Advocacy & Policy

Legislative Updates

Update and Revision of IV Scope of Practice for LPNs in Iowa
Announcement of new procedure code for multilayer compression bandages
CMS eliminates consultation codes
CMS clarifies direct supervision in outpatient clinics
NPUAP Press Release on Staging
Nursing Workforce Expands as Average Age of RNs Increases, HRSA Survey Finds
CMS Implements MDS 3.0

The Centers for Medicare and Medicaid Services (CMS) has officially launched the Minimum Data Set (MDS) 3.0 in long term care facilities. The MDS tool has been used for the past 15 years and during that time, many of the sections have been scrutinized and criticized. October 1, 2010 is the date when the long awaited 3.0 version is to be used during the survey process. Public reporting using the MDS 3.0 data is expected by October 2011.

The entire skin section (section M) has been expanded from 2 questions to 11 questions. There is no longer reverse staging, and pressure ulcers present on admission can be captured. Stage 1-4 are captured along with unstagable and DTI. THERE IS ONE GLITCH THAT YOU SHOULD BE AWARE OF! In the area of pressure ulcer assessment, all blisters (regardless of whether they are serum filled or blood-filled) should be captured as Stage 2. This is contrary to the NPUAP definition, where fluid filled blisters are Stage II, but blood-filled blisters are DTI.

The new MDS 3.0 tool offers improvements of specific interest to WOC nurse clinicians.
Key improvements in Section H-Bowel and Bladder include:
    No longer captures catheter use as continence
    Improved toileting program items
Key improvements in Section M-Skin Conditions include:
    Captures pressure ulcers present on admission Captures Stages I-IV pressure ulcers, as well as Unstagable and Deep Tissue Injury Eliminates reverse staging as a measurement of healing
    Captures pressure ulcer improvement or deterioration Captures risk assessment as well as preventive/treatment efforts

To download a copy of the MDS 3.0 version, follow this link: http://www.cms.gov/NursingHomeQualityInits/downloads/MDS30FinalReport-Appendices.zip

Current Events/Bulletons & Articles

Regulatory Issues Concerning Wound Care Reimbursement

1. Dr. Berwick Appointed to Head CMS

Dr. Donald Berwick has been appointed by President Obama to serve as the new Administrator for the Centers for Medicare and Medicaid Services (CMS). When Dr. Berwick's name was first publicized, many tried to gain political points by painting him as an advocate for heartless rationing of healthcare services among the elderly and disabled. This criticism was unfair as he came to the job highly endorsed by much of the healthcare industry. Many may not realize that before accepting this post to head CMS, Dr. Berwick has come from serving as president and chief executive officer of the Institute for Healthcare Improvement. While our members may not recognize his name, per se, they are familiar with the IHI's 5 Million Lives Campaign and the nonprofit's efforts to reduce pressure ulcers.

2. WOCN Society Guidance on OASIS C Integumetary Questions: http://www.wocn.org/pdfs/GuidanceOASIS-C.pdf

3. FDA Alert: Serious Complications Associated with Negative Pressure Wound Therapy

Government Links

Administrative Rules Review Committee 2010

State of Iowa

United States House of Representatives

United States Senate