AGING AND DISABILITY SERVICES ADMINISTRATION

2005 NH "Dear Administrator" Letters

August 30, 2005

ADSA: NH #2005-025
MDS Assessment Forms

Dear Nursing Facility/Home Administrator:

This letter contains important information for facility staff responsible for completing the Minimum Data Set (MDS) assessments.

 Effective October 1, 2005 the MDS Version 2.0 will be modified to include a new section, Section W: Supplemental Items. This supplemental section includes a National Provider Identification number and information on Influenza and Pneumococcal Immunizations.

In anticipation of this addition to the MDS, it has been determined that the Department of Social and Health Services (DSHS) will no longer print or provide MDS forms for nursing home facilities. If your facility has obtained the MDS forms from DSHS, you will need to secure another source for these forms. Many software vendors as well as forms companies produce the MDS forms or they can be obtained from the Centers for Medicare and Medicaid Services (CMS) website and copied within your facility. To access forms on the CMS website, go to http://www.cms.hhs.gov/quality/mds20 and select “MDS All Forms”.

Information from the nursing home rates division indicates that pre-printed forms used to prepare the MDS are a Direct Care Supply expense and should be included in the cost report account #5118. If your facility chooses to reproduce the forms using your own copier and paper, the blank copy paper can be coded to Administrative Supplies in account #5413 as an Operations component.

If you have questions, or need further information, please contact Marjorie Ray, RN, Washington State RAI Coordinator, at (360) 725-2487 or e-mail rayma@dshs.wa.gov

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services