assumes the department server is usinga proven backup and restore procedure.

Alternatively, storage hardware such as a Zip drive or Tape Drive can be purchased foreach user’s computer, and each person is then responsible for performing her or his ownbackups.

To help insure that users are diligent about saving their data, software can be purchasedthat allows backups to be run automatically, at any time of the day or night, as long as thecomputer is left on and the storage medium is ready.

Think of your backup device as a recovery unit!

The following procedures can maximize the opportunity to recover data. Keep in mindthat these are just recommendations. Please have your computer support personnelreview your current procedures to ensure that they are adequate.

A. Start with 12 tapes and label them as follows:1) Monday 2) Tuesday 3) Wednesday 4) Thursday5) Week One 6) Week Two 7) Week Three 8) Week Four9) Week Five 10) Spare One 11) Spare Two 12) Spare Three

B. Use each of the first four tapes on the respective days of the week: Mondaythrough Thursday. Each morning, the previous day’s tape should be removedfrom the drive unit and placed in a fireproof safe or taken off the premises by acompany owner or member of management. This step must be followed. If thetape is lost or destroyed in a fire or storm, data is also lost, even if all otherprocedures are perfect. If your physical plant is destroyed, retention of vital datasuch as Accounts Receivable, Orders, Estimates, Inventory and the like couldmean the difference between remaining in business or not. Even when acompany’s computers are lost in a physical disaster, data from a tape can berestored to replacement equipment. Activities such as receivables collection andfiling insurance claims can begin quickly. Such tasks will take far longer (or may beimpossible) if data has to be reconstructed or cannot be recovered. In the event ofa natural disaster, many areas of the facility will need the attention of the IT systemadministrator, which can delay the restoration process of the data for the Subacutecare Survey.

C. Use each of the five weekly tapes on the respective Friday of the month: 1st, 2nd,etc. Not all months have five weeks, so you won’t use all five every month. Onthe following working day, each Friday’s tape should be stored or taken offpremises just like any other tape.

D. At the end of the first quarter of the calendar year, or your fiscal year, use the #1(Monday) tape to backup, no matter the day of the week the quarter end falls on.



Label the container for the tape as Q1, 20XX and label the tape itself with the dateof the backup. Replace it with a brand new tape labeled "#1 Monday." At the endof the second quarter, do the same with the #2 (Tuesday) tape and so on. Thesequarterly data collections should be archived off-premises (as in a company safe-deposit box) and retained indefinitely. In this manner, the four most heavily usedtapes are replaced annually. Replace all "weekly" tapes every two to three years onthe same anniversary (such as the end of the fourth quarter).

E. Use a "Spare" tape any time the scheduled cartridge is not available, and put it intothe regular rotation. If you have to use "Spare One" on a Wednesday, forexample, don’t record on the cartridge again during that week.

Alternative 1: Replace the spare with the original tape when it again becomesavailable. If it does not, obtain a replacement tape.

Alternative 2: If the original again becomes available, it should be put back intorotation and the "Spare" returned to spare status. If the original tape can nolonger be used, re-label the "Spare" and use it in daily rotation. Label and use anew tape as the spare.

By using this procedure, a significant amount of time will be saved if the data needs to berestored. You will be creating the following archives:

1) A week’s worth of data is constantly available on tape, along with a month’s worthof backups at weekly intervals. If you find that a file needs restoration or rollingback to an earlier version, you have several data sets to select from.

2) Tape cartridges are replaced routinely, rather than waiting until a tape ages to thepoint that the data it contains may not be readable.

Should you have any questions about how to set up your backup procedures you maycontact Metro-Data at (410) 667-3600.

Manual - Maryland State Archivesmsa.maryland.gov/megafile/msa/speccol/sc5300/sc...In the MSACS...

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