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ASPEN Enforcement Manager _AEM_ v8.7 User Guide

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ASPEN Enforcement Manager _AEM_ v8.7 User Guide Powered By Docstoc
					ASPEN Enforcement Manager
        (AEM) v8.7




For Nursing Home Enforcement Cases
          User Guide
             December 2006
Information in this training guide is subject to change without notice.
All brand or product names are trade names, service marks, trademarks, or
registered trademarks of their respective companies or organizations.
   Systems Environment
Application Development: MS Visual C++ version 7.1
Desktop Database: MS Access 97 version 7.0
Server Database: Oracle Enterprise Server version 9.2.0
Oracle Call Interface and Objects for OLE version 10.1.0.0
MS Internet Explorer version 5.5 (Service Pack 2) or later to support the integrated
Internet browser
   Optional System Environments
MAPI Compliant E-mail client to support e-mail transfer of survey information.


This document may be viewed online or printed in a duplex (two-sided) format.
Blank pages have been automatically inserted as needed for correct pagination in
the printed copy.
Contents



                                AEM User Guide
Contents
I.   Overview ............................................................................................... 7
     What is an ASPEN Enforcement case?......................................................... 7
     How is Enforcement management integrated into ASPEN? ............................. 8
     Navigating in AEM ................................................................................... 9
     Customizing Your Display ......................................................................... 9
          ACO Selection Sets .......................................................................... 10
          Enforcement Case Filter .................................................................... 10
     The AEM Tree ....................................................................................... 11
          My Cases ........................................................................................ 11
          Special Cases .................................................................................. 12
          My Action Items............................................................................... 13
          Case Workers .................................................................................. 17
II. AEM Basics ........................................................................................... 19
     About Cycle Start .................................................................................. 19
     Separate Health/LSC Enforcement Tracks ................................................. 19
     Combined Health/LSC Enforcement Tracks the 7-Day Rule ........................ 19
     Opening a New Case.............................................................................. 20
     Finding and Opening Existing AEM Cases .................................................. 21
III. The AEM Case File ................................................................................ 23
          Hover Guidance ............................................................................... 23
     Title Bar, Case Header and Footer............................................................ 24
     Case Basics Tab .................................................................................... 26
          Beginning Case Type ........................................................................ 27
          Case Workers .................................................................................. 27
          Activities ........................................................................................ 27
          Transferring Cases to the RO ............................................................. 27
          Changing Case Status/Closing a Case ................................................. 28
          Case Notes ..................................................................................... 28
          About Substantial Compliance............................................................ 28
     Surveys & IDR tab................................................................................. 29
          Surveys Subtab ............................................................................... 29
          IJ Situation Subtab .......................................................................... 31
          Citations: All Surveys Subtab............................................................. 32


AEM User Guide                               December 2006                                                    3
Contents


    Remedies Tab ....................................................................................... 34
    CMP Tab .............................................................................................. 36
    NATCEP Tab ......................................................................................... 44
    Notices Tab .......................................................................................... 45
         Generating a letter........................................................................... 46
    Hearing/Appeal Tab ............................................................................... 49
    Upload Tab........................................................................................... 52
         AEM Detail Upload (v8.6) .................................................................. 52
         Manual Uploads ............................................................................... 52
         Automatic uploads ........................................................................... 53
         Monitoring AEM Upload Transactions................................................... 54
IV. AEM Setup in ACO/ARO .......................................................................... 57
    State Enforcement Remedies .................................................................. 57
    Distribution Recipients ........................................................................... 59
    Customizing Enforcement Letters............................................................. 60
         Viewing the CMS Letter Templates ..................................................... 60
         Creating a State Letter Template from a CMS Template......................... 61
         Inserting Text and Graphic into the Header.......................................... 64
         Edit/Format Enforcement Letters........................................................ 64
         About ASPEN Letter Macros ............................................................... 65
V. AEM Reports .......................................................................................... 69
    Setting AEM Report Options .................................................................... 70
         Stored Report Settings ..................................................................... 71
    AEM Sample Reports.............................................................................. 72
         AEM Nursing Home Enforcement Case Profile ....................................... 72
         AEM Nursing Home Enforcement History ............................................. 74
         AEM Nursing Home Enforcement Case Log........................................... 75
         AEM Case Counts Report ................................................................... 77
         AEM Action Items/Next Steps Report .................................................. 79
         AEM Cases For Which No Letter Has Been Sent .................................... 81
         AEM: Surveys Not In An AEM Case ..................................................... 83
         AEM Cases Not Transferred to RO Report............................................. 85
         AEM Nursing Home Denial of Payment Report ...................................... 87
         AEM Nursing Home Termination Report ............................................... 89
         AEM Medicare Hearing Status Report .................................................. 91
         AEM NATCEP Loss Report .................................................................. 93
         AEM Federal CMP Due Report............................................................. 95
         AEM State CMP Due Report ............................................................... 96
         AEM Federal CMP Tracking Report ...................................................... 98
         AEM Federal CMP Analysis Report – Discreet CMPs...............................101


4                                          December 2006                                AEM User Guide
Contents


         AEM Federal CMP Analysis Report – CMPs Grouped By Cycle .................105
         AEM Federal CMP Analysis Report – Cycle Totals..................................109
         AEM Immediate Jeopardy Timeline Report ..........................................112
         AEM Mandatory DPNA Timeline Report ...............................................114
         AEM Waiver Report .........................................................................116
         IDR Report.....................................................................................117
VI. AEM Field Descriptions...........................................................................119
    Title bar, Case Header and Footer...........................................................119
    Case Basics tab....................................................................................122
         Summary ......................................................................................122
         Activities .......................................................................................129
         Case Notes ....................................................................................131
    Surveys & IDR tab................................................................................133
         Cycle Surveys and Citations Management...........................................133
    Remedies Tab ......................................................................................150
    CMP Tab .............................................................................................153
         Case CMP Detail .............................................................................153
         Detail for Highlighted CMP................................................................161
         CMP Interest Calculator ...................................................................168
         CMPTS Detail..................................................................................171
         CMPTS Remarks .............................................................................173
         CMPTS Upload ................................................................................174
    NATCEP Tab ........................................................................................177
    Notices Tab .........................................................................................179
         Notices and Notices History ..............................................................179
         Letter Details .................................................................................183
    Hearing/Appeal Tab ..............................................................................186
         Hearing/Settlement Window .............................................................191
         Upload Tab ....................................................................................193
VII. Enforcement Features in AST ................................................................197
    AST Scheduling View ............................................................................197
    AST Tracking View................................................................................198
    AST My ASPEN View .............................................................................199




AEM User Guide                             December 2006                                                    5
 I.Overview



I.   Overview




     What is an ASPEN Enforcement case?
              An Enforcement case is a process of monitoring Nursing Home (NH)
              facilities to ensure that they remedy deficient practices and establish
              procedures that will sustain continued compliance. In severe instances of
              non-compliance, NH Enforcement allows imposition of significant
              sanctions against the nursing home, including monetary penalties and
              program termination.
              An Enforcement case is initiated, typically by the State Agency (SA), when
              the survey of a Nursing Home results in findings of deficiencies with scope
              and severity of D or above. Once an enforcement case begins, additional
              survey visits may be added to the cycle.
              ASPEN Enforcement Manager (AEM) enables both State Agency and CMS
              Regional Office (RO) staff to efficiently manage all tasks related to NH
              Enforcement. Case workers can assign cases and perform activities such
              as case definition, assignment and maintenance; management of
              immediate jeopardy (IJ) situations; remedy determination; assessment of
              Civil Money Penalties (CMPs); NATCEP-related tasks, and Hearing and
              Appeals tracking.



 AEM User Guide                       Decmeber 2006                                       7
I.Overview


             An Enforcement cycle ends with either compliance or termination
             (voluntary or involuntary). A single cycle cannot exceed 6 months. In
             AEM, a case may remain open until all appeals are exhausted and all
             CMPs paid.

    How is Enforcement management integrated into
    ASPEN?
             ASPEN Enforcement Manager is configured as an additional view—on the
             Enforcement tab—in ASPEN Central/Regional Office (ACO/ARO).




             AEM shares all facility, certification, complaint, and citation information
             captured within ACO/ARO and the ASPEN Complaints Tracking System
             (ACTS). While you can view survey information in AEM, most survey and
             certification data continues to be entered and maintained directly in
             ACO/ARO.
             When working in an Enforcement case, you have a read-only view of
             facilities and surveys that are linked to the case, and can make changes
             to dates (POC tracking dates, for instance) that are relevant to
             Enforcement. Changes made in AEM will be visible elsewhere in ACO the
             next time the survey is opened.


8                                     December 2006                      AEM User Guide
                                                                  Navigating in AEM


        State Licensure Cases
        States can use AEM to monitor enforcement of licensure-only facilities, if
        the ASPEN Facility Type of the licensed facility is defined using 02
        NURSING HOME as the Primary Type Category. Facility Types are defined
        from the System menu: select Facility Types, then Type Maintenance.

  Navigating in AEM
        When you go to the Enforcement tab, the initial display contains the AEM
        Tree in the left pane, and a list of your action items on the right. This
        main view is called the AEM Explorer view.




        The AEM Tree (left pane of the display) provides a number of ways you
        can view and open enforcement cases. Learning to use the features of the
        tree can save considerable time as you work in the application.

  Customizing Your Display
        Since ASPEN enforcement applies only to nursing homes, only nursing
        homes are listed in AEM. Two settings establish which nursing homes and
        enforcement cases you see on the Enforcement tab: the active Selection
        Set and the AEM Case Filter.




AEM User Guide                  December 2006                                       9
I.Overview


      ACO Selection Sets
             The active ACO selection set filters the providers that are listed in the
             AEM Tree. The selection set must include nursing homes, of course, for
             any providers to be visible. In addition, you can use selection sets to limit
             displayed providers to specific counties, management/work units,
             operating status, etc.
             Instructions for creating selection sets are in "ASPEN Technical Training",
             which you can download from www.qtso.com.
                You change selection sets by using the ACO Selection drop-down box
                on the ACO/ARO Main menu bar:




      Enforcement Case Filter
             You can use the Enforcement Case Filter to limit the cases listed in the
             tree to those having a specific Federal Status, which comes in handy
             when you need to see only one type of case, like CMP Collection cases.
                To change the current case filter, right-click ASPEN Desktop at the
                top of the Tree view, and select Set Filter.




                In the Enforcement Case Filter window, choose the status of the cases
                that you want to see.




10                                    December 2006                       AEM User Guide
                                                                        The AEM Tree


  The AEM Tree
        Like other ASPEN tree views, the AEM tree lists providers under alphabetic
        nodes. Providers displayed in blue have at least one open enforcement
        case.
        Click the to expand the facility node and see the enforcement cases
        listed beneath:




        AEM icons apply identifying characteristics to each case:

                   The magnifying glass is the enforcement case icon.

                     An IJ flag indicates a case that involves an Immediate Jeopardy
             (IJ) situation.

                   A magnifying glass with a superimposed arrow indicates a case
             that has been uploaded to the national system.
        In addition to the alphabetic list, the AEM tree contains other nodes that
        are specific to Enforcement:

         •   My Cases
         •   Special Cases
         •   My Action Items
         •   Case Workers




     My Cases
        My Cases is a quick list of those cases to which you have been assigned
        as case worker. With My Cases, you have instant access to details about
        cases and surveys without having to open individual records.
             When you highlight My Cases on the left, the List View in the right
             pane shows a line summary of each case, with tracking number, cycle
             start date and other relevant indicators.




AEM User Guide                    December 2006                                   11
I.Overview




                Expand My Cases (click the     to the left) to list your cases both in the
                tree and list views.
                In either view, double-click a case to see the surveys involved, and
                any attachments (relevant files) linked to the case.
                Double-click a survey to see tags cited and survey team information.

      Special Cases
             The Special Cases node organizes enforcement records four different ways
             to help you isolate important cases:




12                                   December 2006                       AEM User Guide
                                                                       The AEM Tree




           •     Active IJ Cases—Cases that have a current Immediate Jeopardy
                 (IJ) situation
           •     All IJ Cases—Cases with IJ situations that have either Current or
                 Removed status
           •     Open Cases—All open cases
           •     No Opportunity to Correct Cases—Cases with a Beginning Case
                 Type (Federal) of No Opportunity to Correct
        These classifications are not mutually exclusive. You may see cases listed
        under more than one node.

     My Action Items
        Action items can notify you of tasks that require attention, and remind
        you of important next steps in your enforcement cycles.
        The only action items you see in AEM are enforcement-related action
        items, plus any personal action items you may have added to your AST
        calendar. AEM action items are listed on the lower right whenever you go
        to the Enforcement tab, or you can highlight My Action Items in the tree
        to see a full screen list like this:




AEM User Guide                    December 2006                                   13
I.Overview




                Right-click any action item for a menu of options:
                •   Open Enforcement Case – opens the case related to the action
                    item
                •   Alert Properties – Opens the Action Item Properties window,
                    where you can view details about the action item and change its
                    Status (Open or Closed)
                •   Close Multiple Action Items – Allows you to close all selected
                    action items
                •   Print Screen – Sends the list of action items to the printer

             Action Item Types
             In AEM, action items and case activities are tied together (see Activities,
             page 129). Any time an activity is added to the case, a corresponding
             action item is generated. Activities may be added to the case manually, or
             triggered by specific entries in ASPEN.
             When a user adds an activity to an enforcement case, its action item is
             sent to the recipient specified in the activity. When an activity is added to
             the case automatically, the action item goes to the case primary case
             worker(s).
             The automatic entries that add an activity and/or action item to the case
             are:




14                                    December 2006                       AEM User Guide
                                                                         The AEM Tree


            •    NEW SURVEY ADDED
                 NEW SURVEY activities and action items are triggered when a
                 survey is created anywhere in ASPEN (ACO, ARO or ACTS) for an
                 NH that has an active AEM enforcement case. The visit is added to
                 the enforcement case, a NEW SURVEY ADDED activity is created for
                 the case, and a NEW SURVEY ADDED action item is sent to the
                 primary case worker.
            •    IJ CHANGED/REMOVED BY IDR
                 When an IJ-level tag's Scope/Severity (S/S) is changed as a result
                 of IDR or hearing, and the S/S change affects the status of the IJ
                 situation, an IJ SITUATION CHANGED BY IDR activity is added to
                 the case, and the primary case worker receives an action item.
            •    2567 REVISED FOR APPEALED SURVEY
                 When the Revised 2567 date is changed on a survey which has a
                 hearing associated with it in an AEM case, a 2567 REVISED FOR
                 APPEALED SURVEY activity is added to the case and an action item
                 advising of the changed date is sent to the primary case worker.
            •    HEARING RESOLVED
                 When a hearing's Settle/Withdraw Date or Final Decision Date is
                 entered, this action item is sent to both primary case workers. If
                 the date is entered by one of the primary case workers, the action
                 item will not be sent to that person.
            •    IJ SITUATION ADDED
                 When an IJ situation is added to an enforcement case, AEM sends
                 an action item to the RO and State primary case workers.
            •    SUBSTANTIAL COMPLIANCE ACHIEVED
                 When Substantial Compliance is achieved in a case, AEM sends an
                 action item to the primary case workers.

        Action Item Filters
        If your action item list becomes lengthy, you can create filters for it—or
        hide it entirely. You can also create filters that will show action items that
        have been sent to other staff members (your work unit, for instance).

        Note: State users do not have to create an action item filter. If there
        is no filter, AEM shows all enforcement action items.
        RO users, however, have to create and activate a filter in order to see
        any action items. A single filter will work for all states in the region.

        To create and activate an action item filter
        1   Right-click My Action Items and select New Action Item Filter.




AEM User Guide                    December 2006                                     15
I.Overview




                 In the Action Item Filter Settings window:




             2   Select the date range for the action items you want this filter to list.
             3   Indicate whether you want this filter to show personal or enforcement
                 action items. No selection means the filter is not applied, and you will
                 see both.
             4   Choose whose action items you want to see:
                    To create a filter that displays only your action items, select
                    Include Action Items for Current User. If you choose this
                    option, you cannot select additional names. Say Yes to the
                    confirmation prompt.
                    To create a filter that displays action items that have been sent to
                    specific staff members, click Add and select the staff names (you
                    can include yourself on this list).
             5   Choose either Open or Closed action items. If you make no selection,
                 that part of the filter is not applied, and you will see both.
             6   Select Public if you want other people to be able to use this filter.
             7   Type a name for the filter.
             8   Click OK when done.
             9   In the tree, click the next to My Action Items to expand the node.
                 Your new filter is listed beneath with a red check mark . Red check


16                                     December 2006                       AEM User Guide
                                                                          The AEM Tree


            marks mean the filter is not activated.




            Public filters have a globe on the check mark      .
        9   Right-click the filter and select Activate to activate the filter.
            Activated filters have a green check mark .

     Case Workers
        In AEM, you can assign State and Federal case workers to each case, and
        designate primary case workers (see "Case Basics Tab" on page 26).
        Primary case workers receive action item notifications related to the case.
        There are also letter macros that will insert the primary case worker's
        name into an enforcement letter.
        AEM's Case Worker node lists all case workers, both State and Federal,
        that have been assigned to an enforcement case. You can use this list to
        see a list of the cases that have been assigned to any staff member.
            Click the   next to the Case Workers node to expand it.
            Click the next to a case worker name to see his or her assigned
            cases listed beneath.
            Click the next to a case to expand it and see its surveys and
            attachments:




            Highlight any item in the tree to see its details on the right side of the
            screen.




AEM User Guide                    December 2006                                     17
 II.AEM Basics



II. AEM Basics
           There are some basic concepts to keep in mind when working with AEM
           enforcement cases.

    About Cycle Start
           You can create an Enforcement case for any NH facility type – certified,
           licensed or both. The survey that is used to create an enforcement case is
           referred to as the "starting survey," and its Exit Date is the start of the
           enforcement cycle.
           The Cycle Start date begins the six-month clock during which the provider
           must come into compliance or face termination.

    Separate Health/LSC Enforcement Tracks
           Enforcement cycles may be initiated by either a Health or a Life Safety
           Code (LSC) survey. You can simultaneously have an active Health and an
           active LSC case open for a single provider, but you cannot have more
           than one case of the same type active at the same time.
           If you have an enforcement case that is not in Substantial Compliance
           and it contains a Health survey, you cannot open a new enforcement case
           based on a subsequent Health visit. In this instance, AEM will add the
           later Health survey to the existing active Health enforcement case. To
           start a new Health cycle, the previous Health cycle must be in Substantial
           Compliance.
           Once an enforcement case is defined by either a Health or an LSC survey,
           only visits of that type can be added to the case, except in the case of
           Combined Health/LSC Enforcement Tracks.

    Combined Health/LSC Enforcement Tracks — the
    7-Day Rule
           A combined Health and LSC enforcement case occurs when it is initiated
           by Health and LSC visits that are performed within 7 days of each other.
           The 7-day window is defined as extending from the exit date of the earlier
           survey to the start date of the later survey. If you have a combined
           Health/LSC case, you can add subsequent visits of either type to the case.
           When an LSC survey initiates the case, but a Health survey is performed
           within 7 days (before or after the LSC), the enforcement track is
           combined, and the Health survey exit date becomes Cycle Start. There is
           an exception when the LSC survey finds an IJ situation and the Health
           survey does not. In this case, the IJ situation makes the LSC exit date the
           Cycle Start of the case.




 AEM User Guide                    Decmeber 2006                                   19
II.AEM Basics


          AEM does allow the manual addition of LSC surveys to Health cases (and
          vice versa) when the survey dates are outside the 7-day window. You will
          be asked to confirm that the addition is consistent with CMS policy.

     Opening a New Case
          New enforcement cases are created whenever a nursing home is cited for
          deficiencies at Scope/Severity level D and above.
          1     In ACO (or ARO), go to the Enforcement tab, then locate the facility of
                interest in the tree.
          2     Right-click the name, and select New Enforcement.




                The Begin Enforcement Cycle window will appear with a list of the
                facility's surveys. The list includes any surveys that are not already
                part of an enforcement case, ordered by Exit Date.




20                                    December 2006                      AEM User Guide
                                              Finding and Opening Existing AEM Cases




        2   Select the survey that initiated the case and click OK to create a new
            case record.
            The case will open at the Case Basics tab. See "Case Basics Tab",
            beginning on page 26, for details.

  Finding and Opening Existing AEM Cases
        As in other areas of ACO, there is a  Find button at the top of the
        Enforcement tab tree that you can use to locate a provider or a case. The
        Enforcement Find window has enforcement-specific search criteria to
        facilitate finding case records.

        Note: When one user has a case open, other users may view the case
        in read-only mode.

        1   On the Enforcement tab, click Find to open the Find window.
        2   In the Text box, type in a search string — the characters, alpha or
            numeric, that you want ASPEN to find.
        3   Select a search Type. In the figure below, we’re searching for a NH
            Name.

        Note: You can search by certain enforcement-specific criteria: Case
        ID, Docket #, Case Closed Date, and CMP Collection #.

        4   Click Find Now. Records matching the search string will show in the
            Search Results box.



AEM User Guide                   December 2006                                    21
II.AEM Basics




          5     Highlight the record you want, and click Go To Facility. AEM will
                locate the facility in the tree.
          6     In the tree, click the to the left of the provider name to expand the
                node and show the Enforcement cases.
          7     Right-click the case you want and select Modify Enforcement to
                open the case file.




22                                   December 2006                     AEM User Guide
 III.   The AEM Case File



III.     The AEM Case File
             An Enforcement record in AEM contains eight tabs.
                •   Case Basics
                •   Surveys & IDR
                •   Remedies
                •   CMP
                •   NATCEP
                •   Notices
                •   Hearing/Appeal
                •   Upload
             The title bar of the case, and the case header and footer remain visible at
             all times. We will review the uses and contents of each of these features.

         Hover Guidance
             Hover Guidance is context-sensitive pop-up help that provides instantly
             available definitions for certain fields on AEM screens. When you see a
             gray circle next to a field, hold your mouse pointer over it for a moment
             to see a window appear with information about the field, as in the graphic
             below.
             Hover Guidance is activated on a state-wide basis on the State
             Customization screen (System menu). ARO users will see Hover Guidance
             when they are connected to a state that has activated it.




 AEM User Guide                      Decmeber 2006                                    23
III.   The AEM Case File


       Title Bar, Case Header and Footer
                                                            Field descriptions: page 119
            The Title bar (the horizontal bar at the top of the window) shows the Case
            ID, the NH name, the Cycle Start Date and the current status of the case.
            The Case Header remains visible no matter where you are in the case file,
            offering a quick reference to the Latest Alleged Compliance Date (the date
            by which the NH states it will be in substantial compliance), along with
            calculations of key case milestones for IJ Day 23, and 3 months and 6
            months from the Cycle Start date.
            The Facility Detail button on the right opens a read-only view of Facility
            Properties.




            The Footer makes a number of options available while you work on any
            screen in the case file. You can print reports, compose and edit letters
            and notes, as well as attach photos and other digital files.




            Adding Attachments to a case
            You can attach additional files to an enforcement case using AEM's
            Attachments button in the case footer. If you have enforcement letters
            that are created outside AEM, or if you have other documents or digital
            photos related to the case, Attachments can link them to the case record
            so you can open and view them while working in the case.
            The Attachments feature provides a convenient way to exchange relevant
            information about the case with the Regional Office.

            NOTE: Attaching a file creates a copy of the file, compresses it, and
            stores it in the ASPEN database. If you move or delete your original, it
            does not affect the AEM attachment.

            1   In the AEM case footer, click Attachments.




24                                   December 2006                      AEM User Guide
                                                     Title Bar, Case Header and Footer




        2   In the Attachment Documents window, enter a Description of the file
            you are attaching, and click Attach/View.
        3   In the Open window, specify the Files of Type that you are attaching.
            The default is Documents (.doc files). AEM does not limit the type or
            size of file that can be attached. There must be an application
            registered on your system that can open it. For example, .doc files are
            opened by Microsoft Word, .bmps are usually associated with Paint,
            .jpg are usually associated with your web browser.
        4   Navigate to the file you want to attach, select it and click Open. AEM
            will ask you if you want to preview or edit the file.
        5   Say Yes to both attach the file to the case and open the file, or No to
            attach the file without opening.
        6   Click Close to close the Attachment Documents window.




AEM User Guide                   December 2006                                     25
III.   The AEM Case File


       Case Basics Tab
                                                           Field descriptions: page 122
            The first tab in the Enforcement record, Case Basics, will be the active tab
            whenever you open a case. It contains important case summary
            information and dates, and has individual notepads where State and RO
            users can record relevant details.




26                                   December 2006                      AEM User Guide
                                                                    Case Basics Tab


        On the Case Basics tab, you will
           •     Enter the Beginning Case Type
           •     Assign case workers
           •     Add activities
           •     Transfer the case to the RO
           •     Record case notes
           •     Maintain the case status

     Beginning Case Type
        When you open a new case, Beginning Case Type is required. Federal
        Type options are: Opportunity to Correct, No Opportunity to Correct, and
        Past Noncompliance.

        Note: If the nature of the case changes during the enforcement cycle,
        do not change Beginning Case Type. It is intended to record the Case
        Type at the time the case is opened.

        If the starting survey (the survey that initiated the enforcement action)
        does not contain Federal regulations, select State Licensure. You do not
        have to then enter a Federal Type.

     Case Workers
        States may assign State case workers, and ROs may assign Federal case
        workers, to each case. One State and one Federal case worker must be
        designated as Primary case worker. Primary case workers receive action
        items related to the case.

     Activities
        The Activities section can be used both as a scheduling tool and to
        maintain a history of the case. Some activities are created automatically
        by entries into ASPEN, triggering corresponding action items that are sent
        to the primary case workers.
        Each activity that is created for the case has a designated Recipient, who
        receives the action item related to the activity. Case workers can
        manually enter additional activities as needed. States can choose State or
        Regional Office staff to receive an activity, and ROs can select ROs or
        State staff members.

     Transferring Cases to the RO
        States can transfer cases to the RO by using the Set Date function to
        enter a date in the Initial Transfer to RO field. ROs should complete this
        field for any case that is opened by the RO. If AEM detects that a case
        should be transferred, it will provide appropriate warning messages upon


AEM User Guide                    December 2006                                     27
III.   The AEM Case File


            opening and saving the case. See the field descriptions for Initial Transfer
            to RO and Set Date, beginning on page 126, for more information.
                                                     1




        Changing Case Status/Closing a Case
            The Case Basics tab contains fields for both Federal and State status.
            State status fields are enabled only when the case involves State
            Licensure, and may be changed only by States.




            Federal Status may be updated by States up until the point where the
            Regional Office becomes involved with the case. The Federal Status field
            is enabled for States and Regional Offices according to provider
            participation and case type. Rules regarding Federal Status are described
            on page 123.
                    1




        Case Notes
            Case Notes provides an area for recording notes relevant to the case.
            States and Regions can use Case Notes to exchange information. States
            and Regions can always see both sets of notes, but can enter only their
            own.

        About Substantial Compliance
            AEM calculates Substantial Compliance once all tags with a
            Scope/Severity of D and above cited on surveys related to the case are
            either corrected or have a valid waiver. The calculations are more fully
            explained in the Substantial Compliance field description on page 124.
                                                                               1




            You can override the AEM calculation when circumstances require it. The
            override rules are detailed on page 125.




28                                   December 2006                      AEM User Guide
                                                                       Surveys & IDR tab


  Surveys & IDR tab
                                                          Field descriptions: page 133
        The Surveys & IDR tab lists all surveys attached to the case, and all cited
        deficiencies. If there is an IDR requested for any survey, that information
        is on the bottom of the tab. Most information is read-only.
        Use the Surveys & IDR tab to:
           •     Monitor 2567 and POC dates related to the case
           •     Add IJ situations to the case
           •     Track IDRs related to the case
        The top of the Surveys and IDR tab is the Cycle Surveys and Citations
        Management section, with three subtabs:
           •     Surveys — one-line summaries of surveys associated with the
                 case/cycle.
           •     IJ Situation — tracks dates of instances of IJ and the associated
                 survey information.
           •     Citations: All Surveys — provides a master list of all of the
                 deficiencies cited on all of the surveys related to the case, with
                 current plan of correction and correction dates.

     Surveys Subtab
        The Surveys subtab provides line summaries of survey information, with
        buttons that open windows showing more survey detail. Most survey data
        is read-only in AEM, however, you can enter 2576 Issued dates and POC
        Tracking information directly on the grid.
        While AEM adds related surveys to an enforcement case automatically, in
        special circumstances you can add an existing survey (certification or
        complaint) to a case using Add Survey to Cycle.




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III.   The AEM Case File




            The first four columns in the survey grid are frozen, and will not move
            when you scroll to the right.
            Use the function buttons beneath the survey grid to:
               •   Add surveys to the case
               •   View read-only survey and citation detail
               •   Print forms
               •   Remove a survey from the case

            Informal Dispute Resolution Section
            When you highlight a survey on the Surveys tab, its IDR information is
            displayed below it in the IDR section. This is a read-only copy of the
            survey’s IDR record. The heading displays the survey's Event ID and exit
            date.
            The Survey Citation IDR Status grid lists all tags under IDR, and their
            current status.




30                                   December 2006                     AEM User Guide
                                                                    Surveys & IDR tab


     IJ Situation Subtab
        Any survey that contains deficiencies cited at a J, K or L Scope/Severity
        level is flagged ( ) on the Surveys subtab. Go to the IJ Situation subtab
        to record details about specific situations of immediate jeopardy, with
        start and end dates and associated citations.
        Fields displayed in the grid are read-only. In an IJ situation in which there
        is more than one IJ tag cited, with different start and end dates, AEM uses
        the earliest of the Start Dates for the First Day of IJ and the latest of the
        Last Dates for the Last Day of IJ. There can be more than one IJ
        situation per cycle.




        Add an IJ to the Case
        1   On the IJ Situation subtab, select Add IJ.
        2   In the Define IJ Situation window, select the Survey Date of IJ
            Discovery.




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III.   The AEM Case File


                When you choose the survey that discovered the IJ, AEM lists all the
                tags that were cited at S/S level J, K or L at that survey. You select the
                tag(s) that apply to the IJ.
                You can add Survey Date of IJ Removal if known, but it is not
                required at this point.
            3   In the Select Citations Related to IJ Situation section, mark the check
                box next to the tags involved in the IJ. This enables the Start Date and
                Last Date fields.
            4   For each selected tag, enter the Start Date of the IJ. Start Date is
                required. AEM takes the earliest Start Date you enter and inserts it
                into the First Day of IJ field.
            5   For each selected tag, enter the Last Date of the IJ. AEM takes the
                latest Last Date you enter and inserts it into the Last Day of IJ field.
            6   Click OK when done.
            IJ Changes due to IDR
            If, due to a subsequent IDR, the Severity/Scope of an IJ tag is reduced to
            a non-IJ level, AEM removes the tag from the IJ situation (putting a
            strikethrough on the tag in the Define IJ Situation window) and sends an
            action item notification (IJ CHANGED/REMOVED BY IDR) to the primary
            case worker.
            If all tags related to the IJ are changed in this way, AEM removes the IJ
            situation from the case. AEM retains the IJ line item on the IJ Situation
            subtab, with a strikethrough to indicate it is no longer an active IJ. You
            will see IJ Removed in the Day 23 field in the Case Header.

        Citations: All Surveys Subtab




            The Citations: All Surveys subtab provides one-line summaries of each
            deficiency cited in all the surveys associated with this enforcement
            cycle/case.




32                                    December 2006                       AEM User Guide
                                                                   Surveys & IDR tab


        If the same tag is cited in two different survey events (not a survey and
        its revisit), it will be on the list twice.
        Tags are sorted by S/S level, with the most severe at the top. All fields
        are read-only. Federal tags are red; State tags are blue.
        Depending on your display resolution, you may need to scroll to the right
        to see all the information about a deficiency. The Citations: All Surveys
        subtab section, page 146 in Field Descriptions, has a complete illustration.




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III.   The AEM Case File


       Remedies Tab
                                                        Field descriptions: page 150
            The Remedies tab is where you enter Federal and/or State remedies as
            they are recommended, and track the progress of existing remedies. A
            case must have at least one Federal remedy and all Federal remedies
            must have either a State Recommended Effective Date or Effective Date
            before being uploaded.




            States can enter and modify Federal remedies for the case until the case
            is sent to the Regional Office. Once the case is transferred to the RO,
            States can add new Federal remedies, but cannot modify or delete Federal
            remedies already attached to the case.

            Note: You cannot close a case that has Pending remedies.




34                                 December 2006                       AEM User Guide
                                                                       Remedies Tab


        Automatic remedies
        For Federal cases for which the Beginning Case Type is either Opportunity
        to Correct or No Opportunity to Correct, AEM automatically adds remedies
        04B – Mand Deny Pay for New Admits-3 Mo. and 11B – Mandatory
        Termination to the Remedies tab. AEM assigns them a Pending status,
        and inserts Effective Dates and State Recommended Effective Dates of 3
        and 6 months from Cycle Start, as appropriate.
        If the Beginning Case Type is Past Noncompliance (for Federal) or if it is a
        State Licensure case, no remedies are added automatically.
        CMP Remedies
        When a case involves one or more Civil Money Penalties (CMPs), the
        particulars of the individual CMPs are entered on the CMP tab, with the
        associated CMP remedy on the Remedies tab.
        You add the Federal 07 – Civil Money Penalty only once on the Remedies
        tab, even when the case involves more than one Federal CMP.
        If you enter a Federal CMP on the CMP tab, and there is no existing 07 -
        Civil Money Penalty remedy on the Remedies tab, AEM will add the
        remedy to the Remedies tab for you.
        State CMPs also require that a corresponding State CMP remedy be
        entered on the Remedies tab.

        Note: In order for a remedy to be applied to a State CMP, it must
        have CMP Remedy Type selected in the Remedy Lookups window.
        See State Enforcement Remedies, page 57, for information about
        adding State remedies to AEM.




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III.   The AEM Case File


       CMP Tab
                                                           Field descriptions: page 153

            8.7 NOTE: Version 8.7 of AEM eliminates the need for ROs to enter
            CMP information into both the Civil Money Penalty Tracking System
            (CMPTS) and AEM.
            Check the CMPTS Detail section in this chapter and the CMPTS field
            descriptions, beginning on page 171, for more information.

            The CMP tab stores detailed information about both Federal and State
            CMPs. Use the CMP tab to:
               •   Record all CMPs related to the case
               •   View details about each CMP
               •   Generate CMP correspondence
               •   Enter Due Dates for payments of Federal CMPs
               •   Maintain payment history for State CMPs
            When you add the first CMP to the case, AEM will add the Federal 07 Civil
            Money Penalty remedy to the Remedies tab for you, if it has not been
            added already. If you are adding a State CMP, AEM asks you to specify
            which State remedy should be added to the Remedies tab.
            AEM calculates many of the fields on this tab. Details of the calculations
            are provided in Field Descriptions for the CMP tab.
            Case CMP Detail
            The top section of the tab, Case CMP Detail, summarizes information
            about all the CMPs related to the case. There is one CMPTS number
            assigned per case. See CMPTS Detail, later in this section, for information
            about the new CMPTS Detail button.
            Civil Money Penalties (CMP)
            The middle section, Civil Money Penalties (CMP), lists the individual CMPs
            attached to the case on two subtabs, Per Instance and Per Day. Use the
            New, Modify, and Delete buttons to add and update individual CMPs.
            When you highlight a CMP on one of these subtabs, the lower section of
            the screen shows details about that CMP.
            Detail for Highlighted CMP
            In this section you enter notice, appeal, settlement and bankruptcy
            information for the selected CMP. AEM calculates the CMP Total and Net
            amounts for you.
            Sending Notices
            You can generate letter and notices directly from the CMP tab, using the
            envelope button        next to the notice date fields. If you supply a Sent

36                                   December 2006                      AEM User Guide
                                                                           CMP Tab


        Date when you create the letter, AEM will insert that date into the date
        field on the CMP tab for you.
        AEM Interest Calculator
                An Interest Calculator is available next to the Medicare Interest
                Due and Medicaid Interest Due fields. The calculator allows you to
                enter the CMP amount, interest rate, and time period. The
        calculator inserts the result in the Interest Due fields on the CMP tab, and
        AEM includes it in the Total Amount Due. Detailed information about the
        new calculator is provided in CMP Interest Calculator, page 168.
        Payment History
        Availability and use of the Payment History section, which has always
        been optional, changes with AEM v8.7.
        For Federal CMPs imposed against Medicare-certified nursing homes, all
        payment due dates must be entered by ROs in the new CMPTS Detail
        window. For these CMPs, once CMPTS Detail is entered and uploaded, the
        optional Payment History section is removed from the CMP.
        The Payment History section will remain visible for Federal CMPs that
        were assigned a CMPTS number prior to the 8.7 release and for CMPs
        imposed against Medicaid-only NFs (which are not uploaded).
        Payment History functions are unchanged for State CMPs.
        CMPTS Detail
                      The CMPTS Detail button on the CMP tab gives ROs access
                      to a unique communication with the CMPTS system. ROs no
        longer need to enter CMP information into both AEM and CMPTS.
        When a CMP becomes due and payable, ROs enter the amount, number of
        installments, and the due date for each installment in the CMPTS Detail
        section. There is also a Remarks section for entry of notes about the CMP.
        When CMP and other required information (see below) are complete, the
        RO may initiate an upload directly from CMPTS Detail. The data is
        transferred overnight—you can view the uploaded AEM information in
        CMPTS the next morning.
        The CMS Office of Financial Management (OFM) enters payment
        information into the CMPTS system as before, but now OFM payment
        information is downloaded each night and viewable in AEM CMPTS Detail
        the next day.
        ROs can monitor CMP payments in AEM by checking individual cases or by
        printing any one of AEM's applicable CMP reports. The CMP Tracking
        Report, for example, may be configured to list all fully paid CMPs, making
        it easy for ROs to stay on top of cases may be closed.




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III.   The AEM Case File


            What ROs need to know about CMPTS Detail
            CMPTS Detail screen graphics and field descriptions are provided
            beginning on page 171.
               CMPTS Number
               You no longer need to enter a CMPTS number in AEM. The CMPTS
               number is generated and entered as part of the initial CMPTS upload.
               Existing CMPs
               If you have CMPs that qualify for entry into CMPTS but have not yet
               been entered, you must complete the new CMPTS Detail screens for
               those CMPs and upload them from AEM.
               AEM CMPTS Detail is unavailable for Federal CMPs that were assigned
               a CMPTS number prior to the 8.7 release.
               Minimum Data Required for Upload
               The CMPTS upload is a separate transaction from the AEM Detail/462L
               upload, with its own set of minimum data requirements:
               •   A valid Provider Number
               •   Cycle Start Date
               •   The Primary RO Case Worker must be assigned to the case
               •   The Primary RO Case Worker First and Last Name must be present
               •   The Primary RO Case Worker Phone Number must be present

                   NOTE: Case Workers' names and phone numbers are entered in
                   RO staff member records (Config|Manage RO User Accounts)

               •   At least one In Effect Federal CMP must be entered
               •   Medicaid and/or Medicare Participants must be present
               •   The Proposed Number of Installments must be greater than 0
               •   The Proposed Installment Amount must be greater than 0
               •   The Administrator First and Last Name must be present
               •   At least one Installment Due Date must be entered
               In addition to checking that the minimum data elements are present,
               AEM will run a series of edit checks to ensure that entries like dates
               and case numbers are valid.
               After the initial upload, overnight update transactions are sent any
               time changes are made to CMPTS-related information.
               Making Changes in CMPTS Detail
               You cannot change a due date after a payment is recorded for that
               installment. Otherwise, you can change due dates and number of
               installments as needed, but keep in mind that the upload is an
               overnight process, and the CMPTS will not have that data until the
               following day. Conversely, data entered in CMPTS is not seen in AEM
               until the next day.



38                                  December 2006                      AEM User Guide
                                                                           CMP Tab


           For example:
           If you delete a due date, and a payment is applied to that date before
           your deletion is uploaded, AEM will restore the deleted due date with
           its payment the next day.
           If you change a due date, and a payment is applied to the old date
           before your change is uploaded, you will see both due dates in AEM
           the next day. In this case, it is up to you to clean up the dates in AEM.
           Payment Distribution
           For enforcement cases which involve more than one CMP, the
           payment(s) received will be entered in CMPTS. AEM will apply payment
           to the earliest CMP. Once that CMP is paid in full, AEM will then apply
           payment to the next CMP, and so on until the entire payment amount
           is exhausted.
           Deleting a CMPTS record
           ROs cannot delete a CMPTS record. They may initiate the process by
           sending an email to OFM explaining the need for the deletion.




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III.   The AEM Case File


            CMP tab showing Per Instance CMP
            AEM provides totals at the top of the Per Instance tabs to help case
            workers stay within Federal remedy limits. In the data grid, the first five
            columns, in yellow, can be updated directly on the grid.




40                                   December 2006                      AEM User Guide
                                                                            CMP Tab


        Add a Per Instance CMP to the case:
        1   On the Per Instance subtab, click New.




        2   Select the visit during which the instance was cited from the Survey
            Date drop-down list.
        3   Click Choose to see a list of tags cited at the survey you selected.
            Select the citation (only one is allowed) related to the Per Instance
            CMP, and click OK.
            AEM supplies the Scope/Severity of the selected tag.
        4   Enter the Instance Date, the date on which the instance occurred.
            Recommended Amount and Amount Per Instance are not required
            when you first add the CMP to the case. You do have to enter Amount
            Per Instance once you select Yes for CMP in Effect. Per Instance CMP
            amounts may be from $1,000.00 to $10,000.00 per survey.
        5   Select the appropriate CMP in Effect. The default is R Recommended.
        6   Indicate whether this is a Federal or State CMP.
        7   Click OK when done.




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III.   The AEM Case File


            CMP tab showing Per Day CMP




42                             December 2006   AEM User Guide
                                                                              CMP Tab


        Add a Per Day CMP to the case:
        1   On the Per Day subtab, click New.




        2   In the Per Day CMP window, select the survey at which the CMP-
            related tag was cited from the Survey Date drop-down.
        3   First Day is required. This is the first day the CMP will be in effect.
            The default is the Exit Date of the selected survey.
            Dates you enter may not overlap dates entered for other CMPs for this
            case, either Per Instance or Per Day.
        4   Enter the Last Day the CMP is in effect, if known.
            Once both dates are entered, AEM calculates the total number of days.
            Recommended Amount and Amount per Day are not required when
            you first add the CMP to the case. Amount Per Day is required once
            CMP in Effect is Yes.
            Amounts entered must be in $50 increments in the range of $50 to
            $10,000.00.
        5   Select the CMP in Effect status from the drop-down list. The default is
            R Recommended.
        6   Indicate whether this is a Federal or State CMP.
        7   Click OK when done.




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       NATCEP Tab
                                                        Field descriptions: page 177
            The NATCEP tab displays NATCEP triggers and waiver information, and
            provides a place to enter applicable dates. The Most Recent Actual
            NATCEP Loss section is also viewable on the Other tab in Facility
            Properties.




44                                 December 2006                    AEM User Guide
                                                                            Notices Tab


  Notices Tab
                                                         Field descriptions: page 179
        The Notices tab maintains a history of all correspondence related to the
        enforcement case, recorded as you generate the letters, notices and other
        communications. The Notices section at the top of the tab lists the letters
        and notices that have been created, including drafts and finals that have
        not yet been sent.
        When an enforcement case is closed, notices and letters become read-
        only. You can still view and print, but you cannot make changes.
        Click one letter to select it, and you will see its details in the Letter/Notice
        Details section below. Letter/Notice Details shows you tracking and appeal
        information, and the type of notification(s) sent.




        The Create/Notice Letter button opens the Notices History window, where
        you add new letters and record Other Communications, which can be
        relevant notes, e-mails and telephone conversations between State and
        CMS offices.
        AEM letters that are associated with a specific survey may also be viewed
        outside of AEM from the Letter History for that survey.
        Locking Notices
        Once a letter has been sent, you can lock it to make sure that no further
        changes are made. The Lock button prevents editing of letter text, and
        disables the Remove Notice button.



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III.   The AEM Case File


            Letter Contents
            When you highlight any letter in the Notices section, the Letter/Notice
            Details section below provides a quick view of the contents of the letter
            and the date sent and/or delivered.
            Selection of certain letter contents will trigger an automatic upload of case
            information to the national system. Automatic uploads are described in
            "Upload Tab", beginning on page 52.
            Contents must be specified for each letter sent. Select Choose Contents
            and mark the appropriate entries in the Letter Contents window.




            Contents you select will show in the Letter/Notice Detail section when this
            letter is highlighted.

        Generating a letter
            To generate a letter from the Notices tab
            1   On the Notices tab, select Create Notice/Letter.




46                                   December 2006                      AEM User Guide
                                                                             Notices Tab




            The Notices History window lists all letters and Other Communications
            generated for this case. Use the function buttons in this window to
            modify, print, delete and lock letters.
        2   Select New to generate a new letter.
            In the Select Letters and Distribution Lists window:
        3   In the Form Letter section, select the letter you want to print.

        Note: The default list of letters shows all letters that have a Type
        specified as Enforcement. If the letter you need is not on this list,
        select Show All to list all letters in the database.

            In the Distributions section, the facility is selected by default to receive
            the letter (you will see "Letter" in the Action column for the facility).
        4   To send copies to another recipient, highlight the name, and click Set
            Action until cc is in the Action column. This will add the cc notation
            and the recipient's name to the bottom of the letter.
        5   Click Preview to open the letter in the ASPEN word processor.
            If the letter contains Custom Text macros, you will be prompted to
            enter the custom text.

        6   Make whatever changes you need, then click           to print the letter.
        7   Click Save and Exit when you are ready to leave the word processor.
        8   This returns you to the Notices History window, where your letter has
            been added to the list of letters sent related to this case.
        9   Click Close to return to the Notices tab.
        10 Click Choose Contents and indicate which contents apply to this
           letter, then click OK.



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48                         December 2006   AEM User Guide
                                                                 Hearing/Appeal Tab


  Hearing/Appeal Tab
                                                      Field descriptions: page 186
        The Hearing/Appeal tab provides places for entry of all appeal-related
        information, including request dates, docket numbers, and decision
        information.




        Other detail information available from the Hearing/Appeal tab:

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III.   The AEM Case File


            Hearing Settlement Window


               In the Appealed Surveys grid, click the button in the
               column to see additional detail:




            The Hearing/Settlement for Survey window provides summary information
            about all tags cited on the survey in question, and enables users to enter
            settlement information for those that are appealed. Most of the fields are
            read-only; those that are not:
               •   States and Regions can change the Revised 2567 Date.
               •   For Licensure facilities, States can change Hearing/Settlement
                   Status and Undo.
               •   For Medicaid-only facilities, States and Regions can change
                   Hearing/Settlement Status and Undo.
               •   For Medicare/Medicaid Facilities, Regions can change
                   Hearing/Settlement Status and Undo.




50                                   December 2006                     AEM User Guide
                                                           Hearing/Appeal Tab


        Appeal To Window

           In the Appeals section, click         to enter information about
           the appeal:




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       Upload Tab
                                                           Field descriptions: page 193
            The Upload tab is where you can manually upload enforcement case data
            to the national server, and view records of the uploads that AEM sends
            automatically. The Upload tab records all upload transactions for the
            case/cycle and provides descriptive error messages for failed transactions.

        AEM Detail Upload (v8.6)
            With ASPEN v8.6, AEM is sending an additional data set the AEM Detail
            Upload to AEM-specific tables in the Certification and Survey Provider
            Enhanced Reporting (CASPER) system.
            AEM enforcement cases capture more data than was previously collected
            by the Chicago system or the 462L. The Detail upload will make more
            data available for national reporting. New CASPER enforcement reports
            are in development.
            State-specific data, such as licensure-only cases, state remedies applied
            in Federal/State cases, or case worker names, are not included in the AEM
            Detail upload.
            History Load
            In conjunction with the 8.6 release, there will be a one-time bulk load of
            existing AEM cases (those that have previously been uploaded
            successfully) into the CASPER system.
            Upload Procedures
            AEM continues to upload 462L and Chicago data as it has in the past. With
            v8.6, the new Detail data set will be sent to CASPER at the same time.
            The 8.6 AEM Detail upload should not require changes in user upload
            procedures.

        Manual Uploads
            You may upload a case as soon as the minimum data requirements (listed
            below) are complete, and should upload it no later than when it sends its
            first enforcement letter.

            Important: You cannot upload a case from AEM if it has a Cycle Start
            date earlier than October 1, 2004.
            Cases that have a Cycle Start date before October 1, 2004 are entered
            and maintained by the CMS RO using the “Chicago” Enforcement
            System. Pre-October 1, 2004 cases from the Chicago system are
            periodically loaded to the national reporting system.




52                                   December 2006                     AEM User Guide
                                                                             Upload Tab




     Automatic uploads
        Automatic uploads occur behind the scenes. You will not see a message
        before or during an automatic upload, but automatic transactions are
        listed on the Upload tab after the nightly batch processing.
        Automatic uploads are triggered when minimum data requirements are
        met, and
           •     a letter is generated for the case, then locked, and it has any of the
                 following options selected in Letter Contents: Remedies-Impose
                 Non-CMP, CMP-Intend to Impose, CMP-Impose, Remedies-Recom.
                 Non-CMP.
           •     a case is in Substantial Compliance but still not closed (Awaiting
                 Hearing or CMP Collection), and a new case is created for the
                 facility. AEM will check the previous case to see if it has ever been
                 uploaded. If it has not, AEM will initiate an upload.
           •     a case has been uploaded successfully, and additional changes are
                 made.

        Minimum data requirements
        For a successful upload, the case must contain the following (these
        requirements are equivalent to those for CMS Form 462L):
           •     Provider Number
           •     Name and Address (Address required when entering facility)


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III.   The AEM Case File


                •   Date of Survey and Type of Survey (cycle starting survey)
                •   Date CMS-2567 Sent to Facility for cycle starting survey
                •   At least 1 Federal remedy
                •   All Federal Remedies have some form of Proposed Effective Date
            If, after upload, the case is changed so that minimum data requirements
            are not met (most likely to happen when there are changes to the cycle
            starting survey or Proposed Effective Dates), the case will be removed
            from the national system during the nightly batch processing.
            State licensure-only cases are not uploaded.

            Note: AEM uploads do not send survey information to the national
            server. Surveys related to an enforcement case do not need to exist in
            OSCAR COMP or ODIE prior to uploading the case from AEM.

        Monitoring AEM Upload Transactions
            You can monitor all of your enforcement upload transactions from the
            ACO Main menu.
            To view or print upload transactions:
            1   From the ACO Main menu, select Tracking, then Transactions.
            2   In the Please Specify Transactions to List window, choose All
                Transactions for Specified Period (Enforcements).




            3   Click OK.
                This opens the Transactions for <STATE> window, listing the AEM
                upload transactions for the date range you specified:




54                                   December 2006                      AEM User Guide
                                                                          Upload Tab




        From the Transactions window, you can:
           Select a different Sort Order, then click Refresh List to change the list
           to the order you selected.
           Highlight a transaction to see the transaction's errors in the lower
           pane.
           Highlight a transaction and select View Related Enforcement Case
           to go directly to the case file.
           Click Print to print the Enforcement Transactions Report.
           Click OK to close the window.

        Transaction status codes
        ASPEN provides explanatory status codes for each upload transaction:
        -1 – Failed              Invalid or missing data detected, transaction
                                 terminated.
        00 – Pending             Transaction successful, but case is not yet
                                 uploaded to OSCAR.
        05 – Uploaded            Case uploaded to OSCAR.
        10 – Successful          Case accepted by OSCAR.


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III.   The AEM Case File


            12 – OSCAR Info   Transaction successful but OSCAR detected
                              something irregular.
            15 – Failed       Transaction failed at the OSCAR level.




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 IV. AEM Setup in ACO/ARO



IV. AEM Setup in ACO/ARO
          Some components of AEM are maintained through the ACO/ARO Main
          menu:
              •   Adding State remedies to ASPEN Lookups
              Federal remedies are supplied with the system. We will show you how
              to add State remedies to ASPEN Remedy Lookup Values.
              •   Entering distribution recipients
              A comprehensive Distribution List can facilitate sending letters and
              notices. Individuals who commonly receive enforcement
              correspondence should be added to the Distribution List.
              •   Customizing Enforcement letters
              Numerous letter templates are supplied with AEM. You can use them
              as written, or customize them to fit your needs.
          A note about AEM security:

          The AEM system is fully integrated into existing ASPEN security and
          access control systems. This allows each agency to closely control
          which staff may view or change AEM information.
          Your system administrators may refer to the ASPEN Technical Training
          Guide for information about menu, tab, and button security. Since AEM
          concerns only nursing homes, facility type security is not relevant.
          System Administrators should work with enforcement managers to
          define security groups for AEM access. These groups must be given
          access to AEM entry points prior to users accessing the AEM system.

    State Enforcement Remedies
          Remedy Lookup Values contain both Federal and State remedies. On the
          remedy list, Federal remedies are black; State remedies are blue.
          State alternate remedies are first approved by CMS and added to the list
          as a Federal remedy under code 08.
          Some States have their own remedies. These should be added to ASPEN
          lookup values.
          To add a state remedy:
          1   Open ASPEN Central/Regional office.
          2   From the System menu, select Lookup Values, then Remedy
              Lookup Values.




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IV. AEM Setup in ACO/ARO




             On the remedy list, Federal remedies are black; State remedies are
             blue.
         3   Click Add to open the Remedy Lookups window.




         4   Supply a Remedy Code. State remedies always start with S, with two
             additional alpha-numeric characters permitted. Remedies will be listed
             in alphanumeric order by this code.
         5   Enter the Remedy Description.
             462L Code does not apply to State remedies.
         6   States that have a category breakdown for their remedies can use
             State Category to designate the remedy category.




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                                                               Distribution Recipients


        Note: States add remedy categories by selecting System from the
        Main menu, then Lookup Values, then Dictionary. Call the QTSO
        Helpdesk, 888-477-7876, if you need assistance.

        7   If the State remedy you are adding is a CMP remedy, select the CMP
            Remedy Type checkbox. This is required before you can apply the
            remedy to a State CMP.
        8   Click OK when done.
        Replaced or Removed State Remedies
        Select Inactive when a remedy is replaced or eliminated. Inactive
        remedies cannot be added to new enforcement cases, but are still
        available for historical reporting.

  Distribution Recipients
        Before you generate form letters, you should add the individuals and
        entities who commonly receive correspondence to the ASPEN Distribution
        List. Their names and address can then be easily inserted into letters and
        on mailing labels.
        The Distribution List is maintained from the System menu.
        To add a recipient to the Distribution List
        1   From the System menu, select Lookup Values, then Distribution
            Lists.
        2   In the Distribution List window, click New.




        3   Complete the contact information in the Distribution window.



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IV. AEM Setup in ACO/ARO


             When you create letter templates, you’ll see how the elements in the
             Distribution record (recipient, address, city, for instance) are inserted
             automatically into form letters.
         4   Click OK when done.

     Customizing Enforcement Letters
         There are a number of CMS Enforcement letter templates included with
         ASPEN Enforcement Manager. States and Regions can customize these
         templates as needed, or create letters of their own. Since creating letters
         is addressed in other ACO documentation, we will concentrate here on
         tasks specific to creating a letter from a CMS template.

         Regional Offices: Each Region can use one state server to create a
         complete set of enforcement letters, and those letters may be
         replicated to their other state databases. Call the QTSO Help Desk,
         888-477-7876, for more information.

      Viewing the CMS Letter Templates
         CMS letter templates cannot be edited or printed. You can read them to
         see which ones have language that will work for you, then create your
         own templates using the CMS templates as a starting point.
         To view the text of a CMS letter template:
         1   From the System menu, select Letter Management.
         2   In the Letters window, choose 05 CMS Enforcement for Letter Type.
             This will display a list of the CMS templates.




         3   To see the text in a letter, select the letter and click Text.



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                                                       Customizing Enforcement Letters


        4   When you're finished, select File, then Exit to return to the Letters
            window.

     Creating a State Letter Template from a CMS Template
        To customize a CMS letter template for your State, you create a new
        template that contains the contents of the CMS template. Then you can
        modify the text in the new template to suit the requirements of your
        office.
        To create a new State letter template from a CMS template:
        1   From the System menu, select Letter Management, then click New.
            This opens the Letter Description screen. The disabled fields in the
            middle of the window are page setup fields that are no longer in use.
        2   Enter a Description for the letter.
            We suggest including a reference to the template in your description,
            to maintain a record of the letter's source.
        3   Before you can select the source template, go to the bottom of the
            form and select 04 Enforcement for Letter Type.
            This makes the CMS templates available for selection in the Letter
            Templates list.
        4   In the Letter Templates box, select the CMS template you want to use
            as the basis for your new state template.
        5   If the letter contains references to a specific survey, mark the
            Requires Specific Visit Information box.
        6   Select the ENF Letter Class.
            Your options are Federal, State Licensure, or both.




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IV. AEM Setup in ACO/ARO




         7   Choose the ENF Letter Type Default.
             This enables AEM to put the letter on short lists in appropriate areas.
             You will still have access to all letters.
         8   Click OK to return to the Letters window.
             The Letters window still lists the CMS templates.
         9   To change the list to display your template, change the Letter Type at
             the top to 04 Enforcement.
         10 Find your letter, select it and click Text. The AEM word processor
            window will open with your letter.




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                                                      Customizing Enforcement Letters




           You may not get the full effect of the color coding in a black and white
           manual, but on screen you can see that in this sample letter, the text
           is coded using blue for macros (in brackets), red for advisory or
           optional text that may be changed for each letter, and green for text
           that needs to be supplied just once and will stay the same thereafter
           (like signatory lines).

        Note: When you are generating letters in an AEM enforcement case,

        there will be a toolbar button       in the word processor that you can
        use to change all of the text in the letter to black.

        11 Make changes as needed to create a form letter template that suits
           your needs.
        12 Click Save and Exit to save the letter.


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IV. AEM Setup in ACO/ARO


      Inserting Text and Graphic into the Header
         Most offices will want to add a graphic and address information to the
         header of each letter. The process involves inserting a table into the
         header, and placing text and logo in different cells of the table.

         An Important Note about Logos and Graphics: Review of ASPEN
         databases has determined that several states and CMS regional offices
         are using high resolution bitmaps (.BMP files) in the letterhead of their
         ASPEN letter templates.
         BMPs are large files that eat up storage space and slow down saving
         and retrieval of letters. They are appropriate for photographic images
         needing high clarity, but provide no advantage over other smaller
         image formats when used for line art graphics such as logos.
         The performance and storage problems of BMPs can be avoided simply
         by using the “J-PEG” (.JPG) image file format for storing logos. We
         strongly recommend existing letter templates that have been set up
         with large bitmaps have these images replaced with the equivalent
         JPEG graphic, and that new letters are created using only JPEG graphic
         files.

         To add text and graphic to the header:
         1   From the Letters window, select the letter and click Text.
         2   In the word processing window, select View, then Headers and
             Footers. The header area opens with the cursor inside.
         3   Select Table|Insert|Table.
         4   In the Insert Table window, enter 2 for Columns, 1 for Rows, and click
             OK.
         5   Position your cursor in the cell (right or left) where you want your logo
             image, and select Insert|Image.
         6   In the Insert Image window, browse to your graphic file (remember,
             use .jpg please), select it and click Open.
         7   Position your cursor in the cell where you want address information,
             and type the address.
             If you want your text to be right-flush, select all the text in the cell
             and click the Right Flush button      on the formatting toolbar.
         8   Click Save and Exit.

      Edit/Format Enforcement Letters
         The ASPEN word processor contains features that are common to many
         word processors. The "Word Processor Features" section of ASPEN
         Technical Training provides detailed information about available menus
         and commands.


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                                                      Customizing Enforcement Letters


     About ASPEN Letter Macros
        By far the most powerful feature of ASPEN letter management is the
        ability to insert current data from the ASPEN database into letters at the
        time they are generated.
        ASPEN letter macros (also called merge codes) are similar to the mail
        merge functions in many word processors. Each macro references a
        specific piece of information that is stored in the ACO database. For
        example, the Facility Name macro will insert the name of the facility
        associated with the letter.
        There are over 200 letter macros, so there is considerable flexibility
        available to you when constructing letter templates. All macros are
        described in detail in the ASPEN Letter Macro Guide, available for
        download from www.qtso.com.
        Formatting Macros
        Generally, macros you insert assume the formatting of the surrounding
        text. You can safely apply formatting attributes (bold, italic) directly to
        the macro in the template, and that will transfer to the data inserted into
        the letter.
        Macro Brackets
        When you insert a macro into a letter template, you will see the macro
        text in brackets:
        [Facility Name ()]
        Brackets [ ] are used by ASPEN to identify the macros in your template
        letters.
        These brackets, as well as the closed parentheses () at the end of each
        macro, should never be deleted. Doing so will affect ASPEN’s ability to
        process the macro.
        Variable Macros
        All macros have parentheses before the closing bracket. For some
        macros, the parentheses may contain a parameter which extends the
        macro behavior. We give an example of this in "Inserting Macros into a
        Form Letter", on page 66.
        Macro Types
        The list of macros that are available to you when you are creating a letter
        template will differ, depending on the type of letter you are creating.
        If the Letter Type for your template is:
           •     03 Facility or 01 Survey
           You can choose from the basic macros that are available for all ASPEN
           form letters. They include macros like the facility name and phone
           number, and survey exit date.


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IV. AEM Setup in ACO/ARO


             •   02 Complaint
             You can choose from basic macros plus complaint macros, which print
             allegation information, the intake ID, and other complaint-specific
             information.
             •   04 Enforcement
             You can choose basic macros and enforcement macros, which print
             enforcement-specific information like remedies, CMP amounts, and due
             dates.
         Once you generate a letter that contains macros, the macro information is
         normal text that may be edited as needed.

         Inserting Macros into a Form Letter
         Following are examples of the various macro types that are available in
         ASPEN:
             In the Letters window, select the letter in which you are inserting the
             macro and click Text.
         Inserting a macro: Today in Words
         This is a standard macro that inserts today's date in long format (e.g.,
         July 24, 2005) into the letter.
         1   Position the cursor at the point in the letter where you want to insert
             today's date.
         2   Click the down arrow next to the Macros box, then scroll to and select
             Today in Words.
         3   Click Insert. AEM inserts the macro into the letter.
         Inserting a macro: Custom Text Prompt
         Custom Text Prompt is a variable macro that permits you to enter specific
         text each time you prepare a letter to be sent. For instance, if a contact
         name is likely to be different for each letter, you can use Custom Text to
         have ASPEN provide a box for entering the contact name when you
         generate the letter. ASPEN will insert the name you type at the macro
         location in the letter.
         Use the parentheses at the end of the macro to type a reminder of what
         text you should enter.
         1   Position the cursor at the point in the letter where you want to insert
             the Custom Text.
         2   Click the down arrow next to the Macros box, then scroll to and select
             Custom Text Prompt.
         3   Click Insert. AEM inserts the macro into the letter.
         4   Put the cursor between the parentheses and type instructions for the
             custom text.


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                                                       Customizing Enforcement Letters


            Example:
            A Custom Text macro in which you type this text (bold in this
            example):
            [Custom Text Prompt(Enter Name of Department Contact)]
            Will result in a window like this one each time you generate the letter:




        Inserting a macro: Date # Days in Future (Words)
        This macro also uses the paragraphs () at the end of the macro for
        information. In this case, you need to tell ASPEN how many days in the
        future is the date you want ASPEN to print.
        1   Position the cursor at the point in the letter where you want to insert
            the macro.
        2   Click the down arrow next to the Macros box, then scroll to and select
            Date # Days in Future (Words).
        3   Click Insert.
        4   Put the cursor between the parentheses and type the number of days
            in the future.
            For instance, if you type 10 between the parentheses, the macro will
            print the date that is 10 days from today in the letter.




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                                                        Customizing Enforcement Letters



V. AEM Reports
          The AEM workgroup has designed over 30 enforcement reports. For v8.7,
          23 reports (plus variations) are finalized the rest are available for use in
          draft form (the title will say "Draft"). Draft reports were drawn from the
          Chicago System, but have not yet been reviewed and approved by the
          AEM workgroup.
          Enforcement reports are accessed by selecting Enforcement from the
          Reports menu.
          Finalized Reports:
             •  AEM Nursing Home Enforcement Case Profile 1
             •  AEM Nursing Home Enforcement History
             •  AEM Nursing Home Enforcement Case Log
             •  AEM Case Counts Report
             •  AEM Action Items/Next Steps Report
             •  AEM Cases for Which No Letter Has Been Sent
             •  AEM: Surveys Not In An AEM Case
             •  AEM Cases Not Transferred to RO Report
             •  AEM Nursing Home Denial of Payment Report
             •  AEM Nursing Home Termination Report
             •  AEM Medicare Hearing Status Report
             •  AEM NATCEP Loss Report
             •  AEM Federal CMP Due Report
             •  AEM State CMP Due Report
             •  AEM Federal CMP Tracking Report
             •  AEM State CMP Tracking Report
             •  AEM Federal CMP Analysis Report – Discrete CMPs/CMPs Grouped
                By Cycle/Cycle Totals
            • AEM Immediate Jeopardy Timeline Report
            • AEM Mandatory DPNA Timeline Report
            • AEM Waiver Report
            • IDR Report
            • Enforcement Transactions Report 2
          Draft Reports:
             •    OMR: RO Early Processing Times
             •    OMR: Multi Processing Times
             •    OMR: RO-State Early Processing Times
             •    State Visit Processing Times
             •    Compliance Issues
             •    Checks Received Report
             •    Pending Remedy Counts - Detail


 1
  Also available as a Quick Report when you right-click the case in the tree.
 2
  Print from the Tracking|Transactions window. This is an ASPEN report, not an AEM
 workgroup report.

 AEM User Guide                    December 2006                                    69
V. AEM Reports


            •    Pending Remedy Counts – Summary
            •    SA Perf Eval: IJ Term. Process
            •    SA Perf Eval: 6 Mo. Compliance Report
            •    IDR Processing Times
            •    NATCEP Current
            •    All Pending Remedies
            •    Pending Terminations Report
            •    CMPs Paid Report
            •    Closed Cases Report
            •    Terminated Facilities Report

     Setting AEM Report Options
         For most reports, you use the AEM report options screen to customize and
         print. The filters offered depend on which report you are printing. You can
         select the parameters for your report, then name and save the format to
         use again.
         The figure below shows the report options window for reports that have
         been finalized. Note that the lower right section of the options window
         contains a brief summary of the report and its uses.




         Options for reports that are still in draft may vary from the selections
         shown here.



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                                                           Setting AEM Report Options



     Stored Report Settings
        To store a format for a report:
        1   In the report options window, select the time period, filters and other
            settings for your report.
        2   Select Save Settings as, and enter a name for your format.
        3   Select Public if you want the format to be available to other users.




        The format will be saved when you click OK to print the report.
        To print a report using a stored format:
        1   From the Reports menu, select Enforcement, then select the report
            whose format you saved.
        1   In the report options window, go to Stored Settings and select the
            saved format from the drop-down list.




            All stored report formats are listed. Formats with an asterisk * were
            created for the report currently being printed.
        2   Change the date range as needed (date ranges are not saved with the
            report format).
        3   Click OK to print the report.




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V. AEM Reports



     AEM Sample Reports
         The following pages contain samples of finalized AEM reports, including
         Report Definitions sections where applicable.

      AEM Nursing Home Enforcement Case Profile




72                               December 2006                     AEM User Guide
                                 AEM Sample Reports




AEM User Guide   December 2006                  73
V. AEM Reports


      AEM Nursing Home Enforcement History




74                     December 2006         AEM User Guide
AEM Sample Reports



      AEM Nursing Home Enforcement Case Log




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76               December 2006   AEM User Guide
AEM Sample Reports


      AEM Case Counts Report




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V. AEM Reports




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AEM Sample Reports


      AEM Action Items/Next Steps Report




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80               December 2006   AEM User Guide
                                           AEM Sample Reports



     AEM Cases For Which No Letter Has Been Sent




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                                       AEM Sample Reports


     AEM: Surveys Not In An AEM Case




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      AEM Cases Not Transferred to RO Report




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      AEM Nursing Home Denial of Payment Report




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88               December 2006   AEM User Guide
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      AEM Nursing Home Termination Report




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V. AEM Reports




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      AEM Medicare Hearing Status Report




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V. AEM Reports




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                                      AEM Sample Reports



     AEM NATCEP Loss Report




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94               December 2006   AEM User Guide
                                      AEM Sample Reports



     AEM Federal CMP Due Report




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      AEM State CMP Due Report




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      AEM Federal CMP Tracking Report




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      AEM Federal CMP Analysis Report – Discrete CMPs




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      AEM Federal CMP Analysis Report – CMPs Grouped By Cycle




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      AEM Federal CMP Analysis Report – Cycle Totals




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      AEM Immediate Jeopardy Timeline Report




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      AEM Mandatory DPNA Timeline Report




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      AEM Waiver Report




116                       December 2006   AEM USER GUIDE
                                  AEM Sample Reports



     IDR Report




AEM User Guide    December 2006                117
V. AEM Reports




118              December 2006   AEM USER GUIDE
                                                         Title bar, Case Header and Footer


VI. AEM Field Descriptions
           An AEM enforcement case has eight tabs, plus the title bar and case
           header/footer. For each of these, we show a picture of the screen, with
           each field numbered. The definitions of the fields are immediately
           following.

     Title bar, Case Header and Footer
 The title bar and fields in the header remain visible as long as the case file is open,
 even when you move to different tabs within the case.




 Buttons at the bottom of the case (the footer) are also available as long as the case
 is open.




       FIELD/BUTTON         DESCRIPTION – CASE HEADER AND FOOTER

 1     Case ID              A unique identifier generated by AEM when the case is
                            created.


 2     Cycle Start          Cycle Start is displayed in the title bar of the enforcement
                            case. It is the exit date of the survey that began the
                            enforcement case. If the case is a combined Health/LSC case,
                            the Health survey is always the starting survey.


 3     Status               As selected in the Federal Status field (Field #3 on the Case
                            Basics tab).




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VI. AEM Field Descriptions


       FIELD/BUTTON          DESCRIPTION – CASE HEADER AND FOOTER

4      Latest Alleged        For Federal cases. Latest Alleged Compliance is calculated
       Compliance            when all non-waived tags with a S/S of D and above have
       Date                  Completion Dates (X5 - Plan of Correction dates) entered or
                             have a valid waiver. It is re-calculated whenever X5 or waiver
                             dates are changed.
                             •   Latest Alleged Compliance date is the latest of the
                                 Completion Dates (X5) entered for non-waived tags after
                                 all tags with a S/S of D or above have Completion Dates
                                 (X5) entered.
                             • Tags that have an approved annual waiver (waiver
                                 Decision = Approved) are ignored.
                             • If the waived tag(s) are the only tag(s) on the case with a
                                 S/S above C, then the Latest Alleged Compliance is set to
                                 the exit date of the first survey in the cycle in which the
                                 waived tag was cited.
                             • If a tag’s temporary waiver expires while the case is still
                                 open, it is then treated as any other tag, and the tag’s
                                 Completion Date (X5) is used in the calculation of Latest
                                 Alleged Compliance.
                             • Past Noncompliance tags (F698) are ignored. By
                                 definition, they are already corrected when they are cited.
                             • FSES (Fire Safety Evaluation System) tags are ignored.
                             Note: In the case in which a tag has a temporary waiver, and
                             the enforcement case goes into compliance and then at a
                             later visit/revisit, the tag is cited again after the temporary
                             waiver’s expiration date, a new enforcement case would be
                             created.

5      Day 23                23 calendar days after the exit date of the survey during
                             which the earliest active IJ situation was found. If there is no
                             IJ situation, “No IJ” appears in this field.


6      3 Calendar            Adds 3 to the month of the Cycle Start date. If the resulting
       Months                date is invalid, uses the next valid date.


7      6 Calendar            Adds 6 to the month of the Cycle Start date. If the resulting
       Months                date is invalid, uses the next valid date.


8                            Opens a read-only view of the facility record. If you need to
                             make changes to facility information, go to the tree view on
                             either the Alpha or Enforcement tab and right-click the facility
                             name, then select Facility Properties.


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                                                Title bar, Case Header and Footer


     FIELD/BUTTON   DESCRIPTION – CASE HEADER AND FOOTER

9                   Opens the Select Reports to Print window. Reports available
                    are Facility Enforcement History, Enforcement Case Profile,
                    and CMPTS Report.


10                  Opens the Notices History window, where you can view or
                    generate letters and other notices.


11                  Opens the Case Notes area and allows States and ROs to
                    enter and edit Case Notes in a word processor that has more
                    features than the basic text entry area on the Case Basics
                    tab.


12                  Opens the Attachment Documents for Case window, where
                    you can attach and view supporting documents or graphic
                    files to the enforcement case.


13                  Saves and closes the enforcement record, returning you to
                    the tree.


14                  Closes the record without saving your changes. You will be
                    asked to confirm.
                    The Cancel function does not necessarily roll back the record
                    to where it was when you opened it. If you made entries in a
                    secondary window and clicked OK, those entries have been
                    saved and cannot be canceled. Additionally, some entries on
                    forms are saved when you move to another tab, and saved
                    entries cannot be canceled.


15                  Opens a message box advising you that Help is not accessed
                    here. Use the "Hover Guidance" gray dots for Help
                    information.




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VI. AEM Field Descriptions

      Case Basics tab
       Summary




          FIELD/BUTTON       DESCRIPTION – CASE BASICS TAB

                             The checked box indicates the type of survey(s)
  1
                             associated with the enforcement case.



                             IJ Indicator: shows IJ status entered on the IJ
  2
                             situation tab.
                             None = no IJ situation entered.
                             Current = Survey Date of IJ Discovery has been
                             entered.
                             Removed = Survey Date of IJ Removal has been
                             entered for all IJ situations in the case, or all IJ tags
                             were removed as a result of IDR.
                             SQC indicator: Yes means there is an SQC tag cited in
                             a visit connected to this enforcement case. This
                             indicator is recalculated every time a change is made
                             to a citation.
                             An SQC tag is any deficiency with a scope and severity
                             level of F,H, I, J, K or L, that also falls under one of the

122                               December 2006                         AEM USER GUIDE
                                                                     Case Basics tab


        FIELD/BUTTON     DESCRIPTION – CASE BASICS TAB

                         following regulatory groupings: Resident Behavior and
                         Facility Practices, Quality of Life, Quality of Care. This
                         includes tags 221-226, 240-258, and 309-333.


        Federal Status   Options for Federal Case Status are:
 3
                         Open - Active: The case is still being actively
                         processed.
                         Open - Hearing: Active processing is complete and
                         the case is awaiting a hearing beginning or
                         completion.
                         Open – CMP Collection: The case remains open only
                         because a CMP is not fully paid
                         Open – Hearing/CMP Collection: The case remains
                         open awaiting the outcome of a hearing and a CMP
                         collection.
                         Closed: Everything regarding this case is complete.
                         You cannot close a case if:
                         •   A remedy is pending.
                         •   There is a CMP in effect that is not paid in full.
                         •   There is a CMP remedy in effect on the Remedies
                             tab, but no corresponding Per Day or Per Instance
                             CMP entered on the CMP tab.
                         •   The case is a Federal case that has never been
                             uploaded. You cannot close the case until it is
                             uploaded and accepted.
                         Federal Status is enabled for States and Regional
                         Offices according to provider participation and case
                         type:
                         If T19 only: both State and Region can change the
                         status.
                         If T18 and an Opportunity to Correct case: both
                         State and Region can change the status until a
                         Federal case worker is assigned to the case, after
                         which only the Region can change the status.
                         If T18 and the case is No Opportunity to Correct
                         or Past Noncompliance: only CMS staff can change
                         the status.


        Closed           Date the Federal Status was changed to Closed. This
 4

AEM User Guide                 December 2006                                      123
VI. AEM Field Descriptions


          FIELD/BUTTON       DESCRIPTION – CASE BASICS TAB

                             field is not enabled until Closed is selected for Federal
                             Status. You cannot select Closed until the case has
                             been uploaded and accepted.


          State Status       State Status is available for cases having to do with
  5
                             State Licensure, and can only be changed by states.
                             The options are Open and Closed.


          Federal Type       Either Federal Type or State Licensure (#7) must be
  6
                             selected.
                             Options are: Opportunity to Correct, No
                             Opportunity to Correct, Past Noncompliance. This
                             is the Beginning Case Type; so select the type that
                             applies at the time the case is initiated.
                             If any of the surveys on the case have a Federal
                             regulation set, a Federal Type must be selected.


          State Licensure    Select the box if this case involves state licensure.
  7
                             State Licensure and Federal Type operate
                             independently. One or the other (or both) must be
                             selected.
                             If State Licensure is selected, Federal Type is not
                             required. Selecting this box also enables the State
                             Status field.


          Double G           Mark this box when the provider's deficiency history
  8
                             leads to a determination of "Double G" status for this
                             cycle.


          Correction Due     Entered by the State Agency. The date by which the
  9
          Date for           SA will recommend remedies be imposed if substantial
          Opportunity to     compliance is not achieved.
          Correct


          Substantial        For Federal cases. Date the provider came into
  10
          Compliance         substantial compliance. AEM calculates Substantial
                             Compliance when all tags with a S/S of D and above
                             are either corrected or have a valid waiver.
                             AEM checks both health and LSC surveys associated
                             with the case. The date is recalculated whenever
                             changes are made to the 2567B.

124                               December 2006                       AEM USER GUIDE
                                                                 Case Basics tab


        FIELD/BUTTON   DESCRIPTION – CASE BASICS TAB

                       •   AEM will use the latest Correction date for non-
                           waived tags after all tags with a S/S of D or above
                           have Correction dates entered
                       •   Tags that have an approved annual waiver (waiver
                           Decision = Approved) will be ignored.
                       •   If the waived tag(s) are the only tag(s) on the case
                           with a S/S above C, then Substantial Compliance is
                           set to the exit date of the first survey in the cycle
                           in which the waived tag was cited.
                       •   If a tag’s temporary waiver expires while the case
                           is still open, it is then treated as any other tag,
                           and the tag’s Correction date is used in the
                           calculation of Substantial Compliance.
                       •   Past Noncompliance tags (F698) will be ignored.
                           By definition, they are already corrected when they
                           are cited.
                       • FSES tags will be ignored.
                       This field is also displayed on the Surveys grid
                       (Survey & IDR tab).


                       Opens the Substantial Compliance Override History for
 10A
                       Case window, which shows the history of all overrides
                       to the calculated Substantial Compliance date for this
                       case.
                       History shown includes Date Changed, Prior Value,
                       New Value and Changed By.


                       Allows the user to override the calculated Substantial
 10B
                       Compliance date. Before entering the new date, you
                       will be asked to confirm. Once this date is overridden,
                       AEM will no longer calculate Substantial Compliance
                       for the case.
                       This button is visible under the following conditions:
                       •   For State users, when the case involves only state
                           regulations
                       •   For Regional Office users, when the case involves
                           any Federal regulations
                       •   For both State and Regional Office users, when the
                           case has Federal regulations but the provider is a
                           T19-only provider


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VI. AEM Field Descriptions


          FIELD/BUTTON       DESCRIPTION – CASE BASICS TAB

          Cycle Start to     Calculated by AEM. When there is no Substantial
  11
          Today/             Compliance date, this is the number of days between
          Compliance         Cycle Start (in the title bar) and today.
                             Once a Substantial Compliance date is present, the
                             label changes, and this field reflects the number of
                             days from Cycle Start to the Substantial Compliance
                             date.


          Initial Transfer   The date the State Agency first transfers responsibility
  12
          to RO              for processing of the case to the Regional Office. Set
                             the date in this field by clicking      .
                             This date is the equivalent to the date the State would
                             have mailed a paper package to the RO prior to AEM.
                             The label changes to Initial Transfer to RO
                             Needed? when a case should be transferred to the
                             RO and has not been transferred yet. See the
                             conditions for this under Set Date, below.


  13                            opens the Transfer to RO Date History for Case
                             window, showing the history of changes to Initial
                             Transfer to RO dates.


  14                         States use         to simultaneously enter the date of
                             the transfer and create a CASE SENT TO RO Activity.
                             The initial use of Set Date always enters today's
                             date. If today's date is not correct, click    again
                             to change it. This system ensures that any changes to
                             this date will be recorded in the    window.
                             AEM will provide warning messages to use Set Date
                             under the following conditions:
                             •   ROs who create an enforcement case should use
                                 Set Date before saving the case.
                             •   Any case involving a Medicare NH that is No
                                 Opportunity to Correct, Past Noncompliance or an
                                 Opportunity to Correct case that is not corrected at
                                 the first revisit should be transferred to the RO.

          Federal Program    Read-only. This field is derived from the Termination
  15
          Participation      Code (L30) on the most recent CMS Form 1539 for


126                                December 2006                     AEM USER GUIDE
                                                                      Case Basics tab


        FIELD/BUTTON       DESCRIPTION – CASE BASICS TAB

        Status             this provider:


                                                                     AEM Participation
                             1539 Termination Code (L30)
                                                                          Status
                            00 ACTIVE
                                                                   PARTICIPATING
                            07 PROVIDER STATUS CHANGE


                            01 MERGER, CLOSURE                     FACILITY CLOSED

                            02 DISSATISFACTION W/
                            REIMBURSEMENT
                                                                   VOLUNTARY WITHDRAWAL
                            03 RISK OF INVOLUNTARY TERMINATION
                            04 OTHER REASON FOR WITHDRAWAL
                            05 FAIL TO MEET HEALTH / SAFETY        INVOLUNTARY
                            06 FAIL TO MEET AGREEMENT              TERMINATION



        Status Date        The Termination Date (L28) entered on the 1539.
 16
                           Termination date is required when the Termination
                           Code is anything other than 00 ACTIVE.


        Chain (CMS List)   If a Federal chain is associated with this facility on the
 17
                           Other tab in Facility Properties at the time the case is
                           opened, ASPEN will insert the chain's name here. You
                           can also select a chain from the dropdown box.
                           If you change the chain in Facility Properties after the
                           Enforcement case is opened, that change will not be
                           reflected here. Case workers need to decide if the
                           prior or current chain is applicable to this enforcement
                           case.
                           The list of chains is maintained by CMS in Lookup
                           Values.


        Chain (State       If the facility belongs to a State-listed chain, select
 18
        List)              the chain here. States can maintain this list of state
                           NH chains in Lookup Values|Dictionary|FACILITY-
                           FACILITY MASTER|STATECHAINID.


        Request for        AEM provides two date fields for Request for Public
 19
        Termination        Notice of Termination. If there are additional
        Notice #1 & #2     requests, the two most recent should be entered here.

AEM User Guide                  December 2006                                    127
VI. AEM Field Descriptions


          FIELD/BUTTON       DESCRIPTION – CASE BASICS TAB

          Date Notice 1      Dates the Public Notices of Termination appeared in
  20
          Appeared and       the local newspapers. If there are additional
          Date Notice 2      appearances of public notices, the two most recent
          Appeared           should be entered.


          Case Workers       This grid lists the staff members assigned to this case,
  21
                             with phone numbers, date the worker was assigned to
                             the case and an indicator for the State and Federal
                             primary workers. One State and one Federal worker
                             must be designated as Primary. Primary workers are
                             listed on some enforcement reports.
                             Federal case workers are shown in black; State
                             workers in blue.


                             Click Add to add a worker to the list. The Select Case
  22
                             Worker window opens, where you select the worker
                             from a list of all active workers in the personnel table.


                             Highlight a worker and click Remove to remove the
  23
                             worker from the list. You will be asked to confirm. You
                             cannot remove a Primary worker.




128                               December 2006                       AEM USER GUIDE
                                                               Case Basics tab

      Activities




        FIELD/BUTTON   DESCRIPTION – CASE BASICS TAB

 24     Sent           Date the activity is assigned.


 25     Due            Date by which the activity should be completed.


 26     Completed      Date the activity was completed.



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VI. AEM Field Descriptions


          FIELD/BUTTON       DESCRIPTION – CASE BASICS TAB

  27      Type               Description of the activity. In the Define Activity
                             window, the Type is selected from a dropdown list of
                             options.


  28      Responsible        Staff member designated to complete, or monitor and
          Party              confirm the completion of, this activity. Although the
                             activity may be assigned to more than one staff
                             member, only one is designated as the Responsible
                             Party.


  29                         Opens the Define Activity for entry of a new activity.




  30                         Opens the Define Activity window for the selected
                             activity, so you can make changes.



  31                         Deletes the selected activity from the grid. You will be
                             asked to confirm.


  32      Activity           AEM uses the Case ID to identify the activity.




  33                         Opens the Add Activity Recipient window, where you
                             can select a State staff member.


  34                         Opens the Add Activity Recipient window, where you
                             can select a
                             Regional Office staff member.


  35                         Opens the Add Activity Recipient window, where you
                             can select a work unit to be the recipient of the
                             activity. All members of the team are added as
                             recipients, and will receive action items. The first
                             person on the list is selected as Responsible Party, but
                             you can change that as needed.




130                               December 2006                      AEM USER GUIDE
                                                                 Case Basics tab


        FIELD/BUTTON    DESCRIPTION – CASE BASICS TAB

 36                     Removes the selected (highlighted) recipient from the
                        activity. This will not remove action items that were
                        previously sent. It only acts on action items you are
                        preparing to send.


 37     Comments        A text box where you can type any notes relevant to
                        the activity. The recipient can read the comments by
                        right-clicking the action item and selecting Alert
                        Properties.


      Case Notes




       FIELD/BUTTON    DESCRIPTION – CASE BASICS TAB

       State Case      Activated in ACO. States can use this area to record
 38
       Notes           relevant comments about the case.

                       Click               at the bottom of the form to view
                       and edit the same text in a more full-featured word
                       processor.



AEM User Guide               December 2006                                    131
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CASE BASICS TAB

        RO Case Notes        Activated in ARO. ROs can use this area to record case
  39
                             comments.

                             Click               at the bottom of the form to view
                             and edit the same text in a more full-featured word
                             processor.


                             Standard formatting buttons enable you to apply bold,
  40
                             italic and underline attributes to selected text.   is a

                             spell checker.     opens the Import window. You can
                             import RTF and TXT files into this notepad.




132                                 December 2006                       AEM USER GUIDE
                                                                   Surveys & IDR tab

   Surveys & IDR tab
      Cycle Surveys and Citations Management
The Surveys & IDR tab has three subtabs: Surveys, IJ Situation, and Citations: All
Surveys.

         Surveys subtab




AEM User Guide                    December 2006                               133
VI. AEM Field Descriptions


         FIELD/BUTTON        DESCRIPTION – SURVEYS & IDR TAB

  1      Starting Survey     The     in this column marks the survey that initiated
                             the Enforcement cycle. You cannot change the starting
                             survey. If you find that the cycle actually began with
                             an earlier survey, delete the enforcement case and
                             create a new one using the correct starting survey.


  2      IJ
                             An IJ flag     in this column indicates that a survey
                             related to the case contains a tag that is cited at the IJ
                             Scope/Severity level of J, K, or L. The flag marks the
                             visit where IJ was discovered, plus all subsequent
                             visits of the same type with uncorrected J, K or L
                             deficiencies. The flag remains even after the tag is
                             corrected.
                             Specifics of an IJ situation are entered on the IJ
                             Situation subtab. If there is an IJ situation entered on
                             that subtab, and the IJ has been removed, you will
                             see    .


  3      SQC                 If SQC tags have been cited on this survey, you will

                             see   . You can click the flag to open a window listing
                             the SQC tags that were cited.


  4      Survey              Includes Event ID, Health or LSC indication, and start
         Description         and exit dates.


  5      Category            Shows the survey category specified in Survey
                             Properties when the survey was entered into ASPEN.
                             Categories and their abbreviations are:
                             A-Complaint Investigation (CMPIVT)
                             B-Dumping Investigation (DUMP)
                             C-Federal Monitoring (FEDMON)
                             D-Follow-up/Revisit (REVST)
                             E-Initial Certification (INCERT)
                             F-Inspection of Care (IOC)
                             G-Validation (VALID)
                             H-Life Safety Code (LSC)
                             J-Sanctions/Hearing (SANCT)
                             K-State Licensure (LICEN)
                             L-Change of Owner (CHOW)
                             M-Other (OTHER)

134                                December 2006                      AEM USER GUIDE
                                                               Surveys & IDR tab


       FIELD/BUTTON    DESCRIPTION – SURVEYS & IDR TAB

                       T-Recertification (RECERT)

 6     Extent          Extent is specified in Survey Properties when the
                       survey is created. Extents and their abbreviations are:
                       A-Routine/Std Survey (STDSUR)
                       B-Extended Survey (LTC/HH EXTD)
                       C-Partial Ext. Survey (PART)
                       D-Other Survey (OTHER)
                       E-Abbreviated Survey (ABRV)
                       F-Offsite/Paper (OFF)

 7     Highest Cites   A button that shows the highest Scope and Severity
                       cited in the survey, and lists the tags cited at that
                       level. Click the button to open the High Cite Tag List
                       with more details.
                       The Highest Cites calculation ignores tags with
                       correction dates entered, unless they are Past
                       Noncompliance tags (PNC tags are always included).
                       The calculation includes tags with X5=Survey Exit
                       date (corrected tags). Any tags with an approved
                       waiver will not be included in the High Cite Calculation,
                       even temporary waivers that have expired.


 8     Substantial     For Federal cases. Date the provider came into
       Compliance      substantial compliance. Substantial Compliance is
                       calculated when all non-waived tags with a S/S of D
                       and above are either corrected or have a valid waiver.
                       AEM checks both health and LSC surveys associated
                       with the case. Waived tags are ignored. The date is
                       recalculated whenever changes are made to the
                       2567B.
                       •   AEM will use the latest Correction date for non-
                           waived tags after all tags with a S/S of D or above
                           have Correction dates entered
                       •   Tags that have an approved annual waiver (waiver
                           approval date is entered) will be ignored.
                       •   If the waived tag(s) are the only tag(s) on the case
                           with a S/S above C, then Substantial Compliance is
                           set to the exit date of the first survey in the cycle
                           in which the waived tag was cited.
                       •   If a tag’s temporary waiver expires while the case


AEM User Guide               December 2006                                 135
VI. AEM Field Descriptions


         FIELD/BUTTON        DESCRIPTION – SURVEYS & IDR TAB

                                 is still open, it is then treated as any other tag, and
                                 the tag’s Correction date is used in the calculation
                                 of Substantial Compliance.
                             •   Past Noncompliance tags (F698) will be ignored.
                                 By definition, they are already corrected when they
                                 are cited.
                             • FSES tags will be ignored.
                             This field is also displayed on the Case Basics tab.


  9      2567 Issued         Date the 2567 was sent to the facility. Can be entered
                             by State or RO. This field is shared with the SOD Sent
                             field in Survey Properties; the date may be entered in
                             either place.
                             2567 Issued must be filled in before you can upload an
                             AEM case.


  10     Track               Click       (visible after a survey has been added to
         (POC)               the grid) to open the POC Tracking window, where you
                             can enter notes and dates related to the POC. You can
                             also generate letters and record notices from this
                             window.


  10A    POC Due             Date the Plan of Correction is due from the provider.
                             AEM supplies a date that is 10 days from the 2567
                             Issued date, but you can change it.


  10B    Received POC        Date the POC was received from the provider.


  10C    POC Status          Options are 1 Accepted and 2 Not Accepted.


  10D    POC Status Date     Date the POC was either Accepted or Not Accepted.


  10E    POC Revised Due     If the POC is not accepted, this field is activated for
         Date                entry of a due date for the revised POC. This will
                             become the POC Due date on the next row in the grid.


  10F                        Opens the Notices History window, from which you can
                             generate a new letter or other communication related
                             to this POC.



136                                December 2006                       AEM USER GUIDE
                                                                Surveys & IDR tab


       FIELD/BUTTON     DESCRIPTION – SURVEYS & IDR TAB

 10G   POC Notes        A notepad where you can enter relevant comments
                        about the POC. The buttons at the top permit you to
                        add bold, italic and underline attributes to selected
                        text, and to check spelling. Click the Import button to
                        import a TXT or RTF file.


 10H                    Deletes the selected POC record.


 11    Notice of POC    Date the POC was accepted, as entered in POC Status
       Approval         Date in the POC tracking window.


 12    IDR Requested    Read-only. Date the IDR was requested. This date is
                        entered in the Informal Dispute Resolution window,
                        which you can reach by clicking the IDR button in
                        Survey Properties in ACO (the button is disabled in
                        AEM), or by right-clicking the survey in the tree and
                        selecting IDR from the shortcut menu.


 13    IDR Completion   Read-only. Date the IDR was completed. This date is
                        entered in the Informal Dispute Resolution window,
                        which you can reach by clicking the IDR button in
                        Survey Properties in ACO (the button is disabled in
                        AEM), or by right-clicking the survey in the tree and
                        selecting IDR.


 14    State Status     Read-only. Survey status is specified in Survey
                        Properties in ACO/ARO, so states can filter the surveys
                        that are visible in the tree. It has no Medicare or
                        Medicaid role.


 15                     Enables you to link an additional survey to the case, in
                        cases where the survey is not added automatically.
                        This button opens the Enforcement Cycle window,
                        which lists all applicable surveys for this provider that
                        are not already attached to an enforcement case.
                        Highlight the survey you want and click OK to add it to
                        this case. If the date of the selected survey is outside
                        of the 7-day window, you will be asked to confirm that
                        the addition is in accordance with CMS policy.
                        If there are currently two enforcement tracks for this
                        provider, a Health and an LSC, the window will list only


AEM User Guide               December 2006                                  137
VI. AEM Field Descriptions


         FIELD/BUTTON        DESCRIPTION – SURVEYS & IDR TAB

                             health surveys for the Health enforcement track, and
                             LSC surveys for the LSC track.


  16                         Opens the Survey Properties window, which is read-
                             only in AEM. Changes to the survey can be made only
                             in ACO.


  17                         Opens the Citation Manager window, which is read-
                             only in AEM. You can view citations, their properties
                             and text, but can make changes only in ACO/ARO.


  18                         Opens the Select Forms to Print window. From this
                             window, you can print the CMS-2567, CMS-2567B,
                             CMS-670, CMS-1539, CMS-1557, the S/S Grid, ASPEN
                             Quick Reports and CMS-1557. You can also enter 670
                             workload information.


  19                         Highlight a survey in the grid and click this button to
                             remove the survey from the cycle. You will be asked to
                             confirm. The action removes the link between the
                             survey and the enforcement case so that it is no
                             longer part of the case. It does not delete the survey
                             from ACO.
                             You cannot delete the survey that initiated the case. If
                             the starting survey is incorrect, you have to delete the
                             case record and create a new one. See "Starting
                             Survey", page 22.



          IDR for Survey section




138                               December 2006                      AEM USER GUIDE
                                                                    Surveys & IDR tab


       FIELD/BUTTON      DESCRIPTION – SURVEYS & IDR TAB

       Request           Date the IDR request was received.
 20
       Received


       Scheduled         Date the IDR is scheduled to be conducted.
 21


       Conducted         Date the review occurred.
 22

       Conducted by      Name of the individual or entity conducting the IDR. This
 23
                         is an open field that allows entry of any text.


       Withdrawn         If the request for IDR was withdrawn, the date the
 24
                         withdrawal was received.


       Completion        Date the results of the IDR were formally sent to the
 25
                         facility.


       IDR Type          Options are: 01 Desk Review, 02 Phone Review, 03
 26
                         Face to Face Review.


       Additional Doc.   If the provider submits additional documentation, enter
 27
       Rec’d from        the date that documentation is received.
       Provider


       Revised 2567      If the IDR results in issuance of a revised 2567, enter its
 28
                         date here.


                         Opens the Select Attendees window, where you can
 29
                         select or view who attended the review. Options are:
                         01 Administrator, 02 DON/ Facility Nurse, 03 Other
                         Facility Staff, 04 Facility Lawyer,
                         05 Corporate/Owner Representative(s),
                         06 Surveyor, 07 Survey Manager, 08 State Survey
                         Director/Deputy Director, 09 State Lawyer,
                         10 Resident/Family Member/Advocate,
                         11 Ombudsman, 12 CMS Representative(s),
                         13 Other.




AEM User Guide                   December 2006                                   139
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – SURVEYS & IDR TAB

        POC Required         Select this box if a new POC becomes required as a
  30
                             result of the IDR. In ASPEN Scheduling & Tracking, this
                             will list the survey under Waiting for Acceptable POC
                             until the POC Received date is filled in.


        POC Received         Enter the date the newly required POC is received.
  31



          Survey Citation IDR Status
The grid shows current IDR status for each tag cited in the selected survey.




         FIELD/BUTTON         DESCRIPTION – SURVEYS & IDR TAB

         Citation             Tag number and description.
  32

         Cert                 The box in this column is checked if the tag was cited
  33
                              as part of a certification survey or revisit (Certification
                              is selected in Citation Properties).



140                                  December 2006                        AEM USER GUIDE
                                                               Surveys & IDR tab


       FIELD/BUTTON   DESCRIPTION – SURVEYS & IDR TAB

       Complnt        The box in this column is checked if the tag was cited
 34
                      as part of a complaint survey or revisit (Complaint is
                      selected in Citation Properties).


       IDR Status     Options are:
 35
                      01 None - no IDR requested.
                      02 Requested - a request for IDR has been received.
                      03 No Change - the IDR is completed, with no change
                      to the tag.
                      04 Tag Change - tag number was changed as a result
                      of IDR. The tag will have a line through it, and the
                      replacement tag number is listed in the Changed To
                      column.
                      05 Tag Removed - tag was removed as a result of
                      IDR. The tag will have a line through it.
                      06 S/S Change - the Scope and Severity level was
                      changed as a result of the IDR. The old and new SS
                      levels are shown in the Current SS and Original SS
                      columns.
                      07 Examples Removed/Other Wording Change -
                      changes were made to the evidence as a result of IDR.
                      08 SS Change/Examples Removed/Other Wording
                      Change - changes were made to both evidence and SS
                      as a result of IDR. The old and new SS levels are
                      shown in the Current SS and Original SS columns.
                      10 Request Withdrawn - IDR request for this tag was
                      withdrawn.


       Curr SS        Current Scope and Severity level for the tag.
 36

       Orig SS        When Scope and Severity level changes as a result of
 37
                      IDR, the original level is stored in this column.


       Changed to     If the tag was changed to a different tag as a result of
 38
                      IDR, this column will show the new tag number.


       Evidence       Opens a read-only view of the surveyor’s findings
 39
                      concerning this tag.


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VI. AEM Field Descriptions


         FIELD/BUTTON        DESCRIPTION – SURVEYS & IDR TAB

         Request Reason      Show the primary reason given by the facility for
  40
                             requesting IDR. If new information is offered for a tag,
                             always show 05 New Information Available as the
                             primary reason.
                             Options are:
                             01 Errors in Citation Details
                             02 Incorrect Scope
                             03 Incorrect Severity
                             04 Wrong tag/code
                             05 New Information Available
                             06 Code Interpretation
                             07 Other

         Corrected           The Correction Date entered in Citation Properties in
  41
                             ACO/ARO.


         IDR Decision        Indicate the primary reason for the IDR decision. Check
  42
         Reason              01 No Change when there is no change to the citation.
                             If there is more than one reason for any change, and if
                             02 Additional Information Provided is one of them,
                             always indicate the other primary reason.
                             Options are:
                             01 No Change
                             02 Additional information provided after the survey
                             03 Facility found non-culpable for incident
                             04 Insufficient evidence/facts don’t support def.
                             05 Inaccurate facts
                             06 Wording/grammar change
                             07 Other




142                                 December 2006                           AEM USER GUIDE
                                                                    Surveys & IDR tab

        IJ Situation subtab




       FIELD/BUTTON      DESCRIPTION – SURVEYS & IDR TAB

       First Day of IJ   First day the immediate jeopardy situation occurred. In
 43
                         the Define IJ Situation window, this is the earliest of the
                         Start Dates entered for each tag.


       Last Day of IJ    Last day on which the immediate jeopardy situation was
 44
                         present. In the Define IJ Situation window, this is the
                         latest of the Last Dates entered for all the selected
                         tag(s).




AEM User Guide                   December 2006                                  143
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – SURVEYS & IDR TAB

        Event ID of IJ       ID of the visit at which the IJ was discovered. This
  45
        Discovery            survey is selected in the Survey Date of IJ Discovery
                             field in the Define IJ Situation window.


        Survey Date of       Exit date of the visit at which the IJ was discovered.
  46
        IJ Discovery         Select this survey in the Define IJ Situation window. The
                             surveys available for selection are those surveys
                             associated with this enforcement case that have J, K, or
                             L deficiencies.


        Event ID of IJ       Event ID of the visit at which the IJ was found to be
  47
        Removal              removed. Select this survey in the Define IJ Situation
                             window. Surveys available for selection are those
                             surveys associated with this enforcement case.


        Survey Date of       Exit date of the visit at which the IJ was found to be
  48
        IJ Removal           removed. This survey is selected for Survey Date of IJ
                             Removal in the Define IJ Situation window.


        Tag List             Tags that were selected in the Define IJ Situation
  49
                             window as being part of this IJ situation.


                             Opens the Define IJ Situation window, where you can
  50
                             enter information about a new IJ situation.


                             Opens the Define IJ Situation window for the IJ you have
  51
                             selected, so you can make changes.


                             Deletes the selected IJ record. You will be asked to
  52
                             confirm.


        IJ Call from         Date the Regional Office receives the call from the SA
  53
        State                notifying them of the IJ situation.


        Select               Select the box next to each deficiency citation that is
  54
                             part of this particular IJ situation. This will enable the
                             Start Date and Last Date columns.


        Start Date           The day the IJ situation began. This field is enabled once
  55
                             the deficiency is selected.


144                                  December 2006                        AEM USER GUIDE
                                                                  Surveys & IDR tab


       FIELD/BUTTON   DESCRIPTION – SURVEYS & IDR TAB

       Last Date      The last day of the IJ situation. This field is enabled
 56
                      when the deficiency is selected.


       Track ID       Four character identifier (assigned by ASPEN) of the
 57
                      certification or complaint survey event in which the
                      deficiency was cited. This is not a tracking ID for the IJ
                      situation.


       Citation       Reg set, tag number and brief text describing the
 58
       Description    deficiency.


       S/S            Scope and Severity level of the deficiency.
 59

       Cert           This box is checked when the deficiency was cited during
 60
                      a certification survey or revisit.


       Complnt        This box is checked when the deficiency was cited during
 61
                      a complaint survey or revisit.


       First cited    If this tag was cited at more than one survey in the
 62
                      cycle, this is the survey with the earliest exit date.




AEM User Guide                December 2006                                     145
VI. AEM Field Descriptions

          Citations: All Surveys subtab




        FIELD/BUTTON         DESCRIPTION – SURVEYS & IDR TAB

        Bld                  If this is an LSC tag, you will see the 2-character
  63
                             Building/Wing ID for the building. For Health survey
                             tags, you will see 00.


        Tag                  Tag number.
  64

        Type                 Tag Type as defined in Tag Properties. Types are A-
  65
                             Level A, B-Level B, C-Condition, E-Element, L-
                             Licensure, M-Memo, R-Requirement, S-Standard.
                             Nursing home health deficiencies always have a tag Type
                             of R.


        Description          Tag description.
  66

        SS                   Scope and severity level.
  67

        Cert                 This box is checked if the tag was cited as part of a
  68
                             certification survey or revisit.


146                                  December 2006                      AEM USER GUIDE
                                                                  Surveys & IDR tab


       FIELD/BUTTON   DESCRIPTION – SURVEYS & IDR TAB

       Complnt        This box is checked if the tag was cited as part of a
 69
                      complaint investigation or revisit.


       First Cited    Exit date of the first survey in the cycle in which this tag
 70
                      was cited.


       IDR Status     Current IDR status of this tag. IDR status is entered in
 71
                      the IDR Manager, which you can open from the tree or
                      from Survey Properties.


       Completion     Completion date for correction as submitted on the POC.
 72
       (X5)


       Corrected      Date the deficiency was corrected, as stated on the
 73
                      2567B.


       Citation       The button in this column will be blank if no waiver
 74
       Waived         information is entered. Waivers that are not yet
                      approved will display Pending, and an approved waiver
                      will display Waived.
                      Click the button to open the Input Waiver/Exception
                      Detail window, where you can edit and view additional
                      information. See Input Waiver/Exception Detail window,
                      page 148.


       Evidence HX    Click HX (medical abbreviation for "history") for a read-
 75
                      only view of the surveyor’s findings.


       Status         Current tag status. ASPEN assigns tag status as follows:
 76
                      FSES. Applies only to specific LSC tags.
                      Not Corrected. A tag has been cited and no 2567B
                      Corrected date has been entered.
                      Accepted. A Completion date (X5) has been entered,
                      but not a Corrected date. The Completion date (X5) is
                      the date by which the facility says correction will be
                      completed.
                      Corrected. A date has been entered for Corrected, or
                      the Completion date (X5) is the same as the Exit date of
                      the survey, which indicates the correction was made


AEM User Guide                December 2006                                   147
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – SURVEYS & IDR TAB

                             during the survey.
                             Waived. Applies only to specific tags. Tag status is
                             Waived when an Approval Date is entered in the Input
                             Waiver/Exception Detail window.
                             Pending. Applies only to tags eligible for waiver. Tag
                             status is Pending when waiver information is entered in
                             the Input Waiver/Exception Detail window, but the
                             waiver information does not include an Approval Date.



          Input Waiver/Exception Detail window




Note: The entry of Federal waivers on Enforcement cases is limited to Federal LSC
tags and the following Federal health tags: F0353, F0354, F0457, and F0458



        FIELD/BUTTON         DESCRIPTION – SURVEYS & IDR TAB


148                                 December 2006                     AEM USER GUIDE
                                                                  Surveys & IDR tab


       FIELD/BUTTON    DESCRIPTION – SURVEYS & IDR TAB

       Type            Required. Options are 01 Federal Waiver and 02 State
 77
                       Waiver.


       Duration        Required. Options are 01 Temporary and 02 Continuing.
 78

       Request Date    Date the waiver was requested.
 79

       Sent to CMS     Date the waiver was sent to CMS.
 80

       Decision        Required. Options are 01 Approved, 02 Denied, and 03
 81
                       Pending.


       Decision Date   Date the decision was made.
 82

       Last Day in     Required. The last day the waiver is to be in effect.
 83
       Effect


       Comments        Text entry box for notations about the waiver.
 84

                       Opens the POC Details window and provides a read-only
 85
                       view of POC Text entered. POC text may be entered for a
                       tag by right-clicking the tag in the ACO or AEM tree and
                       selecting POC Text.


                       Opens a read-only view of the citation text as entered in
 86
                       Citation Manager for the waived tag.




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VI. AEM Field Descriptions

      Remedies Tab




        FIELD/BUTTON         DESCRIPTION – REMEDIES TAB

        Remedy               Name of the remedy that has been added to this case.
  1
                             For Federal cases for which the Beginning Case Type is
                             either Opportunity to Correct, or No Opportunity to
                             Correct, AEM automatically adds remedies 04B – Mand
                             Deny Pay for New Admits-3 mo. and 11B –
                             Mandatory Termination to this tab. AEM assigns them
                             a Pending status, and inserts Effective Dates and State
                             Recommended Effective Dates of 3 and 6 months from
                             Cycle Start, as appropriate.
                             If the Beginning Case Type is Past Noncompliance (for
                             Federal) or if it is a State Licensure case, no remedies
                             are added automatically.
                             The list of remedies, both Federal and State, is
                             maintained in Lookup Values. CMS maintains the Federal

150                                  December 2006                      AEM USER GUIDE
                                                                     Remedies Tab


       FIELD/BUTTON     DESCRIPTION – REMEDIES TAB

                        list. To add, delete or modify a State remedy, select
                        Lookup Values from the System menu, then Remedy
                        Lookup Values.


       Remedy Type      Will display State or Fed (with the appropriate category),
 2
                        based on the remedy selected.


       Remedy In        Options are 01 Yes, 02 No, 03 Pending, and
 3
       Effect?          04 Recommended. CMP Remedy 07 has the additional
                        option 05 Awaiting Appeal Outcome.


       Effective Date   Effective date of the remedy, whether or not it actually
 4
                        goes into effect.


       Last Day in      Last day on which the remedy was actually in effect.
 5
       Effect


       Reason Not in    These options become available when No is selected for
 6
       Effect           In Effect?:
                        01 State changed its recommendation
                        02 State changed its own decision
                        03 RO didn't accept State's recommendation
                        04 RO changed its own decision
                        05 Compliance prior to effective date
                        06 IDR removed associated level of noncompliance
                        07 Adjudicated hearing decision
                        08 Hearing settlement
                        09 Voluntary termination prior to effective date
                        10 Mand. DPNA not imposed because Discret. DPNA was

       Recommend By     The options are State and RO. The field defaults to the
 7
                        current user’s mode, but can be changed.


       State Reco       The State Agency's recommended effective date.
 8
       Effect Date


       Revised State    Becomes available once a State Recommended Effective
 9
       Reco Effect      Date is entered. If the State's recommended date
       Date             changes, enter it here.


AEM User Guide                  December 2006                                   151
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – REMEDIES TAB

        Next Licensure       Applies to letters dealing exclusively with State
  10
        Letter               Licensure. If the next letter that the State sends uses
                             the "Next Licensure Letter Remedies" macro to list
                             remedies, place a check here to include this remedy on
                             the list.


        Next T18             Applies to letters sent by the State or CMS RO that deal
  11
        and/or T19           with Medicare and/or Medicaid issues (and can also
        Letter               include Licensure issues). If the next letter to be sent by
                             either State or RO uses the "Next T18 and/or T19 Letter
                             Remedies" macro to list remedies, place a check here to
                             include this remedy on the list.


                             Opens the Remedy Input window, so you can add a
  12
                             remedy to the case.


                             Opens the Remedy Input window for the selected
  13
                             remedy, do you can make changes.


                             Deletes the selected remedy. You will be asked to
  14
                             confirm.




152                                  December 2006                       AEM USER GUIDE
                                                                          CMP Tab

     CMP Tab


      Case CMP Detail
The Case CMP Detail section shows summary information about all of the CMPs
related to the case.




       FIELD/BUTTON     DESCRIPTION – CASE CMP DETAIL SECTION

       Referred to      Date the CMP was referred to the Department of Justice
 1
       DOJ              by CMS.


       DOJ Response     Date by which the response from the DOJ should be
 2
       Due              received by CMS.


       DOJ Response     This field tracks whether or not the response has been
 3
       NOT Received/    received. If no date is entered, the field label reads DOJ
       Received         Response NOT Received. Once the receipt date is
                        entered, the label changes to DOJ Response Received.


       Financial        Enter the date the imposing agency, CMS or the State,
 4
       Condition        completes its documentation of the required assessment
       Assessment       of the facility's financial condition.
       Completed and
       Documented


       First CMP        Date of the first written notice during this case of an
 5
       Imposition       imposition of a CMP by the Regional Office or the State.
       Notice           In a case/cycle with more than one imposed CMP, each
                        CMP will have its own Imposition Notice Date. The
                        earliest of those dates is entered in this field.



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VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CASE CMP DETAIL SECTION

        Current Total        These columns combine amounts from all CMPs that are
  6
        Across All           either in effect or awaiting appeal:
        CMPs
                             First column - Separate totals for Federal CMPs and
                             State Licensure CMPs. These figures total the CMPs that
                             are in effect and those that are awaiting appeal, as
                             indicated by "In Effect?" status = Yes or Awaiting
                             Appeal Outcome, and a Last Day in Effect is entered.
                             Amt. Due - Separate totals for Federal CMPs and State
                             Licensure CMPs. These figures include only CMPs that
                             are in effect, as indicated by "In Effect?" status = Yes
                             and a Last Day in Effect is entered.
                             Pmts. Rec'd - Separate totals for Federal CMPs and
                             State Licensure CMPs. These figures include all payments
                             entered for the CMPs. This includes payments made in
                             Payment History, through the Apply Full Payment button,
                             or entered in Payments Rec’d in the CMP Payment
                             Status section.


  7                             Note: This button is disabled for Federal CMPs
                                that have been uploaded from AEM to CMPTS.

                             Separate buttons for Federal and State Licensure CMPs.
                             Opens the Payment Input window where you can enter
                             date and check information. This is a convenience
                             feature you can use when there is a single payment for
                             all of the CMPs in effect.
                             When you enter the payment here, AEM will create a
                             record in Payment History, fill in the appropriate
                             payment fields in the CMP Payment Status section, and
                             change the Payment Status to Paid - Closed.


        CMPTS #              Tracking number for the Civil Money Penalty Tracking
  8
                             System (CMPTS). The CMS Regional Office tracks the
                             CMPs it imposes via the CMPTS number; the State does
                             not use CMPTS for either Medicaid-only or State
                             Licensure CMPs.
                             Beginning with v8.7, manual entry of the CMPTS number
                             is disabled. AEM will now generate this number when all
                             of the CMPs associated with the case are due and
                             payable.
                             There is one CMPTS number assigned per cycle/case.



154                                  December 2006                     AEM USER GUIDE
                                                                        CMP Tab


       FIELD/BUTTON     DESCRIPTION – CASE CMP DETAIL SECTION

                        Enabled only for ROs. Opens AEM's CMPTS Detail window
 8A
                        for entry and upload of CMPTS information. See CMPTS
                        Detail, page 171.


       Residents        AEM supplies the counts of Medicare and Medicaid
 9
       Medicare (F75)   residents from items F75 and F76 on the most recent
       Medicaid (F76)   CMS-672 Resident Census form. You can change these
       with percen-     numbers here if they are no longer accurate. AEM does
       tages and        not update the fields if new numbers are entered on the
       dollar amounts   672 after the case is opened.
                        This section also shows the calculated percentage of
                        total residents for T18 and T19 and the dollar amounts
                        that result by applying that percentage to the Federal
                        Amt. Due.




AEM User Guide                 December 2006                                155
VI. AEM Field Descriptions

          Civil Money Penalties (CMP)         Per Instance




        FIELD/BUTTON         DESCRIPTION – CMP PER INSTANCE TAB

        Per Instance         Total of all the Federal Per Instance CMPs that are either
  10
        Total                In Effect or Awaiting Appeal Outcome. In Figure 12, the
                             three Federal Per Instance CMPs total $8,500.00.


        Day Total            Total of the Federal (Medicare or Medicaid) Per Instance
  11
                             CMPs (In Effect or Awaiting Appeal Outcome) for the
                             selected day. By regulation, this total cannot exceed
                             $10,000. In Figure 12, 01/09/2004 is selected. There are
                             two In Effect CMPs for that day, and their total ($3,500)
                             shows in Day Total.


        Survey Total         Total of the Federal (Medicare or Medicaid) Per Instance
  12
                             CMPs (In Effect or Awaiting Appeal Outcome) for the
                             selected survey. By regulation, this total cannot exceed
                             $10,000. In Figure 12, survey 4PXQ13 is selected, and


156                                  December 2006                      AEM USER GUIDE
                                                                             CMP Tab


       FIELD/BUTTON     DESCRIPTION – CMP PER INSTANCE TAB

                        the total of the Per Instance CMPs for that survey
                        ($3,500) shows in Survey Total.


       Survey Date      ASPEN Event ID, health or LSC indicator, and beginning
 13
                        and ending dates of the visit during which the instance
                        was cited.


       Instance Date    Date on which the instance occurred.
 14

       Amount Per       Amount to be imposed for this instance.
 15
       Instance


       CMP In Effect?   Options are Yes, No, Recommended, and Awaiting
 16
                        Appeal Outcome. Note that only amounts for CMPs
                        marked Yes and Awaiting Appeal Outcome are
                        included in the Federal Totals section above. Defaults to
                        Recommended for new CMPs.


       Fed or State     Indicates whether the CMP is imposed under the
 17
                        authority of the State licensure program (State) or the
                        Federal Medicare or Medicaid programs (Fed). When the
                        State Agency imposes Medicaid CMPs at a Medicaid-only
                        Nursing Home, the CMP should be entered as Fed, since
                        Federal tags are being cited.
                        Your selection here will determine the list of citations
                        you can pick when you click Choose in the Per Instance
                        CMP input window (see Field #23, below).


       High S/S         Scope and Severity level of the tag for which the Per
 18
                        Instance CMP is being imposed.


       Citation         Tag number and S/S of the deficiency for which the CMP
 19
                        is being imposed. To enter this field, click Choose.


                        Opens a new Per Instance CMP window, so you can
 20
                        provide details about a new CMP.


                        Opens the Per Instance CMP window for the selected
 21
                        CMP, so you can view or make changes.



AEM User Guide                  December 2006                                   157
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CMP PER INSTANCE TAB

                             Deletes the selected CMP. You will be asked to confirm.
  22


                             Opens a window with a list of all tags cited in the survey.
  23
                             Based on CMS policy, you can select only one tag for
                             each Per Instance CMP. Your selection will populate the
                             Citation and Scope/Severity fields.


        Recommended          A recommended amount for the Per Instance CMP.
  24
        Amount


          Civil Monetary Penalties (CMP)         Per Day




        FIELD/BUTTON         DESCRIPTION – CMP PER DAY TAB

        Survey Date          ASPEN Event ID and the ending date of the visit during
  25
                             which the CMP-related tag(s) was cited.


158                                  December 2006                      AEM USER GUIDE
                                                                           CMP Tab


       FIELD/BUTTON    DESCRIPTION – CMP PER DAY TAB

       Amount per      Daily amount of the CMP to be imposed.
 26
       Day


       First Day       The first day the CMP will be in effect. The default is the
 27
                       Exit date of the selected survey.


       Last Day        The last day the CMP is in effect. For a CMP that is
 28
                       running at the end of a cycle, this will be the day before
                       the date the facility is in substantial compliance.


       Days            Total number of days from the First Day through the
 29
                       Last Day, inclusive, calculated by AEM.


       CMP In Effect   Options are Yes, No, Recommended and Awaiting
 30
                       Appeal Outcome. Note that CMPs marked Yes and
                       Awaiting Appeal Outcome are included in the total
                       figures above, if a Last Day has been entered. This field
                       defaults to Recommended for new CMPs.


       Fed or State    Indicates whether the CMP is imposed under the
 31
                       authority of the State licensure program (State) or the
                       Federal Medicare or Medicaid programs (Fed). The State
                       agency can impose Medicaid CMPs at Medicaid-only
                       Nursing Facilities. Such a CMP should be entered as Fed.


       High S/S        Available only for State Licensure Per Day CMPs. Highest
 32
                       Scope and Severity grid letter of the tags selected in
                       Citations.


       Citations       Available for State Per Day CMPs. Tag numbers and SS
 33
                       levels of the deficiencies for which the CMP is being
                       imposed. In the Per Day CMP input window, click
                       Choose to open a window with a list of all tags cited in
                       the survey. Select the tag(s) related to this CMP. On the
                       grid, you can click the Citations field to see all the
                       selected citations.


                       Opens a new Per Day CMP window, so you can provide
 34
                       details about a new CMP.




AEM User Guide                 December 2006                                  159
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CMP PER DAY TAB

                             Opens the Per Day CMP window for the selected CMP, so
  35
                             you can view its details or make changes.


                             Deletes the selected CMP. You will be asked to confirm.
  36


        Recommended          A recommended amount for this CMP.
  37
        Amount




160                                 December 2006                     AEM USER GUIDE
                                                                           CMP Tab


     Detail for Highlighted CMP




       FIELD/BUTTON   DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

       Imposition     Date of the written Notice of Imposition of Civil Monetary
 1
       Notice Date    Penalty. If you use the envelope icon next to the field to
                      generate the Notice, AEM will insert its Sent Date here.
                      You can edit the date as needed.


                      Opens the Select Letters and Distribution List window,
 2
                      where you can generate new or view existing letters and
                      notices.
                      The default list will show only letters related to the field
                      next to the envelope button, if your letters were
                      categorized using the Enf Letter Class option in Letter
                      Management. If you don't see the letter you want to
                      send, select Show All for a list of all letters in the


AEM User Guide                December 2006                                    161
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

                             database
                             When you create a letter using the envelope icon, AEM
                             will insert its Sent date in the adjacent field, and open
                             the Letter/Notice Details window, so you can supply
                             tracking, contents, and appeal information.


        Appeal/Appeal        This date defaults to 70 days from the Imposition Notice
  3
        Waiver Due           Date (5 days for mail to the NH, plus 60 days for its
                             response, plus 5 days mail from the NH). However, you
                             can change the date to suit your specific circumstances.
                             CAUTION: Notices are also maintained on the Notices
                             tab. If a different Due Date for the waiver is entered
                             there, that change will not show here.


        Appeal Waiver        When the waiver request is received, enter the received
  4
        Received             date here. If the date you enter is on or before the
                             Appeal/Appeal Waiver Due date, a 35% reduction is
                             applied to the amount due for the CMP.
                             If the Appeal Waiver Received date is after the
                             Appeal/Appeal Waiver Due date, you will see a
                             warning message when you enter the received date. You
                             will still have the option of applying the 35% reduction, if
                             applicable.


        CMP Total            Total amount calculated for this CMP. For a Per Instance
  5
                             CMP, this will be the Amount Per Instance. For a Per
                             Day CMP, AEM will calculate the Amount Per Day times
                             the Number of Days. AEM will make the per-day
                             calculation after the Last Day in effect is entered.


        Less 35%             AEM applies the 35% reduction automatically to the CMP
  6
        Reduction            Total when the Appeal Waiver Received date is on or
                             before the Appeal/Appeal Waiver Due date.
                             If the Appeal Waiver Received date is after the
                             Appeal/Appeal Waiver Due date, you will see a
                             message when you enter the received date, offering you
                             the option of applying the 35% reduction.


        Net Amount           CMP Total minus the 35% reduction, if any. This is the
  7
                             amount that would be due without any hearing order or
                             settlement, or bankruptcy settlement in place.


162                                  December 2006                       AEM USER GUIDE
                                                                         CMP Tab


       FIELD/BUTTON     DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

       Bankruptcy       Select this box if the CMP collection is affected by
 8
                        bankruptcy. Marking the box will enable the other fields
                        in the Bankruptcy section.
                        If this box is checked, the bankruptcy Settlement
                        Amount, even if $0, will be the amount used for
                        AMOUNT DUE in the Payment section.


       Petition Date    Date of the bankruptcy petition.
 9

       End Date         Date of the final bankruptcy court order.
 10

       Settlement       Check this box when the settlement amount is finalized.
 11
       Amount           See Total Amount Due, page 165, for an explanation of
       Finalized        how this box affects the CMP Amount Due calculation.


       Settlement       CMP amount due as a result of the bankruptcy
 12
       Amount           settlement. An amount entered here has precedence
                        over any other amounts due for this CMP.


       Hearing/Settle   Checking this box activates the Hearing
 13
       ment Finalized   Order/Settlement Amount field. See Total Amount Due,
                        page 165, for an explanation of how this box affects the
                        CMP Amount Due calculation.


       Hearing Order/   If the NH requests a hearing and the case is either
 14
       Settlement       settled or completed with the ALJ (Administrative Law
       Amount           Judge) issuing a decision, enter the resulting final
                        amount of the CMP here (even if it is equal to the
                        original, full calculated amount). This amount will
                        become the TOTAL AMOUNT DUE in the Payment
                        section (overriding what was previously there).
                        If there is a subsequent bankruptcy settlement, that
                        amount would override this one.


       Write-off        Check this box and provide a Write-off Reason when it is
 15
                        determined that the Amount Due should be written off.
                        Checking this box inserts the Payments Rec'd amount in
                        the Total Amount Due field, which allows the case to be
                        closed.




AEM User Guide                  December 2006                                  163
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

        Write-off            Select a reason for the write-off from the dropdown list.
  16
        Reason          `    Options are:
                             01 Voluntary Termination
                             02 Involuntary Termination
                             03 Low Outstanding Amount
                             04 Referral to Treasury
                             05 Other

        Payment              Options are:
  17
        Status               None Yet
                             Awaiting CMP Payment
                             Pending Appeal
                             Paid – Closed
                             Extended Payments
                             Overdue CMP
                             Offset to FI
                             Offset to T19 Agency
                             Offset to FI + T19 Agency
                             Awaiting Bankruptcy Outcome
                             IDR Removed CMP
                             Settlement Removed
                             Hearing Removed
                             Other – see Case Notes
                             Choose Extended Payments to enable Payment
                             Terms and Payments Rec'd.


        State                If this is a State Licensure imposed CMP, or if your state
  18
        Collection #         has its own numbering system for Federal CMPs, you can
                             enter the state number here.


        Collection           Date of the first notice to the facility that informed it of
  19
        Notice Date          the actual payment due date of this CMP.


        Payment Due          Date the payment is due. When Collection Notice Date is
  20
                             entered, AEM calculates Payment Due as 25 days after
                             the Collection Notice date. If you change the Collection
                             Notice Date, you will be asked if you want to recalculate
                             the Payment Due date.


        Payment              This field is enabled when Extended Payments is
  21

164                                  December 2006                        AEM USER GUIDE
                                                                          CMP Tab


       FIELD/BUTTON   DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

       Terms          selected for Payment Status. Options are: Up to 6
                      months, 6 – 12 months, Over 12 months.


       Medicare       Medicare portion of interest due. When entered, will be
 22
       Interest Due   added to the TOTAL AMOUNT DUE.


       Medicaid       Medicaid portion of interest due. When entered, will be
 23
       Interest Due   added to the TOTAL AMOUNT DUE.


                      Opens the CMP Interest Calculator. See CMP Interest
 24
                      Calculator on page 168.


       TOTAL          The CMP Amount Due, plus any interest that has been
 25
       AMOUNT DUE     applied.
                      CMP Amount Due (before interest) is determined in the
                      following order:
                      • The CMP Amount entered in the Per Day or Per
                        Instance CMP
                      • If Appeal Waiver Received Date is entered and is on or
                        before the Appeal/Appeal Waiver Due Date, then the
                        35% reduction applies
                      • If the Hearing/Settlement Finalized check box is
                        checked, then the Hearing Order/Settlement Amount
                        (even if 0) replaces the CMP Amount Due
                      • If the Bankruptcy check box is checked and the
                        Settlement Amount Finalized check box is checked,
                        then Settlement Amount (even if 0) replaces the CMP
                        Amount Due
                      • If the Write-off check box is checked, then CMP
                        Amount Due becomes the amount that is in the
                        Payments Received field
                      When the CMP Amount Due = $0 because of a Write-off,
                      Hearing/Settlement or Bankruptcy Settlement, the
                      following 462L Upload edits are ignored:
                      • EN1751: TOTAL AMOUNT DUE MUST BE ENTERED
                        WHEN REMEDY CODE = “07” AND EFFECTIVE DATE IS
                        PRESENT.
                      • EN1754: TOTAL AMOUNT DUE MUST BE ENTERED
                        WHEN TOTAL AMOUNT DUE DATE IS ENTERED.


AEM User Guide               December 2006                                  165
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

        Payments             This field shows the total of all amounts received for all
  26
        Rec'd                the entries in Payment History. The field is enabled when
                             Extended Payments is selected for Payment Status.


        Balance Due          Remaining balance: Total Amount Due minus
  27
                             Payments Rec'd.


        This CMP Fully       The date on which the CMP was fully paid. If you use the
  28
        Paid                 Apply Full Payment feature, AEM will fill in this field.


        Offset Memo to       Enter the date of your memo to the Fiscal Intermediary
  29
        FI                   instructing them to withhold the Medicare CMP amount
                             from the facility's Medicare reimbursement.


        Offset Memo to       Enter the date of your memo to the Medicaid agency
  30
        T19 Agency           instructing them to withhold the Medicaid CMP amount
                             from the facility's Medicaid reimbursement.


        T19 Portion          Date the T19 amount was received by the State. Entered
  31
        Rec'd by State       manually by the SA.


        T19 Portion          Amount received for the T19 portion. Entered manually
  32
        Amount Rec'd         by the SA.


        PAYMENT HISTORY (OPTIONAL) SECTION

        NOTE: Beginning with AEM v8.7, this section can only be used for Federal
        CMPs entered in CMPTS prior to 8.7, or State Licensure CMPs.


        Check Date           Date the check was written.
  33

        Date Payment         Date the payment was received by the RO or the State.
  34
        Received


        Check Number         Check number.
  35

        Amount               Amount of the check.
  36
        Received



166                                  December 2006                     AEM USER GUIDE
                                                                       CMP Tab


       FIELD/BUTTON   DESCRIPTION – DETAIL FOR HIGHLIGHTED CMP

       Principal      Amount applied to principal, if applicable.
 37

       T18 Interest   Amount applied to T18 interest, if applicable.
 38

       T19 Interest   Amount applied to T19 interest, if applicable.
 39

       Title 18       T18 portion of the principal amount paid.
 40

       Title 19       T19 portion of the principal amount paid.
 41

                      Opens the Edit Pay History window, so you can enter a
 42
                      new payment for this selected CMP. Caution: Make sure
                      the highlighted CMP is the one for which you are
                      recording a payment.


                      Opens the Edit Pay History window for the selected
 43
                      payment record, so you can make additions or changes.


                      Deletes the selected payment record. You will be asked
 44
                      to confirm.




AEM User Guide                December 2006                              167
VI. AEM Field Descriptions

       CMP Interest Calculator




        FIELD/BUTTON         DESCRIPTION – CMP INTEREST CALCULATOR

        CMP Amount           AEM inserts this amount as calculated from entries on
  1
        Before Interest      the CMP tab.
                             NOTE: You can change the CMP Amount Before Interest,
                             and adjust the rate if necessary. When you click OK the
                             calculator will insert the new results into the Medicare
                             and Medicaid Interest Due fields in the CMP Payment
                             Status section.
                             Those changes are not retained. The next time you open
                             the calculator, CMP Amount Before Interest will revert to
                             the AEM-calculated amount.


168                                 December 2006                      AEM USER GUIDE
                                                                             CMP Tab


       FIELD/BUTTON        DESCRIPTION – CMP INTEREST CALCULATOR

       Medicare            Medicare Allocation percent as determined by number of
 2
       Allocation %        Medicare residents (F75) on the CMP tab.


       Medicare            Calculated by AEM. Medicare Allocation % multiplied by
 3
       Portion of CMP      CMP Amount Before Interest.


       Medicare            Required. Enter the interest rate as a percentage: for
 4
       Interest Rate       7.5%, enter 7.5 (three decimal places are allowed)
       (%)


       Medicare            Calculated by AEM. Amount of Medicare interest that
 5
       Interest for Full   accrues over a one-year period. Interest Rate multiplied
       Year                by Medicare Portion.


       Daily Medicare      Calculated by AEM. Amount of Medicare interest that
 6
       Interest            accrues each day.
       Amount


       Medicaid            Medicaid Allocation percent as determined by number of
 7
       Allocation %        Medicaid residents (F76) on the CMP tab.


       Medicaid Potion     Calculated by AEM. Medicaid Allocation % multiplied by
 8
       of CMP              CMP Amount Before Interest.


       Medicaid            Defaults to interest rate entered in Medicare Interest
 9
       Interest Rate       Rate. If Medicaid Interest Rate is different, enter the
       (%)                 interest rate as a percentage: for 7.5%, enter 7.5 (three
                           decimal places are allowed).


       Medicaid            Calculated by AEM. Amount of Medicaid interest that
 10
       Interest for Full   accrues over a one-year period. Interest Rate multiplied
       Year                by Medicaid Portion.


       Daily Medicaid      Calculated by AEM. Amount of Medicaid interest that
 11
       Interest            accrues each day.
       Amount


       Day Calculation     Choose Use Dates when you want AEM to use dates to
 12
                           calculate the number of days the CMP is overdue.
                           Choose Type # of Days when you want to type in the


AEM User Guide                     December 2006                                 169
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CMP INTEREST CALCULATOR

                             number yourself.


        Original Due         Original Due Date for this CMP. Activated when you
  13
        Date                 choose Use Dates for Day Calculation.


        New Due Date         New Due Date for payment of the CMP and interest.
  14
        with Interest        Activated when you choose Use Dates for Day
                             Calculation.


        Days CMP is          If Use Dates is selected for Day Calculation, AEM
  15
        Overdue              calculates the number of days.
                             If Type # of Days is selected, you can enter the
                             number here.
                             This field must be complete for AEM to calculate the total
                             Medicare and Medicaid Interest Due.


        Total Medicare       Calculated by AEM. Daily Medicare Interest Amount
  16
        Interest Due         multiplied by Days CMP is Overdue.
                             When you click OK in the calculator, AEM inserts this
                             result into the Medicare Interest Due field in the CMP
                             Payment Status section.


        Total Medicaid       Calculated by AEM. Daily Medicaid Interest Amount
  17
        Interest Due         multiplied by Days CMP is Overdue.
                             When you click OK in the calculator, AEM inserts this
                             result into the Medicaid Interest Due field in the CMP
                             Payment Status section.


        Total CMP            Calculated by AEM. CMP Amount Before Interest + Total
  18
        Amount Due           Medicare Interest Due + Total Medicaid Interest Due.
        (Including
        Interest)




170                                  December 2006                      AEM USER GUIDE
                                                           CMP Tab

     CMPTS Detail




       FIELD/BUTTON   DESCRIPTION – CMPTS DETAIL

       Survey Date    Supplied by AEM. Cycle start date.
 1



AEM User Guide               December 2006                   171
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CMPTS DETAIL

        Cross-ref to         If this CMPTS record is related to another CMPTS record,
  2
        Other Case           enter the CMPTS # of the other record here.


        Deduct CMP           Box is checked when a CMP has not been paid in a
  3
        from Sums            timely manner, and the RO decides to have it offset
        Owed                 through the FI. Continue to use whatever notification
                             procedures you are currently using.


        Administrator        Enter the First Name, Middle Initial, and Last Name of
  4
        Name                 the NH administrator. First and Last Name are required
                             for upload.


        Proposed # of        Enter the number of proposed installments, up to 49.
  5
        Installments


        Proposed             Enter the dollar amount of each proposed installment.
  6
        Installment          This amount may be changed as needed.
        Amount


        Payment Due          At least one Payment Due Date is required. When
  7
        Date                 creating a new installment, click New and enter the
                             payment due date in CMPTS Installment Detail.
                             Payment Due Date cannot be earlier than Cycle Start, or
                             later than Cycle Start + 8 years.
                             You can edit Payment Due Date either in the grid or by
                             clicking Modify up until a payment is recorded for that
                             installment date.


        Payment              Entered in CMPTS and downloaded to AEM.
  8
        Received Data




172                                 December 2006                      AEM USER GUIDE
                                                                      CMP Tab

     CMPTS Remarks




       FIELD/BUTTON   DESCRIPTION – CMPTS REMARKS

                      Opens the CMPTS Remarks window, where you can enter
 1
                      text for your remarks, up to 76 characters. You can
                      create as many new Remarks as you need.
                      New remarks are required when you change the status
                      of a CMPTS record.


                      Opens the CMPTS Remarks window for the selected
 2
                      Remarks. Changes you make will be uploaded with an
                      update transaction.


                      Deletes the selected Remarks. You will be asked to
 3
                      confirm.


AEM User Guide               December 2006                                 173
VI. AEM Field Descriptions

       CMPTS Upload




        FIELD/BUTTON         DESCRIPTION – CMPTS UPLOAD

  1     Action               Type of action for CMPTS Detail may be:
                             03 Add – Upload a new case
                             04 Update – Upload changes to an existing case


  2     Date                 Date of the transaction




174                                 December 2006                      AEM USER GUIDE
                                                                             CMP Tab


       FIELD/BUTTON     DESCRIPTION – CMPTS UPLOAD

 3     Status           Transaction status codes are:
                        -1 – Failed Invalid or missing data detected, transaction
                        terminated.
                        00 – Pending Transaction successful, but case is not yet
                        uploaded to OSCAR.
                        05 – Uploaded Case uploaded to OSCAR
                        10 – Successful Case accepted by OSCAR
                        12 – OSCAR Info Transaction successful but OSCAR
                        detected something irregular.
                        15 – Failed Transaction failed at the OSCAR level.


 4     By               If the transaction was initiated in ACO, this is the name
                        and Federal ID of the person who initiated the upload. If
                        the transaction was initiated in ARO, "Regional Office" is
                        displayed here.


 5     Error            Type of error.


 6     Transaction ID   Identifier assigned by OSCAR to each upload transaction.


 7     Sender Type      R (Region) or S (State).


 8     CASPER Status    CASPER status codes are the same as those for #3
                        Status.


 9                            Click to prevalidate, and initiate an upload
                              transaction.
                              AEM checks the CMPTS record to make sure
                              required information is present and in the
                              appropriate formats.
                              If the prevalidation is successful, you will see an
                              Upload Transaction Pending message, and AEM
                              will issue a CMPTS number for the case.
                              This button is disabled after the first successful
                              upload.


 10                     Returns the list to the original sort order.


AEM User Guide                  December 2006                                      175
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – CMPTS UPLOAD

  11                         Prints a Transaction Report listing all upload transactions
                             in ascending or descending order


  12    Upload               This section appears when the transaction you select in
        Transaction          Prior Enforcement Case Uploads contains errors. It will
        Errors               list the errors. You can copy and paste this information.


  13    Upload               This message appears when you click Prevalidate and
        Transaction
                             Upload and AEM confirms that the required minimum
        Pending
                             data is present. It also appears when changes are made
                             to previously uploaded CMPTS information.
                             After the CMPTS nightly upload, this message will go
                             away, and you will see a description of the transaction
                             on the Upload tab.




176                                  December 2006                      AEM USER GUIDE
                                                                        NATCEP Tab

     NATCEP Tab
The NATCEP tab stores NATCEP loss triggers and relevant NATCEP prohibition and
waiver dates.




       FIELD/BUTTON      DESCRIPTION – NATCEP TAB

       NATCEP Loss       Options are No, Yes, and Potential. Selecting Yes or
 1
                         Potential will activate the NATCEP Triggers grid and the
                         effective date fields.
                         You cannot close a case that has Potential selected
                         here.


       NATCEP Loss       This grid lists the circumstances that trigger loss of the
 2
       Triggers          ability to offer NATCEP. In the Check All Applicable
                         column, select as many triggers as apply to this case. In
       483.151(b)(2)
                         the Is Primary column, select the single circumstance
                         that is the primary reason for NATCEP loss.


       NATCEP Loss       Date the 2-year NATCEP loss period begins, based on
 3
       Effective Date    the Primary Trigger.
       from Primary
       Trigger



AEM User Guide                   December 2006                                 177
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – NATCEP TAB

        Last Day             Last day that NATCEP prohibition is in effect. AEM
  4
                             calculates Last Day as two years from the Effective
                             Date. It cannot be overridden.


        State NATCEP         Select this box if the State is granting a waiver of
  5
        Loss Waiver          NATCEP loss. This will activate the waiver date fields.


        State Waiver         Date of the State’s waiver notice letter.
  6
        Notice Date


        Last Day of          AEM supplies the NATCEP Last Day loss for this date,
  7
        Waiver               but you can change it to an earlier date if the waiver is
                             terminated early. You cannot enter a date later than the
                             Last Day.


        Waiver               When a waiver is withdrawn, enter a brief description of
  8
        Withdrawn            the reason for withdrawing the waiver.
        Reason


        Restored Based       If NATCEP loss is canceled because of a change of
  9
        on CHOW Date         ownership, enter the change of ownership effective date.


        Most Recent          This read-only section is shared with an identical section
  10
        Actual NATCEP        on the Other tab in Facility Properties. When NATCEP
        Loss                 Loss = Yes, this section will supply dates of the most
                             recent actual NATCEP loss (including the current case).
                             •   NATCEP Loss - may be Yes or blank
                             •   Last Day – Last Day of the most recent NATCEP loss
                             •   Last Day of Waiver – Last day of any waiver applied
                                 to the NATCEP loss
                             •   Restored Based on CHOW date – If the most recent
                                 NATCEP was restored following a change of
                                 ownership, the date the NATCEP was restored




178                                  December 2006                       AEM USER GUIDE
                                                                       Notices Tab

     Notices Tab
      Notices and Notices History




       FIELD/BUTTON   DESCRIPTION – NOTICES TAB

       Date Sent      Date the notice (letter) is sent. You can enter this date
 1
                      in the Select Letters and Distribution List window when
                      you create the letter, or you can supply the date later.


       Letter ID      The 4-character ID number that AEM assigns to the
 2
                      letter template. The actual specific letter does not have a
                      separate ID number.




AEM User Guide                December 2006                                 179
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – NOTICES TAB

        Letter               Title of the letter template that was the basis for the
  3
        Description          actual letter.


        Locked               Indicates whether or not the letter is locked against
  4
                             further editing.


        Draft                Indicates whether this letter is a draft.
  5

        Associated           If the letter refers to a specific survey, that survey is
  6
        Survey               listed here. If the template has Requires Specific Visit
                             Information selected in the Letter Desc window, then
                             you specify the visit in Select Letters and Distributions
                             Lists when you create the letter.


        Origin               SA or RO.
  7

                             Opens the Notices History window, from which you
  8
                             create, edit or view letters and other communications
                             associated with this case.


                             If the letter is a draft, click Remove Notice to remove the
  9
                             letter entirely from Letter History. If the letter is not a
                             draft, the button will mark the Notice as Removed in
                             Notices History, and put a strikethrough on the letter in
                             the list.
                             When you select a letter that has been removed, the
                             button label switches to Restore Notice, so you can
                             restore the letter if necessary.


                             Opens the Define Activity window so you can assign a
  10
                             new activity. The button is placed on the Notices tab as a
                             convenience. Activities you create here are added to the
                             list on the Case Basics tab.


        Created              AEM supplies the date the letter was first created. This
  11
                             can be changed in the Notices History window with
                                      .




180                                  December 2006                       AEM USER GUIDE
                                                                         Notices Tab


       FIELD/BUTTON   DESCRIPTION – NOTICES TAB

       Date Sent      Date the letter was sent as entered either in the Select
 12
                      Letters and Distributions Lists window, or in Letter
                      Details. This date can be changed in Letter Details, or in
                      the Notices History window with            .


       Letter ID      The 4-character identifier for the letter template.
 13

       Description    Descriptive name of the letter template.
 14

       Draft          Yes/No. Indicates whether this letter is a draft version.
 15

       Removed        Yes/No. Indicates whether this letter has been removed.
 16

       Locked         Yes/No. Indicates whether this letter is locked.
 17

                      Opens a copy of the selected letter in the word
 18
                      processing window.


                      Opens the Select Letters and Distribution List window so
 19
                      you can select a template, choose recipients, and
                      generate a new letter.


                      Opens the Modify Letter History Date window, where you
 20
                      can change the Created date and Date sent, as
                      needed.


                      Locks/unlocks the selected letter. Locked letters may not
 21
                      be modified or deleted. Lock a letter when it goes in the
                      mail or has been faxed to a recipient.


                      Deletes the selected letter. You will be asked to confirm.
 22
                      The letter will stay on the list; the indicator in the
                      Removed column will change from No to Yes. You
                      cannot delete a locked letter.
                      Deleting a letter (even a draft) here will not remove it
                      from history. To remove draft letters entirely, use
                      Remove Notice on the Notices tab.



AEM User Guide                December 2006                                   181
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – NOTICES TAB

                             Opens the Define Activity window so you can assign a
  23
                             new activity. The button is placed here as a convenience.
                             Activities you create here are added to the Activities
                             section on the Case Basics tab.


        To                   The recipient of the Other Communication. Options are
  24
                             01 State Central Office, 02 Field Office (State), and
                             03 CMS Regional Office.


        From                 The sender. Options are 01 State Central Office, 02
  25
                             Field Office (State), and 03 CMS Regional Office.


        Method               Method of communication. Options are 01 Telephone,
  26
                             02 Written, 03 E-mail.


        Date                 Date of the communication as entered in the Other
  27
                             Communications window.


                             Opens the Other Communications window, so you can
  28
                             add a new communication.


                             Opens the Other Communications window, so you can
  29
                             change the selected communication.


                             Deletes the selected communication. You will be asked
  30
                             to confirm. Unlike letters, deleted communications will
                             disappear from the list.




182                                 December 2006                      AEM USER GUIDE
                                                                            Notices Tab


       Letter Details
This section provides fields for storing useful information about each letter.




        FIELD/BUTTON       DESCRIPTION – NOTICES TAB

        Created            The date the letter or notice was first created in AEM
  31
                           (see #11, page 56). Read-only at this location, you can
                           change it in the Notices History window (click Create
                           Notice/Letter) by selecting the letter and clicking
                           Modify Date.




AEM User Guide                     December 2006                                 183
VI. AEM Field Descriptions


        FIELD/BUTTON         DESCRIPTION – NOTICES TAB

        Letter Sent          AEM supplies the Date Sent from the letter/notice
  32
                             record. You can edit the date as necessary in this field,
                             and AEM will update the letter record accordingly.


        Method               Delivery method. Options are 01 Certified Mail, 02 US
  33
                             Postal Standard, 03 Overnight UPS, 04 Overnight
                             FedEx, 05 Overnight- Airborne, 06 Overnight-
                             Other, 07 Other.


        Tracking #           Use this field to record a delivery service tracking
  34
                             number.


        Fax                  If you fax this letter or notice, use the check box to
  35
                             indicate this, even if you also send it by mail or some
                             other means. Checking the box activates the Fax Sent
                             field.


        Fax Sent             Date the notice was faxed, if applicable.
  36

                             Locks/Unlock the selected letter. Locked letters cannot
  37
                             be edited or deleted. Lock a letter when it goes in the
                             mail or has been faxed.


        Delivered Date       Date the letter or notice was delivered, if known.
  38

        Appeal Rights        Select this box if the provider has a right to appeal the
  39
        Based on this        findings contained in the notice. This will activate the
        notice               Due Date field.


                             Recalculates the Due Date for appeals/waivers according
  40
                             to the rules described in Due Date. Use Recalculate as
                             appropriate if you change the Letter Sent, Fax Sent or
                             Delivered Date fields.


        Due Date             Date by which the provider must submit an appeal. AEM
  41
                             uses a default date that is the earliest of: 70 calendar
                             days from the Letter Sent, 65 days from Fax Sent, or
                             65 days from Delivered Date. You can adjust this date
                             as needed.



184                                  December 2006                       AEM USER GUIDE
                                                                           Notices Tab


       FIELD/BUTTON      DESCRIPTION – NOTICES TAB

       Letter Contents   This area lists all of the contents categories selected in
 42
                         the Letter Contents window.


                         Opens the Letter Contents window, where you can select
 43
                         the subject matter that is included in this letter. Your
                         selections will show in the Letter Details area.
                         Note: You must choose at least one Letter Contents
                         item for a letter.




AEM User Guide                   December 2006                                   185
VI. AEM Field Descriptions


   Hearing/Appeal Tab
Use the Hearing/Appeal tab to store information about all the appeals and hearings
for this cycle/case, including Medicare, Medicaid and State Licensure.




186                              December 2006                     AEM USER GUIDE
                                                                  Hearing/Appeal Tab



       FIELD/BUTTON      DESCRIPTION – HEARING/APPEAL TAB

       Class (on grid)   Type of appeal. Options are Medicare, Medicaid and
 1
       or                State Licensure.
       Medicare/Medi-
       caid/Licensure
       (in window)


       Initial Hearing   Entity who received the initial request for the hearing.
 2
       Request           Options are: DAB (Departmental Appeals Board), RO
       Received By       (Regional Office) and State.


       Acknowledged      Date an acknowledgement of the request is sent to the
 3
       to Facility       facility.


       Date Initial      Date the initial request for a hearing is received.
 4
       Request
       Received


       Forwarded to      Date the hearing request is forwarded to the
 5
       DAB               Departmental Appeals Board.


       Latest Appeal     Begins by displaying the original hearing request, then
 6
       Information       its outcome. If the hearing has been appealed, this area
                         will show to whom it is being appealed, by whom, and
                         the date the appeal is filed. Once an outcome is
                         entered, the outcome date is shown.


                         Opens the Hearing/Appeal window, where you can
 7
                         create a record for a new appeal.


                         Opens the Hearing/Appeal window for the selected
 8
                         appeal, so you can make changes and updates.


                         Deletes the selected appeal. You will be asked to
 9
                         confirm.




AEM User Guide                  December 2006                                   187
VI. AEM Field Descriptions



        FIELD/BUTTON         DESCRIPTION – HEARING/APPEAL TAB

        Related              Select the letter that initially advised of sanctions to be
  10
        Notification         imposed and the right to appeal them. The list includes
        Letter               any notices sent concerning this case that have the
                             Appeal Rights Based on this notice box checked.
                             The letters are identified by their 4-character letter
                             template ID, and the appeal Due Date (from the
                             Notices tab) of the letter.


        Survey               Event ID, type, and survey dates of surveys that are
  11
        Description          being appealed. Surveys are added to this list with the
                             Add Survey button. At least one appealed survey must
                             be entered.


        Basis for Appeal     For Federal citations, the options are Noncompliance
  12
                             and SQC with NATCEP Loss. When you select
                             Noncompliance, you must also specify the Applicable
                             Remedy.
                             For State citations, the options are defined by the State
                             in Lookup Values.


        Choose               Click to open a list of tags cited on this survey, where
  13
        Appealed             you can select the specific tag(s) that are being
        Citations            appealed.


        Hearing/Settle-      The button in this column opens the Hearing/Settlement
  14
        ment Info            window, which is defined beginning on page 66.


                             Opens the Select Survey window, where you can select
  15
                             the survey with the findings that are being appealed.
                             The list contains all surveys that are associated with
                             this enforcement case.


                             Removes the selected survey from the appeal.
  16




188                                 December 2006                        AEM USER GUIDE
                                                                  Hearing/Appeal Tab



       FIELD/BUTTON     DESCRIPTION – HEARING/APPEAL TAB

       Select           The list will display all remedies that are currently in
 17
       Applicable       effect for this case/cycle. Use the check boxes to
       Remedies         indicate which of the remedies are applicable to this
                        appeal.
                        When Basis for Appeal is Noncompliance, at least one
                        remedy must be selected here.
                        If Basis for Appeal is SQC with NATCEP Loss, that is
                        the sole basis of the appeal and remedies should not be
                        selected.


       Appealed To      The entity that will be hearing the appeal. Options are:
 18
                        Federal ALJ (Administrative Law Judge), Federal
                        Departmental Appeals Board, U.S. District Court,
                        U.S. Circuit Court, U.S. Supreme Court, State
                        Admin Levels 1&2, State Court Levels 1-3.


       Appealed By      The entity that is appealing. Options are: Facility,
 19
                        CMS, and State.


       Appeal Date      Date the hearing appeal request is first received by the
 20
                        State (if an appeal of a Licensure or Medicaid case), or
                        by the RO, DAB or higher reviewing entity (for Medicare
                        and Medicare/Medicaid cases).


                        Opens the Appeal To window, where you can add basic
 21
                        information about a new appeal.


                        Opens the Appeal To window for the selected appeal, so
 22
                        you can make changes as needed.


                        Deletes the appeal record from the case. You will be
 23
                        asked to confirm.


       Sought Federal   Select this box when the facility goes to Federal Court
 24
       Injunction       to obtain an injunction.




AEM User Guide                 December 2006                                       189
VI. AEM Field Descriptions



        FIELD/BUTTON         DESCRIPTION – HEARING/APPEAL TAB

        Injunction           If a Federal injunction is granted, enter the effective
  25
        Granted              date here. This will enable the Last Date of Injunction
                             field.


        Last Date of         Enter the last day the injunction is (or was) in effect.
  26
        Injunction


        Government           Government attorney assigned to the appeal that is
  27
        Attorney             selected in the Appeals selection above. The list is of
                             individuals added to the Distribution List (System menu
                             | Lookup Values | Distribution Lists) who have a
                             Distribution Type of 01 Attorney.


                             Opens the Distribution window, so you can add an
  28
                             attorney to the Distribution List.


        Docket/Case          Appeal Docket or Case number. 12-character
  29
        Number               alphanumeric. Use as many or as few characters as are
                             necessary.


        Begin Date           First day of the hearing. Prior to the hearing, this can
  30
                             be the date the hearing is scheduled to begin. When it
                             begins, enter the known beginning date.


        Outcome              Select the outcome from the list. Options are: 01
  31
                             Dismissal, 02 Facility Upheld, 03 Government
                             Upheld, 04 None Yet, 05 Remedy Change, 06
                             Settle Before Hearing, 07 Settle During Hearing,
                             08 Withdraw Before Hearing, 09 Withdraw After
                             Hearing


        Settle/Withdraw      If the appeal is settled or withdrawn, enter the date of
  32
        Date                 the hearing entity's official acknowledgment of the
                             settlement or withdrawal. Mutually exclusive with Final
                             Decision Date. This field will be uploaded for hearings
                             that are settled or withdrawn.




190                                 December 2006                       AEM USER GUIDE
                                                                 Hearing/Appeal Tab



       FIELD/BUTTON     DESCRIPTION – HEARING/APPEAL TAB

       Final Decision   If the hearing proceeds to its conclusion without a
 33
       Date             settlement or withdrawal, enter the date of the hearing
                        entity's decision. Mutually exclusive with
                        Settle/Withdraw Date.


      Hearing/Settlement Window




       FIELD/BUTTON     DESCRIPTION – HEARING/APPEAL TAB

       Revised 2567     Date a revised 2567 was issued due to the hearing
 34
       Date             process.


       Citation         Description of tag(s) cited in the selected survey.
 35

       Cert             This box is checked if the tag was cited as part of a
 36
                        certification survey.




AEM User Guide                  December 2006                                   191
VI. AEM Field Descriptions



        FIELD/BUTTON         DESCRIPTION – HEARING/APPEAL TAB

        Comp                 This box is checked if the tag was cited as part of a
  37
                             complaint investigation or revisit.


        Hearing/             Options are: 01 None, 02 Appealed, 03 No Change,
  38
                             04 Tag Change, 05 Tag Removed, 06 S/S Change,
        Settlement
                             07 Examples Removed/Other Wording Change, 08
        Status
                             S/S Change/Examples Removed/Other Wording
                             Change, 10 Appeal Withdrawn.
                             Hearing/Settlement Status is enabled in ACO for State
                             Licensure and Medicaid-only hearings. It is enabled in
                             ARO for Medicare-only and Medicare/Medicaid hearings.


        Curr SS              Current scope/severity level of this tag.
  39

        Orig SS              Original scope/severity level of this tag. Used when there
  40
                             has been an S/S change.


        Changed To           New tag number as a result of hearing. Used when
  41
                             Status is 04 Tag Change.


        Evidence             Click to see the text of surveyor findings for this tag.
  42

        Corrected            Correction Date.
  43

        Undo                 Click to undo changes to Status. Use Undo when
  44
                             changes to status have disabled the field (Tag Change
                             or Tag Removed) or when S/S Change has been used
                             incorrectly.
                             Undo is enabled in ACO for State Licensure and
                             Medicaid-only hearings. It is enabled in ARO for
                             Medicare-only and Medicare/Medicaid hearings.




192                                  December 2006                       AEM USER GUIDE
                                                             Hearing/Appeal Tab


     Upload Tab




       FIELD/BUTTON   DESCRIPTION – UPLOAD TAB

 1     Action         Type of action for AEM cases can be:
                      01 Delete – Delete a case. This action deletes the case
                      from the National server, and once that deletion is
                      successful, deletes the case from the State server.
                      03 Add – Upload a new case
                      04 Update – Upload changes to an existing case


 2     Date           Date of the transaction




AEM User Guide               December 2006                                 193
VI. AEM Field Descriptions



        FIELD/BUTTON         DESCRIPTION – UPLOAD TAB

  3     Status               Transaction status codes are:
                             -1 – Failed Invalid or missing data detected, transaction
                             terminated.
                             00 – Pending Transaction successful, but case is not
                             yet uploaded to OSCAR.
                             05 – Uploaded Case uploaded to OSCAR
                             10 – Successful Case accepted by OSCAR
                             12 – OSCAR Info Transaction successful but OSCAR
                             detected something irregular.
                             15 – Failed Transaction failed at the OSCAR level.


  4     By                   If the transaction was initiated in ACO, this is the name
                             and Federal ID of the person who initiated the upload. If
                             the transaction was initiated in ARO, "Regional Office" is
                             displayed here.


  5     Error                Type of error.


  6     Transaction ID       Identifier assigned by OSCAR to each upload transaction.


  7     Sender Type          R (Region) or S (State).


  8     CASPER Status        CASPER status codes are the same as those for #3
                             Status.


  9     Upload               This message appears when an upload (either manual or
        Transaction          automatic) has been initiated, but has not been fully
        Pending              processed.


  10                              Click to prevalidate (check the case record to make
                                  sure required information is present and in the
                                  appropriate formats), and initiate an upload
                                  transaction.
                                  This button is disabled after the first successful
                                  upload.




194                                  December 2006                      AEM USER GUIDE
                                                                 Hearing/Appeal Tab



       FIELD/BUTTON   DESCRIPTION – UPLOAD TAB

 11                   Returns the list to the original sort order.


 12                   Prints a Transaction Report listing all upload transactions
                      in ascending or descending order


 13    Upload         This section appears when the transaction you select in
       Transaction    Prior Enforcement Case Uploads contains errors. It will
       Errors         list the errors. You can copy and paste this information.




AEM User Guide                December 2006                                    195
                                                                 AST Scheduling View



VII. Enforcement Features in AST
         There are three main views in AST: Scheduling, Tracking and My ASPEN.
         Each view includes enforcement components that are applicable to the
         function of the view.

   AST Scheduling View
         The Scheduling view lists Certifications, Complaints and Revisits that are
         due to be scheduled.




         In the Certifications to be Scheduled folder, the Active Enforce column
         advises schedulers of existing enforcement actions for a provider. A Yes
         on the button in the column indicates this provider has at least one open
         active case that has no Substantial Compliance date entered.
         Clicking the button will open a window that lists active cases for the
         provider. In this window, you can right-click a row to open a read-only
         view of the case.
         Schedulers who try to schedule a recertification for a provider that has an
         active enforcement case will see:




 AEM User Guide                  December 2006                                     197
VII. Enforcement Features in AST




   AST Tracking View
          The Tracking view is for the monitoring of certifications that have been
          scheduled and/or are in process.




          The Process Tracking: Certifications section of the Tracking tree
          contains an Enforcement node that will list any certification that contains
          a visit related to an active enforcement case. The certifications are further
          broken down according to the following:
                 Active IJ – certifications containing a visit associated with an
                 enforcement case that has an active IJ situation.
                 Non-IJ < 70 Days – certifications containing a visit associated
                 with an active enforcement case that has no current IJ situation
                 and has a Cycle Start date less than 70 days earlier than today.



198                                December 2006                       AEM USER GUIDE
                                                                 AST My ASPEN View


                 MDOPNA in 20 Days – certifications containing at least one visit
                 associated with an active enforcement case that has no Substantial
                 Compliance date and is within 20 days of the Effective Date of a
                 Mandatory Denial of Payment for New Admissions remedy.
                 Case > 90 Days old – certifications containing at least one visit
                 associated with an active enforcement case that has a Cycle Start
                 date more than 90 days earlier than today.
        Highlight a provider name or a survey in the tree to see details in the
        right pane.

  AST My ASPEN View
        My ASPEN lists events and action items that are associated with the
        current user.




        In the My Events folder, the My Enforcements tab lists those enforcement
        cases to which the logged-on user is assigned as case worker.
        Users can right-click to open and work in an enforcement case from this
        view.




AEM User Guide                    December 2006                                   199

				
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