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					MARYLAND SUBACUTE CARE SURVEY
COMAR 10.2 4.05
PATIENT LE VEL DA TA    REPO RTING      REQUIREME NTS




           USER MANUAL
!                                      For version 5.0




                        Division of Data Systems and Analysis
                                 4160 Patterson Avenue
                               Baltimore, Maryland 21215
                            Telephone No. - 410-764-3460 or
                                     1 (877) 245-1762
                                    Fax: 410-358-1236


               Barbara G. McLean                Donald E. Wilson, M.D.
                 Executive Director                     Chairman



                       Document Issue Date: September 18, 2002
This page was intentionally left blank.
Table of Contents

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

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

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

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

V.     USING YOUR SOFTWARE
       A. Opening the program ................................................................................................................. 25
       B. Data Entry .................................................................................................................................... 26
Table of Contents
VI.   PATIENT INFORMATION – KEYS TO DATA COLLECTION
      A. Subacute Care Survey Patient Level Data Set ......................................................................... 29
      B. Data Set Elements ....................................................................................................................... 29
         1. Identification Information .................................................................................................. 30
             A. Facility Identification Number................................................................................. 30
             B. Patient Identification Number ................................................................................. 30
             C. Bed License Type....................................................................................................... 31
         2. Length of Stay....................................................................................................................... 31
             A.     Admission Date ........................................................................................................ 31
             B.     Discharge Date ......................................................................................................... 32
         3. Demographic Information.................................................................................................. 32
             A.     Gender ....................................................................................................................... 32
             B.     Race ............................................................................................................................ 33
             C.     Date of Birth............................................................................................................. 33
             D.     Estimated Age in Years ........................................................................................... 34
             E.     Ethnicity .................................................................................................................... 34
             F.     ZIP Code of Residence ........................................................................................... 35
             G.     Area of Residence..................................................................................................... 35
             H.     Marital Status ............................................................................................................ 36
             I.     Living Situation Prior to Current Referral............................................................ 37
         4. Admission Information....................................................................................................... 38
             A.     Source of Admission................................................................................................ 38
         5. Discharge Information ........................................................................................................ 41
             A.     Patient Outcome ...................................................................................................... 41
             B.     Early or Unplanned Discharge............................................................................... 41
             C.     Reason for Early or Unplanned Discharge .......................................................... 42
             D.     Discharge Destination ............................................................................................. 42
         6. Cognitive Patterns................................................................................................................ 45
             A.     Comatose................................................................................................................... 45
             B.     Memory/Orientation............................................................................................... 46
             C.     Cognitive Skills for Daily Decision Making ......................................................... 47
         7. Activities of Daily Living .................................................................................................... 48
         8. Behavioral Symptoms.......................................................................................................... 52
         9. Skin Condition on Admission ............................................................................................ 53
         10. Principal and Other Diagnoses .......................................................................................... 55
             A.     Principal and Other ICD-9 Diagnoses on Admission for Care ........................ 55
         11. Additional ICD-9 Diagnoses Identified During Stay ..................................................... 57
         12. Therapies Provided .............................................................................................................. 57
Table of Contents
                 13. Special Treatments and Procedures................................................................................... 58
                     A.     Medication Administration ..................................................................................... 58
                     B.     Administration of Nutrients/Fluids ...................................................................... 59
                     C.     Monitoring................................................................................................................. 59
                     D.     Care of Tubes/Catheters (Frequency of Treatment).......................................... 60
                     E.     Other Treatments (Frequency and Total Number of Days) ............................. 61
                 14. Financial Information.......................................................................................................... 63
                     A.     Primary and Secondary Payment Source .............................................................. 63

VII.       REPORTS
           A. Report Types................................................................................................................................ 67
           B. Viewing and Printing Reports ................................................................................................... 69

VIII. PREPARE AND TRANSMIT THE SUBACUTE CARE SURVEY VIA THE
      BULLETIN BOARD SERVICE (WORLDGROUP MANAGER)
      A. Run the Error Report and Zip the File for Transmission..................................................... 71
      B. The WorldGroup Manager ....................................................................................................... 75
         1. To Install the WorldGroup Manager ................................................................................ 75
         2. To Logon to the WorldGroup Manager the First Time ................................................ 79
         3. When You Logon to the WorldGroup Manager for the Second Time ....................... 81
         4. To Register for the Maryland Subacute Care Survey ...................................................... 83
         5. Transmission of the Automated Survey Data.................................................................. 84
         6. Special Notes ........................................................................................................................... 87


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

X.        TROUBLE-SHOOTING
           A. Possible Error Messages............................................................................................................. 96
Table of Contents
XI.   APPENDICES
       A. Subacute Care Survey Hard Copy of Data Collection Form
       B. Subacute Care Survey Questions and Answers (including Data Set Completion
          Timetable)
       C. Samples of Some of the Reports
       D. Summary of Interdependent Data Items & Consistency Checks
       E. 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


                                                                                        Section



                                                                                         I
    I. INTRODUCTION

A. WELCOME AND IMPORTANT TELEPHONE NUMBERS

Welcome to the Maryland Subacute Care Survey (MSACS) software. The software was specifically
designed 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 to
help the user with installation of the software through transmission of required files. It includes
help with setup configurations, getting acquainted with the layout of the software, report
explanations, utilities, problems you may encounter, and back-up procedures. We hope this
software makes submitting your file as easy as possible.

There are two (2) software packages you will use. The first package, the Maryland Subacute Care
Survey software, collects the data and prepares the file for transmission to MHCC by zipping the
file. The second package, called WorldGroup Manager, transmits the zipped file to the MHCC via
telephone 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 when
necessary. 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 at
the bottom of the screen. The user may use the Enter key to access menu items and to move from
field to field. The system also has built-in error and consistency checks to assist the user in entering
accurate data.


I C O N   K E Y

" Valuable Info           Have questions? Look for these icons throughout this manual.
# Contact Info
$ Software Notes
% Very Important




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# Contact Info

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

     Maryland Health Care Commission
     Donna Bullen
     4160 Patterson Avenue
     Baltimore, MD 21215

     Telephone No.: (410) 764-3460 or 1 (877) 245-1762
     Facsimile: (410) 358-1236
     Email: dbullen@mhcc.state.md.us

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

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

           Telephone: (410) 667-3600
           Facsimile: (410) 667-3655
           Email: info@metro-data.com


B.         PURPOSE OF THE SUBACUTE CARE SURVEY

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


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C.   HISTORY OF THE SUBACUTE CARE SURVEY

To assist staff in designing the Subacute Care Survey, the MHRPC established a nine-member
Technical Advisory Committee on Subacute Care Data Reporting in April 1995. The Technical
Advisory 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 Maryland
Hospital Association, the Health Facilities Association of Maryland, the Maryland Association of
Non-Profit Homes for the Aging, the Maryland Medical Directors Association, the Health Services
Cost Review Commission, the Maryland Medical Assistance Program, the Johns Hopkins University
School of Public Health, and the Office of Licensing and Certification (now the Office of Health
Care Quality) Programs. The Technical Advisory Committee held a series of six meetings to define
the scope and content of the patient-specific data set that will be collected for patients discharged
from subacute care in participating facilities

Survey participants are required to provide patient-specific data on all discharged patients as well as
program-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 patient
identifier which shall be the last six digits of each patient's social security number; diagnostic data by
ICD-9 code, frequency and intensity of special treatments provided, patient status, and outcome
information, including readmissions; other relevant medical, demographic, and functional status data
that 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 the
subacute care unit; and aggregate information on staffing, interdisciplinary team approach, and care
plans.

Revisions have been made since 1995 to simplify the data collection, leaving the most critical data
items that can not be obtained through other sources in the survey. In 1998, approximately 70 data
items were removed from the survey, including information on levels of cognition, types and
numbers 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 the
survey, including sections on nursing rehabilitation and restorative care, nursing diagnosis
information, and costs and charges. With the release of version 5.0, the survey now collects the 116
data items on each discharged patient which best describe the patient’s functional status at the time
of discharge or death.

Effective October 1, 1999, the Maryland Health Resources Planning Commission (MHRPC) merged
with the Maryland Health Care Access and Cost Commission (HCACC) to become the Maryland
Health 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 CON
Approved/Exempt Subacute Care Projects), all new facilities that were approved to provide
subacute care services under Regulations .03-.06 will be required to provide data to the Commission
upon initiation of the service. Over the years the actual facilities participating in the survey have
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changed. In the initial years, facilities were required to provide data on the full range of settings, as
designated by Regulation .07A(2), serving the needs of post-acute patients. Those settings included
facilities licensed for comprehensive care, extended care, and chronic hospital care located in both
acute care and freestanding facilities. In designating the survey participants, the Commission
consulted with trade associations to identify facilities with subacute care units and the Office of
Health Care Quality Programs to identify facilities licensed for Special Care Units under COMAR
10.07.02.

Effective January 1, 2001, the non-hospital based acute care and freestanding facilities were dropped
from the Subacute Care Survey. Currently the hospital-based comprehensive care units, chronic
hospitals and the three (3) facilities licensed to provide extended care participate in the survey. The
Commission has designated the following hospital-based facilities licensed to provide
comprehensive care to report data.

L O O K
                      For your reference the Facility ID numbers, unique numbers assigned by
" Valuable Info       MHCC 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 Facility
          0481501       Calvert Memorial Hospital
          0881605       Civista (formerly Physician’s Memorial) Hospital
          1081606       Frederick Memorial Hospital
          1102117       Garrett Memorial Hospital
          3051998       Good Samaritan Hospital
          0358904       Greater Baltimore Medical Center (GBMC)
          1212001       Harford Memorial Hospital
          1581701       Holy Cross Hospital
          3081603       James L. Kernan Rehabilitation Hospital
          2078710       Memorial Hospital at Easton – Skilled Nursing Facility
          3081601       Mercy Hospital
          1581702       Montgomery General Hospital
          0202037       North Arundel Hospital
          0381501       Northwest Hospital
          2289110       Peninsula Regional Medical Center
          1681802       Southern Maryland Hospital Center
          3058905       St. Agnes Health Care
          0358902       St. Joseph’s Hospital
          1515140       Suburban Hospital Skilled Nursing Facility (The Pavilion)



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      (b) Extended Care Facilities

           Facility ID Facility Name

           0101202        Sacred Heart Hospital/St. Catherine’s Extended Care Unit
                          (Western Maryland Health Systems)
           3051111        Union Memorial Hospital Extended Care Facility
           21224333       Washington County Hospital Extended Care Facility

      (c) Chronic Hospitals

           Facility ID Facility Name

           3013963        University of Maryland Specialty Hospital - Deaton
           2235001        Deer's Head Center
           1613964        Gladys Spellman Nursing Center
           3081604        James L. Kernan Rehabilitation Hospital*
           3037149        Johns Hopkins Geriatric Center
           3013962        Levindale Hebrew Geriatric Center and Hospital
           2135002        Western Maryland Center

           * Effective Quarter 3, 2002

The facilities designated in (a) and (b) above are required to report data reflecting the utilization of
beds licensed for comprehensive/extended care. The facilities designated in (c) above are required
to 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 the
reporting requirements of COMAR 10.24.05. Those facilities begin collecting and reporting the data
items 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 been
transmitted for a resident from a past submission. The data needs to be retained in a manner for easy
retrieval for the facility for five (5) years from the submission date. You may choose to keep either the
electronic data files or the hard copies of the data collection tool. Each facility must also retain a list with
the resident names, with the associated the Patient ID numbers used on the survey, and the facility’s
Patient ID number. If you have questions about what should be retained, please contact the Subacute
Survey Coordinator at (410) 764-3460 or 1 (877) 245-1762.




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F.   HOW TO USE THE MANUAL

The User Manual for the Maryland Subacute Care Survey: COMAR 10.24.05 Patient-Level Data
Reporting Requirements is designed to provide detailed instructions to survey participants. The
manual is organized in eleven major sections: 1) Introduction, 2) General Instructions for
Completing the Subacute Care Survey, 3) Installation and Setup, 4) Getting Started, 5) Using Your
Software, 6) Patient Information Sections, 7) Reports, 8) Prepare and Transmit the Subacute Care
Survey via the Bulletin Board Service (WorldGroup Manager), 9) Utilities, 10) Trouble-shooting, and
11) 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 the
required machine-readable format. Information on the survey submission date as specified in
COMAR 10.24.05, penalties for non-reporting, and procedures for requesting an extension to the
survey 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 your
computer. Information on the hardware configurations needed, password maintenance, how to set
your 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 screen
types.

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 each
discharged patient. The section also includes definitions, reporting requirements, and coding
specifications 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 from
the Subacute Care Survey. This does not include reports that compare your facility to all of the
facilities reporting in the Subacute Care Survey.


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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 MHCC
using the Health Data Connect Bulletin Board Service (BBS). The Commission’s BBS software
package is WorldGroup Manager.

Utilities (Section IX)

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

Trouble-shooting (Section X)

This section of the manual provides common error messages the user may encounter while using
this program. Each error message is accompanied by the action the user must take to resolve the
problem 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.




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                                                                                              Section




II. GENERAL INSTRUCTIONS FOR COMPLETING
                                                                                             II
THE 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 has
developed the Maryland Subacute Care Survey Data Collection, Verification, and Transmission
Software. This software is available to all participating facilities at no cost. The Commission's
Bulletin Board System (BBS) provides a way to transmit the data files generated by the survey
software 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 to
transmit 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 the
     quarter:


                                                                                          L O O K
                Quarter                     Due Date
                                                                                          " Valuable Info
                                                   th
                  1                         May 15                                        % Very Important
                  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 the
     instructions 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 first
     seven positions will always be the same. They are your facility ID. The eighth (8th) position is
     the 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 for
     Subacute. The second (2nd) position after the dot (.) is the last digit of the calendar year of the
     data 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 seven
     digits are 8888888, the facility ID; the eighth digit, 2, reports that the facility generated the file
     two 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 last
     position 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 (for
     instructions 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. If
     your facility requires an alternate media type for submission of its data, please contact the
     Commission for permission and instructions. In the case of technical difficulties, the data may
     be transmitted on 3½ diskettes or via e-mail.

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

                 Facility Name
                 Contact Person’s Name
                 Date the data was sent
                 Quarter # and Year of the Data
                 Number of Diskettes in Submission (i.e., 1 of 2, 2 of 2)
                 File Name(s)
                 Fax Number for a receipt to be sent to
                 Important - Tell us whether you experienced technical problems during the
                          data collection and transmission process, or no problems at all. The
                          events to advise us of include: a computer crash during the data
                          collection, you switched to a new computer, the computer did not
                          close properly, or other technical problems.

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


L O O K                For additional information concerning the automated submission of
# Contact Info         survey data, please contact:

                          Donna Bullen, Subacute Care Survey Coordinator
                                 Division of Information Systems
                               Maryland Health Care Commission
                                     4160 Patterson Avenue
                                      Baltimore, MD 21215

                                Telephone Number: (410) 764-3460 or
                                     Toll-free: 1 (877) 245-1762
                                           Fax: (410) 358-1236
                                  Email: dbullen@mhcc.state.md.us
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B. SURVEY SUBMISSION DATE

Survey participants shall report the patient-level data set to the Commission within 45 days following
the 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 who
was admitted after September 30, 1995, including patients formally discharged from the program
and 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 violation
               continues after consideration of the willfulness and seriousness of the withholding as
               well 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 relief
               considered appropriate by the Commission.


E. PROCEDURES FOR REQUESTING AN EXTENSION TO THE
   SURVEY SUBMISSION DATE

A facility may request an extension of its submission date by letter to the Subacute Care Survey
Coordinator 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.




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                           A written request for an extension should be submitted to:
L O O K

" Valuable Info                                        Donna Bullen
# Contact Info                                Subacute Care Survey Coordinator
                                              Maryland Health Care Commission
% Very Important                                   4160 Patterson Avenue
                                                Baltimore, Maryland 21215

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




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                                                                                        Section




III. INSTALLATION AND SETUP
                                                                                        III
______________________________________
Please Note:

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


A.        MINIMUM COMPUTER CONFIGURATION
          to run the Subacute Care Survey Software:

          Microsoft Windows compatible Personal Computer with Pentium class processor
          32 MBs RAM
          2 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 Card
          Operating System: Windows 95/98/ME/XP/2000 or DOS 6.
          PC Anywhere (Version 9.x or higher)
          Modem 56000 Baud, Analog phone line
          Diskette Drive 3.5 inch, back-up Software and Back-up Procedures
          Media for Back-up (diskettes or tape)
          Printer (Dot matrix, Laser)


B.        “PRE-INSTALLATION” INSTRUCTIONS

L O O K
                       Please follow the instructions listed below before you attempt to install the
$ Software Notes       software diskette.
% Very Important
Each computer that will be running the Subacute Care Survey software on Windows95 or 98 it will
need 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 rebooted
before you proceed with the installation. For further instructions on how to make changes to the
config.sys or config.NT files, please contact your computer support personnel.


C.        “PRE-NETWORK INSTALLATION” INSTRUCTIONS

L O O K
                       Please follow the instructions listed below before you attempt to install the
$ Software Notes       software on a network.
% Very Important

When installing the software on a network, the installation must be done to a mapped drive
letter. If you plan to install this program in a subdirectory (for example I: \APPS), please
permanently "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 ALONE
          PC OR NETWORK)

L O O K
                       Note: These instructions presume that your 3.5 inch floppy drive is assigned
$ Software Notes       as drive letter “A:”
% Very Important

If your 3.5 inch floppy drive has a different drive designation, you must substitute your drive
letter 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: floppy
        drive.

     2. If you access software from a menu or through Windows, please exit out of these programs
        to the DOS prompt C:\ >. Check with computer support personnel if you need assistance
        with 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 network
                           drive 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 enter
        C 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 diskette
        and press C to Continue. You will again receive the “Please wait” message.
        After the message displays, Installation Complete, the Installation is finished. A reminder
        screen will appear after installation of the software to confirm that you have made changes
        to 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

L O O K
                             This MUST be completed before you add any records.
$ Software Notes
% Very Important

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




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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 and
               MA provider number. This information is automatically included with your
               transmissions to identify your facility to MHCC. If you are not sure of your county
               code, use the first two digits of your facility ID number.

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




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F.        KEYS TO THE SYSTEM SETUP SCREEN

L O O K
                        The following descriptions will help you to understand the various “Setup
$ Software Notes        Screen” options.
% Very Important

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

          COLOR LOGO - If the color MHCC logo causes problems with starting the program, or if
          it 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 to
          protect the confidentiality of the information entered into the Maryland Subacute Care
          Survey software, you can turn passwords on by putting a "Y" in this field. If you decide it is
          not 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) you
                 must have passwords turned on. Users will then be tracked and an Audit Log can be
                 printed from the Utilities Menu. Since MHCC does not have access to these
                 passwords you must keep them in a place for easy retrieval by the facility’s Systems
                 Administrator.

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

          VERSION - This will show the current version of the Maryland Subacute Care Survey
          software 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 is
          shown above for MSBACKUP. Refer to your MS-DOS users guide for the exact command
          for 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 User
          Manual.

          BACKUP FILES - This option can be chosen to begin the backup session specified in the
          SYSTEM SETUP. If you do not already have this capability at your facility, you must take
          action to backup the Maryland Subacute Care Survey data. It is extremely important to
          backup 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 to
       diskette.

       PASSWORD MAINTENANCE - This option is used to control access to the various
       system functions. Each option on the Main Menu, as well as PASSWORD
       MAINTENANCE 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 an
       area 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 along
               with the PASSWORD. Options at the bottom of the screen will allow you to
               manipulate the information as you choose. To choose the option you want, enter
               the 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 at
                               the top of the screen.

                      <D>ELETE - Deletes currently selected user and password shown at the
                             top 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, and
                      CHANGE PATIENT ID NUMBER.

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

                      REPORTS - Prevents user access to the REPORTS option on the Main
                      Menu.



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                      DATA XFER - Prevents user access to the RUN ERROR CHECKS AND
                      ZIP FILE FOR TRANSMISSION 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 the Utilities Menu.

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




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

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

                              Printing on a Network - You will have access to printers set up by
                              your system administrator. The Maryland Subacute Care Survey
                              software will send the reports to your default printer (LPTl:).
                              Highlight the printer from the list that most closely matches this
                              printer. If printing to a network printer, you must capture port LPT1
                              to redirect the print job to the network. If you have problems, please
                              call your system administrator.

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

                          SYSTEM SETUP - Used to set system control parameters. It should only
                          be 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 to
                          MHCC. Data should be retained for at least two years. Detailed information
                          is provided in Section IX. - Utilities of this manual.

                          DELETE INDIVIDUAL PATIENT – Used to completely delete a
                          patient 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 ID
                          number and/or admission date that were entered incorrectly. Detailed
                          information is provided in Section IX. - Utilities of this manual.

                          PRINT AUDIT LOG - This option will print a log of users and times
                          connected to the system. This report is only available to those using
                          passwords. Detailed information is provided in Section IX. - Utilities of this
                          manual.

H.        ICON FOR SUBACUTE CARE SOFTWARE - Optional:

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


                         If you have ANY problems installing this software, DO NOT try to
L O O K
                         reinstall. Please call for Technical Support from Metro Data, Inc. 9:00
# Contact Info           a.m. to 5:00 p.m., Monday through Friday at (410) 667-3600.
$ Software Notes
% Very Important




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                                                                                        Section




IV. GETTING STARTED
                                                                                        IV
______________________________________
L O O K

$ Software Notes      A.      KEYS TO KNOW
% Very Important


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

[Num Lock] - Located in the upper right portion of the keyboard. When [NUM LOCK] is on, a
light in the upper right corner of the keyboard will be On. This is a toggle key to allow you to type
numbers 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 the
next.

[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. When
the screen is enlarged, you may move between the survey screen and other open programs by
clicking 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 is
broken down into two main types of screens - Menu screens and Data Entry Screens. There are
four (4) Menu screens that will direct you into general areas for data entry or report options. They
are 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 are
accessed from the Patient Information Menu. These screens are similar to the hard copy paper
forms 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 to
highlight the selection you would like to choose. Shown below is the “Main Menu” of the software
with 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.




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

Data Entry Screens contain descriptions of data requested and Data Boxes for entering the
information. Data boxes (for users with color screens) are the red boxes on your screen. This is the
area 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. This
      information includes the facility assigned Medical Record Number and the name of the
      patient.

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

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

           The program “hot keys” are as follows:

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




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               [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 available
               code options. A message will be shown in the field-by-field help or at the bottom of
               the screen as shown below. The list of options may be larger than can be listed in
               the 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 not
               previously listed. If you know the first letter of the option you would like, you can
               press that letter and the highlight bar will go to the first option in the list that begins
               with that letter. To choose a selection from the list, highlight the selection you
               would like and press [↵Enter]. Your selection will be entered automatically into the
               data 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.
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                                                                                       Section



                                                                                       V
V. USING YOUR SOFTWARE
______________________________________
L O O K

$ Software Notes      A. OPENING THE PROGRAM
% Very Important

The command to start the Maryland Subacute Care Survey software is “msacs”. From the DOS
prompt where the program was loaded, type msacs then press [↵Enter]. Press any key to bypass the
splash 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 Password
Entry 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 the
Data 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 screen
and 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 ask
for a patient number (the last 6 digits of the social security number) and the admission date. The
patient ID number can be entered by hand. By pressing the [F10] key, all residents previously
entered will appear in a "pop-up" box as shown below. When you type the first letter of a resident’s
name the list will automatically go to the first person whose name starts with that letter.




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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 Social
Security Number. In that case you can still enter that number as long as their periods of stay do not
overlap. The second person entered with the duplicate Patient ID Number will show the Name and
Medical Record Number of the first person. Simply write correct information in place of incorrect
information and data will be entered properly. If periods of stay do overlap, please call MHCC for
an 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 ask
if 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 the
software) and then take you to the Patient Information Menu for Patients. This screen is shown
after the “Note” below.

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


L O O K
                      NOTE: An Admission Date cannot be entered for a previously admitted
$ Software Notes      patient unless a Discharge Date was entered for previous stay. An Admission
% Very Important      Date 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 DEMOGRAPHIC
section is greater than two days. (The calculation of two days is 48 hours between the Admission
Date 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 to
be less than two days away from the ADMISSION DATE, these sections will be cleared of their
information.

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

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


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                                                                                       Section




VI. PATIENT INFORMATION – KEYS TO DATA
                                                                                       VI
COLLECTION
______________________________________
A. SUBACUTE CARE SURVEY: PATIENT-LEVEL DATA SET

The Subacute Care Survey must be completed for each patient discharged from the program, who
was admitted after September 30, 1995, including patients formally discharged from the program
and 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 the
        same 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 subsequently
        readmitted, regardless of whether or not a bed was held for the patient during the absence
        from the facility.

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

B. DATA SET ELEMENTS

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




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1.   IDENTIFICATION INFORMATION

     A.        FACILITY IDENTIFICATION NUMBER

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

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

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

     Other Comments: If you have questions about your Facility Identification Number, please
     contact 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 Social
     Security Number.

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

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

     Other Comments:

     1.        Each facility should retain for five years a list of Patient Identification Numbers used
               in responding to the Subacute Care Survey that can be traced back to the patient's
               medical 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 able
               to determine the number from the patient's Medicare Number. The numeric part of
               a Medicare Number is the Social Security Number; however, if the Medicare
               Number is followed by a "D", it is not the patient's Social Security Number. In this
               case it is the spouse's Social Security Number and should not be used as the Patient
               ID 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 as
               the Patient ID in this survey.

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     3.        If the patient's Social Security Number is unknown, use your facility's assigned
               patient ID number preceded with the letter "N". This response should be left
               justified. For example, if your facility uses a 4-digit patient identifier, the correct
               response 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 patient
     is admitted as determined by the Office of Health Care Quality (OHCQ). Special Care Units
     are 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 of
     Health Care Quality.

     Reporting Requirements: The Bed License Type is required to be coded for all specified
     discharges 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 Care
               2               Comprehensive Care: Special Care Unit
               3               Extended Care
               4               Chronic Hospital

     Other Comments: To confirm if your Bed License Type is Comprehensive Care, Extended
     Care or Chronic, go to Section I. Section D. of this manual. To confirm if your Bed License
     Type is Comprehensive Care: Special Care, go to your facility license or an attached licensing
     letter 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 was
     accepted for care in the subacute program. In the case of a patient transferred to an acute care
     hospital or other location who subsequently returns to the program, the Admission Date
     should reflect the month, day, and year on which the patient was readmitted to the program.

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

     Coding Specifications: The Admission Date should be coded using two digits to identify the
     month and day, and four digits to identify the century and year. For months and days with only
     one 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 was
     discharged from the subacute program.

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

     Coding Specifications: The Discharge Date should be coded using two digits to identify the
     month and day, and four digits to identify the century and year. Use all columns provided to
     record 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 as
     follows:




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 from
     the program in the Header of each Record Type.




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

               Code           Gender

               1              Male
               2              Female


    B.         RACE

    Definition: Race refers to the racial/ethnic background of the patient as observed by the
    facility 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 from
    the 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              White
               2              African American
               3              Asian/Pacific Islander
               4              American Indian/Eskimo/Aleutian
               5              Other
               9              Unknown


    C.         DATE OF BIRTH

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

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

    Coding Specifications: The Date of Birth should be coded using two digits to identify the
    month 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 of
    discharge.




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    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 are
    known, 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 of
    admission 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 all
    specified 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 Estimated
    Age. For patients whose exact Date of Birth is known and reported, the Estimated Age
    will automatically be coded "777" (Not Applicable). The Estimated Age must be at
    least 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 observed
    by the facility staff.

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

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

               Code             Ethnicity

               1                Spanish/Hispanic Origin
               2                Not of Spanish/Hispanic Origin
               9                Unknown




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    F.         ZIP CODE OF RESIDENCE

    Definition: The ZIP Code of Residence refers to the five-digit code assigned by the U.S. Post
    Office 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 all
    specified discharges from the program with the exception of patient coded "Homeless" (Code
    6) for Living Situation Prior to Current Referral.

    Coding Specifications: Use all columns provided to record the five-digit ZIP code. The ZIP
    Code 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 in
    Maryland 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 specified
    discharges from the program with the exception of patients coded "Homeless" (code 6) for
    Living Situation Prior to Current Referral.

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

               Maryland
               01 Allegany               13   Howard
               02 Anne Arundel           14   Kent
               03 Baltimore County       15   Montgomery
               04 Calvert                16   Prince George's
               05 Caroline               17   Queen Anne's
               06 Carroll                18   St. Mary's
               07 Cecil                  19   Somerset
               08 Charles                20   Talbot
               09 Dorchester             21   Washington
               10 Frederick              22   Wicomico
               11 Garrett                23   Worcester

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               12 Harford                30 Baltimore City

               Delaware
               40 Kent                   42 Sussex
               41 New Castle             43 Unidentified Delaware

               Pennsylvania
               44 Adams                  50   Greene
               45 Bedford                51   Lancaster
               46 Chester                52   Somerset
               47 Fayette                53   York
               48 Franklin               54   Other PA County
               49 Fulton                 55   Unidentified Pennsylvania

               West Virginia
               56 Berkeley               61   Morgan
               57 Grant                  62   Preston
               58 Hampshire              63   Tucker
               59 Jefferson              64   Other WV County
               60 Mineral                65   Unidentified West Virginia

               Virginia
               66 Alexandria             71   Prince William
               67 Arlington              72   Stafford
               68 Fairfax                73   Westmoreland
               69 King George            74   Other VA County
               70 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, the
    program 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 to
    the subacute program.

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

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

               Code           Marital Status

               1              Never Married
               2              Married
               3              Separated
               4              Divorced
               5              Widowed
               9              Unknown

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

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

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

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

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


    I.         LIVING SITUATION PRIOR TO CURRENT REFERRAL

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

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

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

               Code                      Living Situation Prior to Admission

               1                         With Spouse
               2                         With Children
               3                         With Other Relatives
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               4                         With Unrelated Persons in Institutional Setting
               5                         Lived Alone
               6                         Homeless
               8                         Other Living Situation
               9                         Unknown

     Other Comments: Determining the individual who owns or maintains the patient's place of
     residence may help in deciding which category to code. For instance, if the patient lives with a
     child 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 facility
     where the patient was staying immediately prior to entering this program. This may or may not
     coincide with the patient's Living Situation Prior to Current Referral.

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

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

               Code Source of Admission

               01      Private Residence
               10      Adult Foster Care/Project HOME
               11      Senior Assisted Housing
               12      Boarding Home
               13      Continuing Care Retirement Community (CCRC) -Independent Living Unit
               14      Continuing Care Retirement Community (CCRC) - Assisted Living
               15      Assisted Living
               16      ICF-Mentally Retarded
               20      Comprehensive Care Facility
               21      Extended Care Facility
               30      Rehabilitation Hospital
               31      Chronic Hospital
               32      Psychiatric Hospital
               33      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)
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               88      Other
               99      Unknown

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

               Adult Foster Care/Project HOME - Patients in this classification were admitted
               to the program from adult foster care or Project HOME programs. Adult foster
               care programs are operated by some local departments of social services and provide
               a protective living environment in a group home setting for adults usually suffering
               from head injury or dementia. Project HOME provides Certified Adult Residential
               Environment (CARE) homes operated by the Department of Human Resources
               where persons (usually suffering from chronic mental illness or AIDS) receive
               supervision and are taught independence skills.

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

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

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

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

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

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


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

               Extended Care Facility - Patients in this classification were admitted to the
               program from 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 admitted to the
               program from a licensed special hospital-rehabilitation facility. This classification
               includes free-standing rehabilitation hospitals and excludes distinct-part rehabilitation
               units located in acute care hospitals.

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

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

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

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

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

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

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



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


5.   DISCHARGE INFORMATION

     A.        PATIENT OUTCOME

     Definition: This refers to the patient's disposition at the end of his or her stay. When
     evaluating the Patient Outcome, consider the patient's condition relative to his/her primary
     diagnosis. For instance, did the patient show improvement relative to his/her primary
     diagnosis? 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 specified
     discharges from the program.

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

               Code           Patient Outcome

               1              Improvement to same or greater level of Health/Function
               2              Partial Improvement in Health/Function
               3              Stabilization of Vital Functions (Prevent Decline/Death)
               4              No Change
               5              Patient Decline
               6              Patient Death

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


     B.        EARLY OR UNPLANNED DISCHARGE

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

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


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    Coding Specifications: The following coding scheme should be used:

               Code           Early or Unplanned Discharge

               0              No
               1              Yes
               7              Not Applicable


    C.         REASON FOR EARLY OR UNPLANNED DISCHARGE

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

    Reporting Requirements: Reason for Early Or Unplanned Discharge is required to be
    reported 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 Advice
               2              Condition Required Admission to Other Health Care Facility
               3              No Longer Qualified by Third Party Payer
               4              Patient Recovered Earlier Than Expected
               7              Not Applicable
               8              Other


    D.         DISCHARGE DESTINATION

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

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




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

               Code Discharge Destination

               01     Private Residence
               10     Adult Foster Care/Project HOME
               11     Senior Assisted Housing
               12     Boarding Home
               13     Continuing Care Retirement Community (CCRC) - Independent Living Unit
               14     Continuing Care Retirement Community (CCRC) - Assisted Living
               15     Assisted Living
               16     Intermediate Care Facility (ICF) - Mentally Retarded
               20     Comprehensive Care Facility
               21     Extended Care Facility
               30     Rehabilitation Hospital
               31     Chronic Hospital
               32     Psychiatric Hospital
               33     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 Applicable
               88     Other
               99     Unknown

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

               Adult Foster Care/Project HOME - Patients in this classification were admitted
               to the program from adult foster care or Project HOME programs. Adult foster
               care programs are operated by some local departments of social services and provide
               a protective living environment in a group home for adults usually suffering from
               head injury or dementia. Project HOME provides Certified Adult Residential
               Environment (CARE) homes operated by the Department of Human Resources
               where persons (usually suffering from chronic mental illness or AIDS) receive
               supervision and are taught independence skills.

               Senior Assisted Housing - Patients in this classification were discharged from the
               facility to Group Senior Assisted Housing or Multi-Family Senior Assisted Housing
               programs administered by the Maryland Office on Aging. Senior assisted housing is
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               a level of housing between independent living and institutionalization which
               combines shelter with meals, housekeeping, and assistance with activities of daily
               living for elderly persons who require support to maintain independent functioning.

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

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

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

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

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

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

               Extended Care Facility - Patients in this classification were discharged from the
               facility 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 the
               facility to a licensed special hospital-rehabilitation facility. This classification includes
               free-standing rehabilitation hospitals and excludes distinct-part rehabilitation units
               located in acute care hospitals.

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

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

               Acute Care Hospital (Medical-Surgical Unit) - Patients in this classification were
               discharged from the facility to the medical-surgical unit of a licensed acute care
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               hospital. This category excludes patients discharged to a distinct-part rehabilitation
               unit located in an acute care hospital (Code 30) and patients discharged to a
               psychiatric unit located in an acute care hospital (Code 34).

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

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

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

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

               Acute Care Hospital (Rehabilitation Unit) - Patients in this classification were
               discharged from the program to a distinct-part rehabilitation unit located in an acute
               care 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 specified
     discharges from the program.

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



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    B.         MEMORY/ORIENTATION

    Definition: The Memory/Orientation section of the survey includes items designed to
    measure 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 it
    has been presented. Long-Term Memory refers to the patient's ability to recall information
    after a longer period of time has elapsed.

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

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

               Code Memory

               0      No
               1      Yes

    Other Comments:

    a) Can Recall After Five Minutes: Ask the patient to describe a recent event that both of
    you had the opportunity to remember. You could also use a more structured short-term
    memory 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. After
 YOU have stated all three items, ask the patient to repeat them (to verify that you were heard
 and understood). In five minutes, ask the patient to repeat the name of each item. If the patient
 is 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 the
    time 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 medical
    record, general knowledge, or family).

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                                              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 is
 your 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 know
    the room number, but can at least find the way to the room. Knows that he/she is in a hospital
    or 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 staff
    member'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 the
    patient each item directly. For example, "What is the current season?" "What is the name of
    this place?" "What kind of place is this?" If the patient is not in his/her room, ask questions
    like, "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 make
    everyday decisions about the tasks or activities of daily living.

    Reporting Requirements: Cognitive Skills For Daily Decision-Making on admission are
    required 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      Independent
               1      Modified Independence
               2      Moderately Impaired
               3      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.
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                Modified Independence - Patient organizes daily routine and makes safe decisions
                in familiar situations but experiences some difficulty in decision-making when faced
                with 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 (or
                rarely) 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; using
            environmental cues to organize and plan (e.g., clocks, calendars, posted listings of
            upcoming events); using awareness of one's own strengths and limitations in regulating
            the day's events (e.g., asks for help when necessary); making the correct decision
            concerning how to get to the lunchroom.


7.   ACTIVITIES OF DAILY LIVING

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

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

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

     Activities of Daily Living should be coded to reflect Self Performance (SP) and Support for the
     following: Bed Mobility; Transfer; Eating; and Toileting. Self Performance (SP) indicates the highest
     degree 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 Support
     indicates the highest level of physical assistance provided over the last seven (7) days, with
     codes ranging from 0-3, and 8 for Bed Mobility and Transfer. If no help was provided or the

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    activity did not occur (for Bed Mobility and Transfer) at all during the entire seven (7) days use
    code 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 Staff
     1   Supervision                                 1   Setup Help Only
     2   Limited Assistance                          2   One-Person Physical Assistance
     3   Extensive Assistance                        3   Two-Person + Physical Assistance
     4   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's
         activities are unable to be observed. The coding of "8" may not be used for Eating or Toileting. Also, when
         a patient is completely bed-ridden, meaning he/she is not transferred from bed for any reason, "8" may be
         coded for the Bed Mobility or Transfer. The code "8" should not be used for Toileting for a catheterized
         patient or for a patient using a bedpan. For those patients who are incontinent and did not use a bathroom
         for their toilet usage, and were never catheterized nor using a bedpan, a "4" (Total Dependence) should be
         coded for Self-Performance and the number of people required to provide care should be reflected in the
         Support 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 without
     assistance, indicating balance between patient self-performance and assistance staff members
     provided for each activity. For each ADL category, code the appropriate response for the
     patient'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 only
                 1 or 2 times during the last 7 days.

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

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

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               Extensive Assistance - While patient performed part of the activity over the last 7
               days, 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-day
               period. [NOTE: This must include all subtasks of more complex ADL activities. If
               patient 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 code
               is limited to situations where the ADL activity was not performed by the patient or
               staff and is primarily applicable to fully bed-bound patients who neither transferred
               from 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 for
               Support. 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 by
    staff over the last 7 days for each ADL, even if that level of support only occurred once.. For
    each ADL category, code the maximum amount of support given during the last seven days on
    the Staff Support line labeled “Staff Support" - irrespective of the frequency over the 7-day
    period. Code regardless of patient's Self-Performance classification (e.g., if someone was
    independent 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 to
               perform 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 to
               situations where the ADL activity was not performed and is primarily applicable to
               fully bed-bound patients who neither transferred from bed nor moved between
               locations over the entire 7-day period. [Note: When an "8" code is entered for
               Support, also enter an "8" code for Self Performance. A resident who has not been
               out of bed in the past 7 days could be coded “8.”]
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The examples below clarify coding for both Self-Performance and Staff Support. The
answers appear to the right of the patient descriptions. Cover the answers, read and score
the example, and then compare your answers with those provided.



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

 Patient was physically able to reposition self in bed but had a tendency to           1       0
 favor and remain on left side; needed frequent reminders and monitoring
 to reposition self while in bed.

 Received supervision and verbal cueing for using a trapeze for all bed                1       3
 mobility. On two occasions when arms were fatigued, patient received
 heavier physical assistance of two persons.

 Because of severe, painful joint deformities, patient was totally dependent           4       3
 on two persons for all bed mobility. Although unable to contribute
 physically to positioning process, patient was able to cue staff for the
 position she wanted to assume and at what point she felt comfortable.
 Transfer

 Despite bilateral above-the-knee amputations, patient always moved                    0       0
 independently from bed to wheelchair (and back to bed) using a transfer
 board he retrieves independently from his bedside table.

 Patient moved independently in and out of armchairs but always received               2       2
 light physical guidance of one person to get in and out of bed safely.

 Transferring ability varied throughout each day; received no assistance at
 some times and heavy weight-bearing assistance of one person at other                 3       2
 times.




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

 Eating

 Patient arose daily after 9 am preferring to skip breakfast and just munch            0       0
 on fresh fruit later in the morning. She ate lunch and dinner
 independently in the facility's main dining room.

 Patient is blind and confused. He ate independently once staff oriented               1       1
 him to the types and whereabouts of food on his tray and instructed him
 to eat.

 Patient fed self with staff monitoring at breakfast and lunch but tired later         3       2
 in day; was fed totally by nursing assistant at supper meal.
 Toileting

 Patient used bathroom independently once up in a wheelchair; used                     0       1
 bedpan independently at night after it was set up on bedside table.

 When awake, patient was toileted every two hours with minor assistance                3       2
 of one person for all toileting activities (e.g., contact guard for transfers
 to/from toilet, drying hands, zipping/buttoning pants); required total care
 of 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          3       3
 (e.g., being handed toilet tissue or incontinence pads).


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't
     much different than others on the unit; there are many noisy patients.) Identify the presence of
     Behavioral Symptoms during the patient's stay. Wandering is movement with no identified
     rational purpose; patient appears oblivious to needs or safety. This behavior must be
     differentiated from purposeful movement - e.g., a hungry person moving about the unit
     in search of food; or pacing.
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     Reporting Requirements: Behavioral Symptoms on admission are required to be reported
     for all specified discharges from the program who are not coded "Comatose."

     Coding Specifications: Code the frequency of each descriptive behavior. Code "0" if patient
     did not exhibit that type of behavior during his/her stay. [Note: This code applies to
     patients who have never exhibited the behavior or who have exhibited the behavior but
     no longer exhibit it, including those whose behavior is fully managed by psychotropic
     drugs, restraints, or a behavior-management program.] Report on the most disruptive
     patient behavior across all three shifts.

                Code          Frequency

                0             Behavior Not Exhibited
                1             Behavior of this Type Occurred Occasionally
                2             Behavior of this Type Occurred Often, But NOT Daily
                3             Behavior of this Type Occurred Daily

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


9.   SKIN CONDITION ON ADMISSION

     Definitions: Skin condition includes the number of ulcer sites, the types of ulcers, the
     existence 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 on
     admission 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 both
     pressure 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 ulcer
     on the patient's body. Assign the appropriate code. If the patient does not have a pressure
     ulcer or a stasis ulcer, code a "0" (No Ulcers of this type).

         Code                 Ulcer Type
         0                    No Ulcers of this type
         1                    Stage 1
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         2                    Stage 2
         3                    Stage 3
         4                    Stage 4

     (3) If the patient has any burns (second or third degree), an open wound/lesion, a skin tear or
     cut (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 that
       has been subjected to pressure or friction. Other terms used to indicate this condition
       include bed sores and decubitus ulcers.

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

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

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

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

       Stage 4 Ulcer - Full thickness skin loss with extensive destruction, tissue necrosis, or
       damage 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 not
       include first degree burns (changes in skin color only).

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


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

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

      Assessing a Stage 1 pressure ulcer requires a specially focused assessment for patients
      with darker skin tones to take into account variations in ebony-colored skin. Based on
      one 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 the
      appearance 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 category
      that directly resulted in the patient's admission to the program. The Principal Diagnosis is
      not necessarily the reason for the patient's initial illness or medical problems. For example, an
      individual who has been diagnosed with Parkinson's Disease is admitted to the program
      because she has fractured her hip. The Principal Diagnosis in this case is the hip fracture, not
      Parkinson's Disease. The Principal Diagnosis does not include the treatment or service
      provided to the patient. For instance, ventilation would not be appropriate as a Principal
      Diagnosis. Other diagnoses are any other diagnoses or disease categories that may or may not
      be 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 mentioned
      above, 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 the
      time 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 to
      reflect the status on the day of admission to the program. Principal and other diagnoses should
      be coded using ICD-9 codes. Space is provided for up to 2 decimal places. This data item is
      left-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.



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    When codes contain only one decimal, left-justify the decimal, and leave the second decimal
    box 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 in
     the 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 other
       spaces blank. If the patient has more than nine other diagnoses, use your best
       clinical judgement to determine which most closely meets the definition listed
       above.

    2. Do not use ICD-9 procedure codes, E-codes, or V-codes. Procedure codes, from Volume
       3 of the International Classification of Diseases, 9th Revision, Clinical Modification are
       codes consisting of no more than 4 digits, including two decimal places (e.g., 84.10) and
       refer to therapeutic or diagnostic procedures performed. The condition that necessitated
       the performance of the procedure and not the procedure itself should be coded on the
       Subacute 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.


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      3. Use the most specific ICD-9 Diagnosis Code available when coding Principal and Other
         Diagnoses. 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 medical
         record 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 developed
      during the patient's stay or that were identified after his/her admission. Only note these
      diagnoses if they are different from the diagnoses assigned to the patient at admission.

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

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


12.   THERAPIES PROVIDED

      Definition: Record the number of days each therapy type was administered during the
      patient's stay for at least 10 minutes during a day. Record services provided inside the
      program only. If the therapy was not administered during the patient's stay, or if it was not
      given for at least 10 minutes during any one day, record "0" for both days and minutes. To be
      counted, 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 plan
                       documented in the medical record.

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

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

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

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

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                Occupational Therapy - Therapy services that are provided or directly supervised
                by a Licensed/Registered Occupational Therapist (OTR). Licensed/Certified
                Occupational Therapy Assistant (COTA) may provide therapy but not supervise
                others (aides or volunteers) giving therapy. Include services provided by a COTA
                who is employed by the nursing facility only if they are under the direction of an
                OTR.

                Physical Therapy - Therapy services that are provided or directly supervised by a
                Licensed 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 they
                are under the direction of an LPT.

                Respiratory Therapy - Included are coughing, deep breathing, chest PT, heated
                nebulizers, aerosol treatments, and mechanical ventilation, etc., which must be
                provided by a licensed/certified professional. Respiratory therapy does not include
                pulse 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 the
      patient during the stay. Frequency of administration refers to how often the physician's order
      requires the treatment to be administered. Days administered refers to the total of days during
      the resident’s visit the treatment was administered.

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

      Coding Specifications: Frequency of Special Treatments should be coded to reflect the
      treatment frequency ordered by the physician, as reflected on the patient's medical record, for
      treatments that were provided during the stay. If the frequency changed during the stay, code
      the 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 of
                medications intravenously without combining them with a fluid solution.
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                PO Medication Administration - The administration of medications orally as
                ordered by the physician.

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


     B. ADMINISTRATION OF NUTRIENTS/FLUIDS

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

                Hyperalimentation (TPN) - The continuous administration of nutrients via
                percutaneous 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 of
                feeding.


    C.     MONITORING

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

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

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

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

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

                Cardiac Monitoring - The use of specialized equipment, including telemetry, to
                continuously assess heart rate rhythm and inform the staff of any potentially serious
                variations.



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

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

               Treatment Frequency Codes:
               1H = (qh) every hour
               2H = (q2h) every two hours
               3H = (q3h) every three hours
               4H = (q4h) every four hours
               6H = (q6h) every six hours
               8H = (q8h) every eight hours/shift

               1D = (qd or hs) once daily
               2D = (BID) two times daily (Includes every 12 hours)
               3D = (TID) three times daily
               4D = (QID) four times daily
               5D = five times daily

               1W = (QWeek) once every week
               2W = twice every week
               3W = three times every week
               4W = four times every week
               5W = five times every week
               6W = six times every week
               QO = every other day

               1M = (QMonth) once every month
               2M = Twice every month

               PR = As necessary
               CC = Continuous

               77 = Not applicable
               88 = Other
               99 = Unknown

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

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

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

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

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

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

               Peripheral IV, PICC, or Central IV Line - The insertion of an intravenous line
               into a peripheral vein and extending into the central circulatory system. Excludes
               PICC 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 the
     treatments listed above. Frequency of administration of these special treatments should be
     coded by selecting the frequency response code that reflects how often the physician ordered
     the 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 hour
              2H = (q2h) every two hours
              3H = (q3h) every three hours
              4H = (q4h) every four hours
              6H = (q6h) every six hours
              8H = (q8h) every eight hours/shift

              1D = (qd or hs) once daily
              2D = (BID) two times daily (Includes every 12 hours)
              3D = (TID) three times daily
              4D = (QID) four times daily
              5D = five times daily

              1W = (QWeek) once every week
              2W = twice every week
              3W = three times every week
              4W = four times every week
              5W = five times every week
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              6W = six times every week

              QO = every other day

               1M = (QMonth) once every month
               2M = Twice every month

               PR = As necessary
               CC = Continuous

               77 = Not applicable
               88 = Other
               99 = Unknown

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

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

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

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

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

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

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

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

               Ventilator Weaning - The process of gradually reducing ventilatory support with a
               goal of eventual discontinuation of the ventilatory and/or tracheostomy support.
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                This involves the monitoring of patients that are being permitted to breathe on their
                own for gradually increasing periods of time. Requires close nurse, physician and
                respiratory staff monitoring along with assistive devices such as apnea and pulse
                oximetry monitors, and laboratory monitoring of blood gases.

                Radiation Therapy - Specialized care involving the use of radiation therapy or a
                radiation 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 was
      expected to pay for the greatest amount of the charges incurred by the patient. The Secondary
      Payment Source refers to the funding source that paid for additional charges incurred by the
      patient.

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

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

                Code           Primary Payment Source

                01             Private (Self) Pay
                02             Medicare
                03             Maryland Medical Assistance
                04             D.C. Medicaid
                05             Other State Medicaid
                06             Private Insurance
                07             VA Contract
                10             Health Maintenance Organization
                12             CHAMPUS
                88             Other
                99             Unknown

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




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               Code           Secondary Payment Source

               01             Private (Self) Pay
               02             Medicare
               03             Maryland Medical Assistance
               04             D.C. Medicaid
               05             Other State Medicaid
               06             Private Insurance
               07             VA Contract
               10             Health Maintenance Organization
               12             CHAMPUS
               77             Not Applicable
               88             Other
               99             Unknown

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

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

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

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

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

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

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

               Health Maintenance Organization - Patients in this classification had the greatest
               amount of their charges paid for by the Health Maintenance Organization to which
               they belong.



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               CHAMPUS - Patients in this classification had the greatest amount of their charges
               paid for by the Office of Civilian Health and Medical Programs of the Uniformed
               Services.




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                                                                                           Section



                                                                                          VII
VII. REPORTS
______________________________________
                         Reports are what make the Maryland Subacute Care Survey software
L O O K                  immediately useful to your facility. These reports can show who was in your
" Valuable Info          facility during a particular time period. You may print hard copy forms of the
                         completed data collection tools for the survey and identify trends according
$ Software Notes         to age, length of stay, outcome, and more. Samples of some of the reports
                         are provided in Appendix C.

A.        REPORTS TYPES (WITH DESCRIPTIONS)

          Survey Forms

     •    PATIENT SURVEY FORMS BY LIST OF PATIENTS - This report will produce hard
          copies 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 copies
          of the Maryland Subacute Care Survey for a specified date range.


          Trend Reports

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

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

     •    OUTCOME REPORTS - This report will show the number of discharges your facility had
          during 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 of
       discharges your facility had during a range of dates according to criteria you select, and their
       percentage of total discharges.

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

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

   •   ACTIVITIES OF DAILY LIVING FREQUENCY REPORT (ADL) - This report will
       show the distribution of the discharges that your facility had in each area of ADLs during a
       selected range of dates. The ADLs are: Bed Mobility, Transfer, Eating, and Toilet Use. This
       report 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 in
       your 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 a
       specified date range. Any information that is not an acceptable answer for a question will be
       listed 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 by
       diskette or via modem.




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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]. To
        send 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 name
        of 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 a
        list of patients with their respective admission dates to be printed. NOTE: It will print all of
        the page 1’s first for the group and then all of the page 2’s.

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                                The screen, shown below, uses [F10] "pop-up" screens for easy
  L O O K
                                access to patient names and admission dates. (For information
  $ Software Notes              about [F10] "pop-up" screens, see section IV. Getting Started).
  % Important Info              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 and
       press [↵Enter] to start printing the report.




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




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                                                                                        Section



                                                                                       VIII
VIII. TRANSMITTING THE SUBACUTE CARE
      SURVEY VIA THE BULLETIN BOARD
      SERVICE (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 the
information to MHCC. The information should be sent to a Bulletin Board System using a
modem. The Bulletin Board System is simply a computer set up at MHCC to collect
information. 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 consistency
             checks. The checks verify that the mandatory fields have been entered and certain
             answers make sense in relation to other answers. The consistency checks are listed
             in Appendix D. From the Main menu, click on “3. Run Error Checks and Zip
             Transmission File.

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




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            The Error Log will show all unacceptable answers for the quarter specified. The
            Patient 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. All
            errors must be corrected before you will be able to zip the file that will be sent to
            MHCC.

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




    4.      Enter the Quarter and the Year of the information you wish to submit. The
            appropriate dates will automatically be displayed in the box provided. If you wish to
            submit 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 done
            when requested by MHCC.)

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




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

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

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




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

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




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




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




            Example: If facility number 1234567 attempted to submit the information 3 times for
            the 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 for
            assistance. After you have verified the file name and the number of records
            provided, you can press any key to return to the Main Menu.

    14.     This file is password protected to ensure the confidentiality of the information
            provided to MHCC.
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B.        THE WORLDGROUP MANAGER

                  The WorldGroup Manager is the software application that provides access to
L O O K           Health Data Connect, the MHCC Bulletin Board System. MHCC provides
$ Software Notes  this software free. It enables facilities to electronically communicate with
% Very Important  MHCC 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 your
information changes. Before installing this application, CLOSE ALL open applications on your
computer.

1.   TO INSTALL THE WORLDGROUP MANAGER:

     If your computer already has the WorldGroup Manager, Do not re-install it. Contact
     MHCC 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, click
               OK.


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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 is
               switched.

    h.         When the World Group Plug-in Installation screen appears that describes the plug-in
               process, 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. With
               the 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, it
               will 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 you
               are using a modem, be sure that the circle next to “Modem” is selected.




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




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

    q.         If calling Baltimore from your facility is long distance, be sure that “1” is inserted in
               front 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 that
               the correct “COM” Port is set up. You may confirm the COM Port by clicking on
               Start in the lower left portion of your screen, clicking on Settings, then Control
               Panel and Phone and Modem Options. Look at the General Diagnostics tab or
               the Modems tab to see the COM Port to which your modem is set.




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     s.        Next, confirm that the correct modem has been selected on the Settings screen. If
               your modem is not listed, we recommend that you use “28800 Generic” as the
               default, 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 a
               check in the box next to “Log on as new user.” If you are a new user and have not
               transmitted 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 your
L O O K
                     facility has been successfully submitting data on another, go to the “How to
$ Software Notes     Logon” section of the Properties screen.
% Very Important

     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 know
               your User-ID or password, contact MHCC at (410) 764-3460 or
               1 (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 to
               our BBS.

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




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

L O O K
                     NOTE: You will need to apply for a HEALTH DATA CONNECT account.
$ Software Notes     If you have used WorldGroup Manager previously and it is still loaded
% Very Important     on your machine, you do not have to apply to Health Data Connect a
                     second time.

If you are using WGM on a new machine and have transmitted the survey previously, you
do not have to apply again. Please contact our office to walk you through the process to set
up 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 apply
to connect to Health Data Connect at least one week before attempting to submit your survey
to the Bulletin Board. ****

     a)        From the WorldGroup Manager screen, the HDC icon will appear. Before clicking
               on 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 Service
               Properties 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 application
                                                   as 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 you
               access the system in the future. Because the information submitted to the
               Commission is confidential, the security of Health Data Connect is extremely
               important.

               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 others
               can find it and please remember your User-ID and password. You will then be
               asked to answer questions about yourself and your company. Please answer those
               questions completely so the Commission will be able to send information back to
               you 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 the
               screen below.




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      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 the
               HDC 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 a
               Health Data Connect User. You will be contacted via fax once this has occurred, or
               you 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 Donna
               Bullen 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 application
               has 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 Manager
               software for the first time. This means the software in your computer is
               automatically downloading new files for WorldGroup Manager from the Bulletin
               Board. When the download is completed, the screen below will appear. The gray
               screen may also appear at other times.




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    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 that
               you have not filled out your Registry entry yet. Click on the message “You haven’t
               filled 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 the
               transmission of your survey. It is your responsibility to maintain the ‘Registry’ with
               the most current information for your facility. MHCC issues the receipt for the

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

     f)            You will also have two e-mail messages – “Welcome new user” and “Class Switch
                   Notification.” 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 directly
                   to the “Home” page (first screen) as shown below, labeled “Electronic Data
                   Submission.” Here you will be able to use options for e-mail, downloading
                   programs from the library, or select the Subacute Care Survey. Available options can
                   be 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 is
          separate from the application and the information will be used to generate receipts from the Commission when
          your file is transmitted.

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




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     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 Name
                         Contact name
                         Job Title of the contact person
                         Phone Number of the contact person
                         Fax number of the contact person
                         Survey(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 or
          not you experienced technical problems during the data collection and transmission
          process or no problems at all. Particular events to advise the Commission of include:


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

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

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

     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 the
                   root directory of the drive on which you installed the Subacute Care Survey. From
                   that root directory, go to the “msacs” folder. Click on the file that was created and
                   zipped 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 Survey
                   software and zip the file again, this time noting the name and location of the file
                   listed at the end of the process.

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

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               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 this
               is an electronic file for Subacute.

               The second (2nd) position after the dot (.) is the last digit of the calendar year of the
               data 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 seven
               digits are 8888888, the facility ID; the eighth digit, 2, reports that the facility
               generated the file two 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 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 the
               name of the staff person to receive the FAX receipt, your current fax number, your
               facility name, and any special comments. NOTE: Be sure to include a statement
               about whether you experienced technical problems during the data collection
               and transmission process, 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, the computer did not close properly, or other
               technical problems. When this information is complete, single click on OK.




Description

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




     l)        To return to the home page, single click on File from the menu. Single click on
               Exit from the drop down menu. If you do not receive a receipt via facsimile within
               five (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 and
                      is updated frequently with the latest virus signature files.

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

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




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

                                                        Donna Bullen
                                              Subacute Care Survey Coordinator
                                              Maryland Health Care Commission
                                                   4160 Patterson Avenue
                                                    Baltimore, MD 21215
                                                Telephone: (410) 764-3460 or
                                                       1 (877) 245-1762
                                                    FAX: (410) 358-1236
                                              E-mail: Dbullen@mhcc.state.md.us




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                                                                            Section



                                                                       IX
IX. UTILITIES
______________________________________

L O O K                Utilities are those processes that are not used in the day-to-day entry
$ Software Notes       of survey information. These sections will help you customize,
% Very Important       protect, and fix your program when you choose to do so. There are
                       nine (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 in
the “System Setup.” If you do not already have this capability at your facility, you must
take action to backup the Maryland Subacute Care Survey data. It is extremely important
to backup your data to protect your organization from data loss. The Maryland Subacute
Care 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 your
hardware, operating system, and computing environment. Refer to Appendix E. for
recommended backup procedures.


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B.       PASSWORD MAINTENANCE – Use this option to control access to the
various system functions. Each option on the Main Menu, as well as “Password
Maintenance” and “Purge Data Files” on the Utilities Menu, can be protected. Users have
the ability to assign different levels of security as shown below. The "Y" in each column
indicates 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 that
feature. Passwords are not active unless that option is chosen in the System Setup.
MHCC recommends password protecting these files to maintain the confidentiality of this
information.




Upon entering this screen, the first user will be displayed in the Name field along with the
Password. Options at the bottom of the screen will allow you to manipulate the
information as you choose. To choose the option you want, enter the 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 the currently selected user and password shown at
        the top of the screen.

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

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


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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 on
       the 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 Transmission
       File” 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 the
       Utilities Menu.


C.      PRINTER SETUP - Use this to choose your default printer type. This option
will identify what kind of printer is being used. This option will not select the printer in
your 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 “System
Setup.” Choosing this option will give you the screen shown below. Simply highlight the
printer you would like and press [↵Enter].




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

       When Printing on a Network - You will have access to printers set up by your
            IT system administrator. The Maryland Subacute Care Survey software
            will send the reports to your default printer (LPT1:). Highlight the printer
            from 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 is
received. “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 the
software installation. Changes at your facility may require you to make updates from time
to 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 is
automatically included with your submissions to identify your facility.

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

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


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       PASSWORDS - If you decide to use passwords to protect the confidentiality of
                   the information entered into the Maryland Subacute Care
                   Survey software, you can turn passwords on by putting a "Y" in
                   this field. MHCC recommends using passwords. If you decide
                   it is not 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) you must have passwords turned on. Users
                           will then be tracked and an Audit Log can be printed from the
                           Utilities Menu.

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

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

       COMMUNICATIONS – This field is currently not available. Skip to the next
                 field. The field contains the start-up command for the
                 communications software that will be used to send survey
                 information to MHCC via a modem. This command should
                 include the drive and path of the communications software.

       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 is MSBACKUP.

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

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




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




G.      DELETE INDIVIDUAL PATIENT - Completely deletes a patient and
admission 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's
ID Number and/or an Admission Date that was entered incorrectly. To change this
information, enter the incorrect Patient ID Number and Admission Date under Old Data
and enter the correct Patient ID Number and Admission Date under New Data. All files
will be automatically updated with new information.

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




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                                                                                    Section




X. TROUBLESHOOTING
                                                                                X
______________________________________
The following are common error messages the user may encounter while using this
program. Each error message is accompanied by the action the user must take to resolve
the problem, or the user is instructed to call technical support at Metro Data, Inc. Please
remember: when you encounter an error message, the first thing you must do is write it
down. If you do not see the error message in this list, then call technical support and read
the error message to them.

                     Note: Technical support is provided by Metro Data, Inc., Monday
L O O K
                     through Friday from 9:00 AM to 5:00 PM. They can be reached at
$ Software Notes     (410) 667-3600 or via email at “info@metro-data.com.” Metro
% Very Important     Data, Inc. does not recommend that you make any changes to your
                     system 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 technical
support.

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

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

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

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

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

"Printer not ready" - Make sure all the printer cables are connected properly. See if you can
print from other programs first. If the error message persists, call your IT systems
administrator 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 between
the computer and the printer. If you still get this message, call your IT systems
administrator or technical support.

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

"The record you want is in use by someone else right now. Do you want to try again? (Y/N)" - If you
say "No" the program will discontinue the process it is working on and not all files will be
updated. 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 IT
systems administrator. If unable to resolve the problem, please call technical support for
assistance.

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

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

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"A hardware error has occurred" - Your disk or directory may be full or there may be a disk
failure. 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 for
assistance.

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

"There is a problem writing the file to disk" - Check to make sure that the disk is not write
protected 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 technical
support for assistance.

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

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

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

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




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“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 the
instructions above, if the user is still receiving this message, call technical support
immediately.

“The file you need is missing!”




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




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“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 the
error message and call technical support




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                                     Appendix



                                     A
SUBACUTE CARE SURVEY HARD COPY OF
THE DATA COLLECTION FORM
______________________________________




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                                                                                      Appendix




QUESTIONS & ANSWERS
                                                                                        B
                                  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 from
the designated facility, or unit within the facility, who are admitted after September 30, 1995. If, for
example, 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 submission
to the Commission. A patient admitted to the facility on September 2, 1995 and discharged on October
10, 1995 should be excluded from the Subacute Care Survey. A patient who is less than two years old
should 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 item
should be completed.

(3) Is a minimum length of stay (LOS) required in order for a patient to be
included 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 with
lengths 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 the
patient.
         (1) If the patient is expected to stay in the program for 14 days or longer, then most of these items
         must be completed by the seventh day of the patient’s stay. (You may complete these items earlier

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         if you desire.) Note: Many facilities complete the survey for all residents to ensure that the data
         has 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 the
         following items can be skipped: Cognitive Patterns, Activities of Daily Living, Behavioral
         Symptoms, 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., the
         admission was a “mistake” or the patient died within 48 hours of admission) should not be
         included 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”. Discharge
Destination should be coded as “77.” Early or Unplanned Discharge, and Reason for Early or
Unplanned 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 the
Subacute 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. For
facilities reporting data for Medicare-skilled patients only, a patient should be reported as discharged when
the criteria for skilled care are no longer met.

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

No.

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

No.


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(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 for
that patient again (e.g., a patient who is transferred to an acute hospital for surgery
and then readmitted to subacute care)?

Yes.

(10) In some facilities, subacute and Medicare skilled patients are placed in the
same unit. If a patient’s status changes from subacute to Medicare skilled, but the
patient 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 patient
remains 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 patient
considered discharged?

Officially, bed hold never affects the definition of discharge. If the patient leaves the subacute unit for 24
hours or longer, he/she is always considered discharged. If the patient returns, a new survey must be
completed. (a) A patient who leaves the subacute program temporarily is not considered discharged if
he/she returns within 24 hours (b) Also, a patient is not considered discharged if he/she has left the
program for the purposes of family visitation. However, the total number of hours spent visiting the family
should not exceed 24 hours. In either of these situations, a new survey should not be completed. Continue
to 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 needs
time to rest. Thus, the purpose of respite care is to provide relief for the regular caretaker. Never complete
a survey for a patient who has been formally admitted for the purposes of respite care. However, if a respite
patient becomes ill and is formally admitted to the subacute unit as a subacute care patient, then he/she
must be included in the survey until his/her status changes again and formal discharge occurs. In the case
of comprehensive care facilities, if a respite patient becomes a permanent resident, then he/she must be
included in the survey once his/her status changes.

(13) MDS items incorporated in the Maryland Subacute Care Survey must be
completed for all discharges with lengths of stay less than 14 days. Doesn’t this
requirement conflict with the CMS guidance that the MDS be completed only for
patients 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.




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                           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 surveys
such 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 in
foreign countries?

See Section VI. 3-G in this manual.

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

If the patient lived in the institution for many years, then code the area of residence in which the institution
is located. If the patient was only in the institution for a short period of time (less than a year), then code
the 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. The
code 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 patient
who lives in an apartment attached to a residence?

Determining the individual who owns or maintains the patient’s place of residence may help in deciding
which category to code. For instance, if the patient lives in an apartment that is attached to the residence of
a 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.” Such
settings may include: ICF-Mentally Retarded, Comprehensive Care Facility, Extended Care Facility,
Rehabilitation Hospital, Chronic Hospital, Psychiatric Hospital, Acute Care Hospital, or Veterans
Administration Hospital.

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If the patient was living in a community-based settings, then the appropriate code would be 8 for “Other
Living Situation.” Such settings may include: Adult Foster Care/Project HOME, Senior Assisted
Housing, 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 2-3
days 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 patient
considered discharged from subacute care? (b) If the patient is considered
discharged when his/her treatment has been completed, what is the discharge
destination for the patient who remains in the subacute unit? (c) If the patient’s
eventual discharge destination is home, won’t the assessment of the program’s
efficacy 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) The
discharge destination for the patient should be coded “88” for “Other.” (c) Even though the intent is to
send the patient home, in actuality, the patient is not going home directly after the subacute treatment has
ended. Therefore, it would not be valid to code the patient’s discharge destination as “private residence.” It
would be equally misleading to label the patient’s discharge destination as “comprehensive care.” Since the
current 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: All
Memory/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.




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                                      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 that
mention 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 completing
these 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 the
program. If a patient has two equally important diagnoses, consider the effect of each diagnosis on the
patient’s condition as a whole. For instance, a patient may be admitted after a fall during which he/she
broke both an arm and a hip. The broken hip may be the injury that incapacitated the patient because it
restricted mobility. Therefore, the broken hip may be the primary reason for the patient’s admission to the
subacute care program, and should be used as the principal diagnosis. Remember, there can be only one
principal diagnosis.

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

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


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

Yes.


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(2) Does respiratory therapy include trach masks? Does respiratory therapy
include 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 the
total number of days of physical therapy. Additionally, if the treatment provided is specifically mentioned
in the category labeled “Special Treatments and Procedures,” the number of days and frequency of the
treatment 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 and
frequency 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 is
almost always drip rather than push.

For the purpose of the current survey, the item “Intravenous Med. Admin. (IV Push)” (under “Special
Treatments 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 the
subacute care unit? It is common knowledge that the insertion of all central lines
is a complicated process that requires equipment usually available in acute care
hospitals only.

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

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

(3) The in-house provision of particular treatments (e.g., radiation, dialysis) must
be indicated on the survey form. (a) What is the definition of in-house? (b) Does
in-house refer to the subacute care unit? (c) If subacute care is administered in a
unit 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 within
the subacute unit itself (e.g., dialysis); however, these services may be provided in another unit housed within
the same facility. In such a case, the service is considered to be provided “in-house.” As a rule of thumb, if
a patient receives services in an area that has the same facility number as the subacute unit, the service is
considered “in-house.” Exceptions may occur. For instance, two parts of a facility may have different
facility identification numbers solely due to differences in licensure. A comprehensive care patient, for
example, may receive radiation therapy in a chronic hospital. Although both the comprehensive care unit
and 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, is
this 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, the
appropriate ICD-9 V-code should be entered as an Other Diagnosis.

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

You should record the total number of days that the treatment was given for the patient’s entire stay. For
instance, if a patient received suctioning three times a day each day of his/her stay, and the length of stay
was five days, then the total number of days of the treatment is five. The frequency of treatment, as ordered
by the physician, is 3D (three times a day). If a patient received treatment as needed (PR), then suctioning
may 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. The
frequency would be PR.
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(7) There may be active orders for a patient to receive a certain treatment for three
times a day for two weeks, but the patient may receive the treatment three times a
day 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 the
patient’s chart. In this case, the frequency would be 3D. However, the total number of days that the
treatment was received should reflect reality. In this case, the patient received 7 days of treatment, not the
14 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 between
admission and discharge?

The User Manual states that the Primary Payment Source refers to the one funding source that paid or
was 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 of
his/her care, the actual primary payment source would be determined upon the patient’s discharge.




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                  DATA SET COMPLETION TIMETABLE
    _____________________________________________________
          The following chart indicates the approximate time when each item
                          should be completed (per patient):
                                                                Measurement Period
                                                                                                    Reference
                 Data Item                              On                    On           During
                                                                                                     MDS 2.0
                                                      Admission            Discharge        Stay
I. IDENTIFICATION INFORMATION
  Facility ID#                                    √                                                 ------
  Patient ID#1                                            √                                         AA.5
  Bed License Type                                        √                                         ------
II. LENGTH OF STAY
  Admission Date                                  √                                                 AB.1
  Discharge Date                                                           √                        R.4
III. DEMOGRAPHIC INFORMATION
  Gender                                                  √                                         AA.2
  Race2                                                   √                                         AA.4
  Date of Birth                                           √                                         AA.3
  Estimated Age in Years                                  √                                         ------
  Ethnicity2                                              √                                         AA.4
  Area of Residence                                       √                                         ------
  ZIP Code                                                √                                         AB.4
  Marital Status                                          √                                         A.5
  Living Situation Prior to Current Referral              √                                         ------
  Treatment Plan Goal                                     √                                         ------
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                                                 √                                         B.1
 Memory/Orientation                                       √                                         B.2
 Cognitive Skills for Daily Decision Making               √                                         B.4




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VII. ADLs (Activities of Daily Living)
 Bed Mobility                                             √                    √                    G.1 a
 Transfer                                                 √                    √                    G.1 b
 Eating                                                   √                    √                    G.1 h
 Toilet Use                                               √                    √                    G.1 i
VIII. BEHAVIORAL SYMPTOMS3
 Wandering                                                                                      √   E.4 a
 Verbally Abusive Behavior                                                                      √   E.4 b
 Physically Abusive Behavior                                                                    √   E.4 c
 Socially Inappropriate                                                                         √   E.4 d
 Resists Care                                                                                   √   E.4 e
IX. SKIN CONDITION
  Ulcers
    Stage 2 (Number of Sites)                             √                                         M.1 b
    Stage 3 (Number of Sites)                             √                                         M.1 c
    Stage 4 (Number of Sites)                             √                                         M.1 d
  Type of Ulcer
    Pressure Ulcer                                        √                                         M.2 a
    Stasis Ulcer                                          √                                         M.2 b
  Other Skin Conditions
    Burns (Second/Third Degree)                           √                                         M.4 b
    Open Lesion (Other than Ulcer)                        √                                         M.4 c
    Skin Tears or Cuts (Other than Surgery)       √                                                 M.4 f
    Surgical Wounds                                       √                                         M.4 g
X. PRINCIPAL AND OTHER
DIAGNOSES
 Principal (ICD-9) Diagnosis on Admission         √                                                    ------
 Other (ICD-9) Diagnoses on Admission                     √                                            ------

XI. Additional Diagnoses (ICD-9) Identified
During Stay                                                                                     √      ------


XII. THERAPIES PROVIDED4
 Speech-Language Pathology & Audiology                                                          √   P.1 b.a
 Occupational Therapy                                                                           √   P.1 b.b
 Physical Therapy                                                                               √   P.1 b.c
 Respiratory Therapy                                                                            √   P.1 b.d.




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XIII. SPECIAL TREATMENTS AND
PROCEDURES5
 Medication Administration
   IV Chemotherapy                                                                              √   P.1 a. a
   Intravenous Med. Admin. (IV Push)                                                            √   P.1 a.c
   PO Med. Admin.                                                                               √   ------
   IM/SQ Med. Admin.                                                                            √   ------
 Administration of Nutrients/Fluids
   Hyperalimentation                                                                            √   K.5 a
   Intravenous Fluid Admin.                                                                     √   ------
   Tube Feeding                                                                                 √   K.5 b
 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                                                                            √   P.1 a.j
   Indwelling Urinary Cath/Irrigation                                                           √   ------
                                                                                                √   ------
   Peripheral IV, PICC, or Central IV Line
 Other Treatments (Frequency & Total
       Number of Days)
                                                                                                √   ------
   Blood Transfusion
                                                                                                √   ------
   Hemodialysis
                                                                                                √   P.1 a.g
   Oxygen Therapy
                                                                                                √   ------
   Peritoneal Dialysis                                                                              P.1 a.i
                                                                                                √
   Suctioning                                                                                       M.5 f
                                                                                                √
   Surgical Wound Care                                                                              M.5 e
                                                                                                √
   Ulcer Care                                                                                       P.1 a.l
                                                                                                √
   Ventilator Care                                                                                  ------
                                                                                                √
   Ventilator Weaning                                                                               P.1 a.h
                                                                                                √
   Radiation Therapy
XIV. FINANCIAL INFORMATION
 Primary Payment Source6                                                      √                     A.7
                                                                              √                     ------
 Secondary Payment Source




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Notes:

1. The Patient ID Number in the Subacute Care Survey consists of the last six digits of
the 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 in
the MDS 2.0 and the frequency coding provided in Form 3871. Alterability is not coded
in the Subacute Care Survey.

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

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

7. The Payment Source/Payment Type data items in the Subacute Care Survey include
response categories not used in the MDS 2.0.




          User Manual – Subacute Care Survey
                                     Appendix




SAMPLES OF SOME OF THE REPORTS
                                     C
______________________________________




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                                                                                                Appendix




   SUMMARY OF INTERDEPENDENT DATA
                                                                                                D
   ITEMS AND CONSISTENCY CHECKS
   _____________________________________________________

    Record/          [F10] “pop-
                                        Data Item        Interdependent Items              Consistency Checks
    Section           up avail?
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 the
                                                                                   letter "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, 1995
                                                                                   or later.

                                                                                   First two characters of the year must
                                                                                   be 19 or 20.

                                                                                   The program automatically checks
                                                                                   the month, day, and year for valid
                                                                                   values.
R1-7 Part II.        No             Discharge Date      Admission Date             Required field for submission - The
                                                                                   Discharge Date coded must be equal
                                                                                   to or greater than the Admission
                                                                                   Date.

                                                                                   First two characters of the year must
                                                                                   be 19 or 20.

                                                                                   The program automatically checks
                                                                                   the month, day, and year for valid
                                                                                   values.

                                                                                   If the Discharge Date is not coded,
                                                                                   then the following data entry
                                                                                   screens 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 will
                                                                              NOT permit entry of discharge
                                                                              values for the following items:
                                                                                   • ADLs – on Discharge

                                                                              If the patient is discharged less than
                                                                              48 hours after admission, then the
                                                                              data entry program will not permit
                                                                              entry of the following items:
                                                                                   • Cognitive Patterns
                                                                                   • ADLs (On Admission/On
                                                                                        Discharge)
                                                                                   • Behavioral Symptoms
                                                                                   • Skin Condition
                                                                                   • Therapies Provided

                                                                              NOTE: The calculation of less than
                                                                              48 hours is based on the Admission
                                                                              and Discharge Dates (e.g., a patient
                                                                              admitted on 10/5/02 and discharged
                                                                              on 10/7/02 would be counted as a
                                                                              two-days or less than 48 hr. Length
                                                                              of Stay).
R1-7 Part III     No           Gender              Patient Suffix             Required field - If Patient Suffix =
                                                   (i.e., Mr. Mrs., Ms.)      Mrs. or Ms. then Gender must be
                                                                              coded '2' (Female).

                                                                              If Patient Suffix = Mr. then Gender
                                                                              must be coded “1” (Male).
R1-7 Part III     Yes          Race                                           Required field.
R1-7              No           Date of Birth       Admission Date             Required field – Either Date of
Part III                                           Discharge Date             Birth or Estimated Age must be
                                                                              completed.
                                                                              Date of Birth must be less than
                                                                              Admission Date; Greater than or
                                                                              equal to 01/01/1875 and must at
                                                                              least 730 days prior to the Discharge
                                                                              Date.

                                                   Estimated Age              Year of Birth cannot be the current
                                                                              Year.

                                                                              Date of Birth will be skipped if
                                                                              Estimated Age is entered with other
                                                                              than "777", “1” or blank.


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                                                                                  NOTE: Program will calculate age
                                                                                  and automatically enter "777" for
                                                                                  Estimated Age when a valid DOB is
                                                                                  entered.
R1 Part III         No           Estimated Age (in     Date of Birth              The Estimated Age must be greater
                                 years)                                           than 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 is
                                                                                  blank.
R1 Part III         Yes          Ethnicity                                        Required field.
R1 Part III         Yes          ZIP Code of                                      Required field.
                                 Residence
R1 Part III         Yes          Area of Residence     ZIP Code                   Required field - If the ZIP Code is
                                                                                  included in the Maryland ZIP
                                                                                  Code/County database, then the
                                                                                  Area of Residence code must be
                                                                                  valid for the ZIP Code. If the Area
                                                                                  of Residence is greater than 30 and
                                                                                  the ZIP Code is not in the Maryland
                                                                                  Zip Code/County database or if the
                                                                                  Area of Residence = 99, then the
                                                                                  program will accept the Area of
                                                                                  Residence.
R1 Part III         Yes          Marital Status                                   Required field.
R1 Part III         Yes          Living Situation      Marital Status             Required field - If Marital Status is
                                 Prior to Current                                 coded 1 (Never Married), 4
                                 Referral                                         (Divorced), 5 (Widowed), or 9
                                                                                  (Unknown), then Living Situation
                                                                                  Prior to Current Referral cannot be
                                                                                  coded 1 (With Spouse).
R1 Part IV          Yes          Source of                                        Required field.
                                 Admission
R1 Part V           Yes          Patient Outcome                                  Required field - If Patient Outcome
                                                                                  is coded "6" (Death), then the
                                                                                  program will automatically enter
                                                                                  "7" or ”77” (Not Applicable) in the
                                                                                  following items:
                                                                                       • Early or Unplanned
                                                                                           Discharge
                                                                                       • Reason for Early or
                                                                                           Unplanned Discharge
                                                                                       • Discharge Destination

                                                                                  If Patient Outcome is coded "6"
                                                                                  (Death), the program will
                                                                                  automatically enter: "9" (Unknown)
                                                                                  for all Activities of Daily Living
                                                                                  Items on Discharge.




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R1 Part V          No           Early or              Patient Outcome            Required field - If Patient Outcome
                                Unplanned                                        is coded "6" (Death), then the
                                Discharge                                        program will automatically enter
                                                                                 "7" (Not Applicable) in Early or
                                                                                 Unplanned Discharge.
R1 Part V          Yes          Reason for Early      Early or Unplanned         Required field - If Early or
                                or Unplanned          Discharge                  Unplanned Discharge is coded "0"
                                Discharge                                        (No), then program will
                                                                                 automatically enter "7" (Not
                                                                                 Applicable) in Reason for Early or
                                                                                 Unplanned Discharge.
                                                      Patient Outcome
                                                                                 If Patient Outcome is coded “4" (No
                                                                                 Change) or “5” (Patient Decline),
                                                                                 then Reason for Early or Unplanned
                                                                                 Discharge cannot be "4” (Patient
                                                                                 Improved).

                                                                                 If Patient Outcome is coded "6"
                                                                                 (Death), then the program will
                                                                                 automatically enter "7” (Not
                                                                                 Applicable) in Reason for Early or
                                                                                 Unplanned Discharge.
R1 Part V          Yes          Discharge             Patient Outcome            Required field - If Patient Outcome
                                Destination                                      is coded "6" (Death), then the
                                                                                 program will automatically enter
                                                                                 "77" (Not Applicable) in Discharge
                                                                                 Destination. The code of “77" in
                                                                                 Discharge Destination is only valid
                                                                                 when Patient Outcome is ”6”.

                                                                                 If Reason for Early or Unplanned
                                                      Reason for Early or        Discharge is "2" (Condition
                                                      Unplanned Discharge        required admission to other health
                                                                                 facility) then Discharge Destination
                                                                                 must be another health facility
                                                                                 (codes 20 through 38).
R2 Part VI         No           Comatose                                         Required field.
R2 Part VI         No           Memory/               Comatose                   Required field - If Comatose is
                                Orientation                                      coded "1" (Yes), then
                                                                                 Memory/Orientation items are left
                                                                                 blank.
R2 Part VI         No           Cognitive Skills      Comatose                   Required field - If Comatose is
                                for Daily Decision                               coded "1" (Yes), then Cognitive
                                Making                                           Skills for Daily Decision Making is
                                                                                 left blank.




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R2 Part VII      Yes        Activities of     Admission Date              Required field - If patient discharge
                            Daily Living      Discharge Date              is within two days of admission,
                            (ADLs)            Patient Outcome             entry of ADL data items not
                                                                          required.

                                                                          Self Performance and Staff Support
                                                                          are checked for consistency using
                                                                          the following standards:
                                                                               If Self         Staff Support
                                                                           Performance:           must be:
                                                                                  0         0, 1, 2
                                                                                  1         0, 1, 2, 3
                                                                                  2         0, 1, 2
                                                                                  3         2, 3
                                                                                  4         2, 3
                                                                                 8*         8*
                                                                                 9**        9**
                                                                          * Self Performance and Staff
                                                                          Support “8” is only valid for Bed
                                                                          Mobility and Transfer.

                                                                          ** Self-Performance and Staff
                                                                          Support “9” is only valid for the
                                                                          Admissions. It is not valid for the
                                                                          evaluations at Discharge.
R2 Part VIII     Yes        Behavioral        Admission Date              Required field - If Comatose is
                            Symptoms          Discharge Date              coded "1" (Yes), then Behavioral
                                              Comatose                    Symptom data items are left blank.

                                                                          If patient discharge is within two
                                                                          days of admission, entry of
                                                                          Behavioral Symptom data items is
                                                                          not required.
R3 Part IX       No         Ulcers: Number    Admission Date              Required field - If patient discharge
                            of Sites          Discharge Date              is within two days of admission
                                                                          entry of Number of Ulcer Sites is
                                                                          not required.

                                                                          Number of Sites must be > 0 or <=
                                                                          99.

                                                                          "77” and “99" are invalid number of
                                                                          sites. These numbers are reserved
                                                                          for Not Applicable and Unknown,
                                                                          which are not valid answers for this
                                                                          data item.




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R3 Part IX       No         Types of Ulcer      Ulcers: Number of          Required field - If Number of Sites
                            (Highest Stage)     Sites (By Stage)           = 0, Type of Ulcer (Highest Stage)
                                                Admission Date             must = 0 for both Pressure and
                                                Discharge Date             Stasis Ulcers. If there are Ulcer
                                                                           Sites, the Type of Ulcer must be
                                                                           greater than “0” for at least one
                                                                           type. If Stage 2 (Number of sites) is
                                                                           greater than “0”, then Type of Ulcer
                                                                           (Highest Stage) must be “2” for
                                                                           Stasis or Pressure. (NOTE: This
                                                                           same edit applies to Stage 3 and 4
                                                                           (Number of Sites.)

                                                                           If patient discharge is within two
                                                                           days of admission, entry of Type of
                                                                           Ulcer is not required.
R3 Part IX       No         Other Skin          Admission Date             Required field -If patient discharge
                            Conditions          Discharge Date             is within two days of admission,
                                                                           entry of Other Skin Conditions is
                                                                           not required.
R3 Part X        Yes        Principal/Other                                Principal Diagnosis - Required
                            ICD-9 Diagnoses                                field. V-codes and E-codes cannot
                            on Admission for                               be used for Principal Diagnosis.
                            Care
                                                                           The Principal Diagnosis code
                                                                           cannot be repeated in coding Other
                                                                           ICD-9 Diagnoses on Admission.

                                                                           A code entered once under Other
                                                                           ICD-9 Diagnoses on Admission
                                                                           cannot be repeated.

                                                                           All codes are validated using
                                                                           International Classification of
                                                                           Diseases - Ninth Revision, Clinical
                                                                           Modification (ICD-9-CM), Sixth
                                                                           edition. (2002)
R3 Part XI       No         Additional ICD-     Principal Diagnosis        A Diagnosis Code entered as
                            9 Diagnoses         Other Diagnoses            Principal or Other Diagnosis 1-9
                            Identified During                              cannot be repeated in Additional
                            Stay                                           ICD-9 Diagnoses Identified During
                                                                           Stay.
R5 Part XII      No         Therapies           Admission Date             Required field - The number of days
                            Provided            Discharge Date             coded for Therapies Provided must
                                                                           be less than or equal to Length of
                                                                           Stay or coded "0" for None.

                                                                           If patient discharge is within two
                                                                           days of admission, entry of
                                                                           Therapies Provided is not required.



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R5 Part XIII    Yes        Special           Admission Date              Required field - The number of days
                           Treatments and    Discharge Date              coded for Special Treatments/
                           Procedures        Number of Days              Procedures must be less than or
                                                                         equal to the Length of Stay or coded
                                                                         "0" for None.

                                                                         If Days = 0, then data entry program
                                                                         will assign "77" (Not Applicable) to
                                                                         Frequency.

                                                                         If Days > 0, then frequency cannot
                                                                         be “77” (Not Applicable)
R6 Part XI      Yes        Primary Payment                               Required field.
                           Source
R6 Part XI                 Secondary         Primary Payment             Required field - The Primary and
                           Payment Source    Source                      Secondary Payment Sources cannot
                                                                         be the same.




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                                                                              Appendix




RECOMMENDED BACKUP PROCEDURES
                                                                                  E
_______________________________

In today's technological working environment, almost everyone relies on a computer to
store documents, correspondence, financial reports, and many other invaluable resources.

Imagine working for weeks or months on something and then it is all lost because a
computer file is deleted or damaged. While hardware can be replaced and application
software reloaded from original media, recovery of data files relies on regular backup
procedures.

       MHCC strongly urges you to make routine backups of your
       Subacute 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? Do
           they 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 questions
           indicates a risk for which remedial steps should be
           considered.
It should be a top technology priority for every computer user to ensure that the data on
faculty and staff machines is backed up on a regular basis to a secure place. There are
many 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
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their data to their server accounts. This approach assumes the department server is using
a proven backup and restore procedure.

Alternatively, storage hardware such as a Zip drive or Tape Drive can be purchased for
each user’s computer, and each person is then responsible for performing her or his own
backups.

To help insure that users are diligent about saving their data, software can be purchased
that allows backups to be run automatically, at any time of the day or night, as long as the
computer 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 mind
that these are just recommendations. Please have your computer support personnel
review 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) Thursday
       5) Week One 6) Week Two 7) Week Three 8) Week Four
       9) 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: Monday
       through Thursday. Each morning, the previous day’s tape should be removed
       from the drive unit and placed in a fireproof safe or taken off the premises by a
       company owner or member of management. This step must be followed. If the
       tape is lost or destroyed in a fire or storm, data is also lost, even if all other
       procedures are perfect. If your physical plant is destroyed, retention of vital data
       such as Accounts Receivable, Orders, Estimates, Inventory and the like could
       mean the difference between remaining in business or not. Even when a
       company’s computers are lost in a physical disaster, data from a tape can be
       restored to replacement equipment. Activities such as receivables collection and
       filing insurance claims can begin quickly. Such tasks will take far longer (or may be
       impossible) if data has to be reconstructed or cannot be recovered. In the event of
       a natural disaster, many areas of the facility will need the attention of the IT system
       administrator, which can delay the restoration process of the data for the Subacute
       care 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. On
       the following working day, each Friday’s tape should be stored or taken off
       premises 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.
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       Label the container for the tape as Q1, 20XX and label the tape itself with the date
       of the backup. Replace it with a brand new tape labeled "#1 Monday." At the end
       of the second quarter, do the same with the #2 (Tuesday) tape and so on. These
       quarterly data collections should be archived off-premises (as in a company safe-
       deposit box) and retained indefinitely. In this manner, the four most heavily used
       tapes are replaced annually. Replace all "weekly" tapes every two to three years on
       the 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 into
       the regular rotation. If you have to use "Spare One" on a Wednesday, for
       example, don’t record on the cartridge again during that week.

       Alternative 1: Replace the spare with the original tape when it again becomes
       available. If it does not, obtain a replacement tape.

       Alternative 2: If the original again becomes available, it should be put back into
       rotation and the "Spare" returned to spare status. If the original tape can no
       longer be used, re-label the "Spare" and use it in daily rotation. Label and use a
       new tape as the spare.

By using this procedure, a significant amount of time will be saved if the data needs to be
restored. You will be creating the following archives:

1)     A week’s worth of data is constantly available on tape, along with a month’s worth
       of backups at weekly intervals. If you find that a file needs restoration or rolling
       back 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 the
       point that the data it contains may not be readable.

Should you have any questions about how to set up your backup procedures you may
contact Metro-Data at (410) 667-3600.




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