August, 2000

Informational Bulletin 00-22
NH-48
CBC-25

Medicare State Operations Manual Update
Transmittal 15

This bulletin contains information for certified nursing facilities pertaining to the Health Care Financing Administration's (HCFA) issuance of Transmittal 15 of the Medicare State Operations Manual.

Transmittal 15 contains new and/or revised material of the State Operations Manual (Chapter 9) and Appendixes P and PP.

Some Key Areas of this Update:

  • Exhibit 86, Resident Census and Conditions of Residents, Form HCFA-672 (7/95), is DELETED and was previously replaced with Exhibit 264, the revised Form HCFA-672 (10/98) in transmittal 8.

  • Exhibit 90, Roster/Sample Matrix, HCFA-802, was DELETED and was replaced by

    Exhibits 265; Form HCFA-802 (7/99) the Roster/Sample Matrix,

    Exhibit 266; Form HCFA-802P (7/99) the Roster/Sample Matrix Provider Instructions,

    Exhibit 267; Form HCFA 802S (7/99) the Roster/Sample Matrix Instructions for Surveyors.

The above revised Long Term Care Survey Process Forms of HCFA 802, HCFA 802S and HCFA 672 were presented to representatives of the joint provider/surveyor training in the August 1999 Nursing Home Initiative Survey Process Training.

Transmittal 15 includes a revised Form HCFA 802 P which includes a crosswalk to the Minimum Data Set, dated 12/99. See below.

Hard copies of HCFA forms were also sent with MDH Informational Bulletin 99-23 in August 1999. These exhibits were not posted on the MDH web site due to document formatting.

The forms can be downloaded from the Health Care Financing Administration (HCFA) web site at:

http://www.cms.hhs.gov/medicaid/mds20/mdsforms.asp
Scroll down and Click on the desired link.
[To view and print PDF files you will need Adobe Acrobat Reader (free download from Adobe Web site.)]  

You may access Transmittal 15 which includes these changes/revisions at the following HCFA website:
http://www.cms.hhs.gov/manuals/pm_trans/2000/transmittals/comm_date_dsc.asp
Scroll down the column entitled File. Click on R15.SOM.  
[To view and print PDF files you will need Adobe Acrobat Reader (free download from Adobe Web site.)]

  • Exhibit 266, Roster/Sample Matrix Provider Instructions (12/99), ( Form HCFA 802P) is revised to add a crosswalk to the Minimum Data Set.

  • Appendix P: Survey Procedures for Long Term Care Facilities, is revised to delete an incorrect sentence in the Objectives of Task 4, Sample Selection.

  • Appendix PP: Guidance to Surveyors- Long Term Care Facilities, is revised at F329 to delete antipsychotic drugs no longer used, to remove confusing guidance about behavior charts, revises the antidepressant drug list to reflect antidepressants currently in use, to correct typographical errors in quoted text, and to restore interpretive guidance at F430 that was inadvertently deleted.

If you have any questions related to this Information Bulletin, please contact:

Minnesota Department of Health
Compliance Monitoring Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4101

Updated Friday, March 25, 2011 at 02:53PM