Division of National Systems
Operationalizing Data Submission for
ACA Section 3004
Stacy Mandl, RN
Division of National Systems
Who Are We?
• The Division of National Systems is located
within the Data and Systems Group (DSG).
• DSG is located within the Center for Medicaid
and CHIP (Children’s Health Insurance
Program) Services (CMCS) at CMS.
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What Do We Do?
• Support CMS’ fulfillment of statutory quality
assurance responsibilities under the Social Security
Act.
• Support major initiatives, such as Home Health
Compare and Nursing Home Compare.
• Develop, evaluate and implement data systems.
• Support operations related to the submission of the
data collected for CMS using specified assessment
tools, e.g., the IRF-PAI.
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What Do We Do?2
• Maintain and collect quality data on certified
providers /suppliers, e.g. Home Health Agencies.
• Support Survey & Certification efforts, e.g. Skilled
Nursing Facilities.
• Provide data system operations for data that is used
to improve the quality and effectiveness of services
provided by Medicare/ Medicaid/ CLIA.
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What Do We Do?3
• DNS supports the submission of data files to CMS
systems:
– Quality Improvement and Evaluation System
(QIES)
– Part of QIES is the Assessment Submission and
Processing (ASAP) System which will be used
to collect LTCH submission.
• This data is stored in the QIES National Database.
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QIES…
What Is QIES?
• Quality Improvement and Evaluation System
(QIES) serves as the focal point for resident and
patient assessments, quality indicators, survey and
certification, complaint, and enforcement
information concerning providers and suppliers.
• Using QIES we maintain and collect quality data
on certified providers/suppliers.
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QIES
• QIES permits information to be shared quickly
and conveniently between federal and state
governments.
• QIES users total over 100,000.
• Contains data on 17 different types of providers/
suppliers totaling over 291,100 active facilities
(as of 2/2011).
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QIES: The Data
• QIES already provides data submission for all
Certified Inpatient Rehabilitation Facilities, Home
Health Agencies, Skilled Nursing Facilities/
Nursing Facilities, and Swing Bed units.
• Beginning October 1, 2012, QIES will also
provide for data submission for all certified
LTCHs as well.
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Data Assessment Tools
• Assessment Data instruments currently submitted
by specific provider types are:
o Inpatient Rehabilitation Facility Patient Assessment
Instrument, IRF-PAI
o Minimum Data Set, MDS 3.0
o Outcome and Assessment Information Set, OASIS-C
o Newest: LTCH CARE Data Set
• Provide free software for all of these settings
o jRAVEN, IRVEN, HAVEN, LASER
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Assessment Data Uses and Users
• Depending on the provider type, this data is used
for purposes such as payment, fraud investigation,
quality measurement, and survey and certification
purposes, care planning, public reporting, and
research.
• Enables CMS to monitor and report on the quality
and effectiveness and services provided to
beneficiaries.
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Data Uses
• Enables consumers to make educated choices
about providers (e.g., Nursing Home Compare).
• Enables quality improvement within providers.
• Users include providers, CMS CO, State and
Regional Survey and Certification, OIG,
Ombudsmen, researchers, and others.
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Our Partners
• We serve as liaison between policy staff and
developers
• State Survey Agencies
• Regional Offices
• CMS Stakeholders (e.g., Office of Clinical Standards
and Quality, Survey & Certification, Centers for
Medicare, Office of Information Systems)
• Providers/ Suppliers
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Our Partners
• Quality Improvements Organizations
• Fiscal Intermediaries/ Medicare Administrative
Contractors
• Regional Home Health Intermediaries
• Accrediting Organizations
• Vendors
• Corporations and Researchers
• Other Federal Agencies
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Provider Stakeholders
• QIES supports data for over 291,100 providers/suppliers
– Hospitals, e.g. acute, LTCHs, IRFs, CAHs, etc.: 6,179
– Skilled Nursing Facility (SNF): 15,104
– Nursing Facility (NF): 609
– ICF/MR: 6,430
– Home Health Agency (HHA): 11,556
– Hospice: 3,522
– Outpatient Physical Therapy (OPT): 2,513
– Comprehensive Outpatient Rehabilitation Facility
– (CORF): 339
– X-Ray: 564
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…And…
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End-Stage Renal Dialysis Facility (ESRD): 5,653
Rural Health Clinics (RHC): 3,875
Ambulatory Surgical Centers (ASC): 5,324
Organ Procurement Organization (OPO): 58
Community Mental Health Centers (CMHC): 641
Federally Qualified Health Centers (FQHC): 4,819
Psychiatric Residential Treatment Facilities
(PRTF): 366
– Clinical Laboratory Improvement Amendments
(CLIA): 223,625
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Submissions
We will now hear more about the QIES data
submissions process as it relates to your data
submission.
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