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Insulin Pens & Infection Control



On May 18, 2012, CMS published S&C 12-30-ALL regarding the use of insulin pens in healthcare facilities.  This memorandum refers to reports of healthcare personnel not adhering to safe practices while using insulin pens and those healthcare personnel may not be aware of the risks that the improper use of the insulin pens pose to residents.     



OIG Eastern Enforcement Branch has moved 


 Please update your records:

Office of Inspector General

Eastern Enforcement Branch

3470 Blazer Parkway, Suite 300

Lexington, Kentucky 40509

Phone: 859.246.2301

Fax: 859.246.2307



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The Surveyor Training Website maintenance was a success! 

Attention Surveyors:  Due to the website maintenance, the deadline for completing the mandatory surveyor training 'National Partnership to Improve Dementia Care/ Antipsychotic Initiative' has been extended to September 30th.





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Issue: #09-2013
September 2013
Welcome to the Office of Inspector General, Division of Health Care's September 2013 edition of the Long Term Care Provider Newsletter.  This newsletter is a valuable vehicle to update you on current events affecting Long Term Care.  
Please feel free to share this newsletter with anyone you think would benefit.  To continue receiving this newsletter, be sure to join our mailing list by clicking the link at the bottom.  We look forward to serving you through this communication vehicle.
The Burning Issue: Scalds

Risk of Burns in the Elderly

The elderly are more at risk for burns related to their age, reduced mobility and underlying medical conditions.  The most common type of burn for the elderly is a scald, which is caused by a hot liquid or steam.  As we age, the skin becomes dry, loose, and thinner, which increases the absorption of heat and causes more serious physical harm.  The Centers for Medicare and Medicaid (CMS) provides excellent guidance on burns under 42 CFR 483.25 F323 Accidents.

Water Temperature - Water may reach hazardous temperatures in hand sinks, showers, and tubs. Burns related to hot water/liquids may also be due to spills and/or immersion. Many residents in long-term care facilities have conditions that may put them at increased risk for burns caused by scalding. These conditions include: decreased skin thickness, decreased skin sensitivity, peripheral neuropathy, decreased agility (reduced reaction time), decreased cognition or dementia, decreased mobility, and decreased ability to communicate.

The degree of injury depends on factors including the water temperature, the amount of skin exposed, and the duration of exposure. Some States have regulations regarding allowable maximum water temperature. Table1  illustrates damage to skin in relation to the temperature of the water and the length of time of exposure.
It is important that staff monitor the environment to reduce the risk for burns and injury.  Remember to monitor the water temperature in residents' rooms and the temperature of foods.  Scalds are the most common form of burns, but burns have occurred related to radiators, open flames (candles) in rooms and electrical burns.
MDS/RAI Announcements

OIG Has New MDS/RAI Coordinator!

We are pleased to announce that as of September 1st, Jan Keeling became the new MDS/RAI Coordinator.  You may contact Jan with assessment or coding issues by phone at 502-564-7963, ext. 3301 or by e-mail at 


You may continue to contact Rhonda Littleton-Roe at 502-564-7963, ext. 3300 or by e-mail at for any transmission or technical issues. 


A special thanks to Michelle Mitchell for filling in during this transition period.



RAI Manual Posted!!

The Long-Term Care Facility Resident Assessment Instrument User's Manual, V1.11 (RAI User's Manual, V1.11) and change tables are publicly available at the following link:  MDS 3.0 RAI Manual.  Check the Downloads section.  This manual is effective 10/01/2013. 



Complete Discharge Assessments for Inactive Residents by September 30, 2013

CMS has issued a memo S&C:13-56-NH, outlining steps nursing home providers must take to address any MDS 3.0 Discharge assessments that have not been completed and/or submitted since the inception of MDS 3.0 that have resulted in any residents appearing on the facility's current MDS 3.0 Roster report who are no longer active residents. Providers must complete the steps outlined under Facility Procedures in the S&C memo no later than September 30, 2013.
The memo also outlines CMS's policy for Discharge assessments which is detailed in Chapter 2 of the RAI User's Manual. CMS has included in the S&C memo information about setting the Assessment Reference Date (ARD) on a discharge assessment (i.e., for a Discharge assessment, the ARD is not set prospectively, as with other assessments; the ARD for a discharge assessment is always the discharge date).  

Discharge Assessments & the Use of Dashes

A PowerPoint version of the 'Discharge Assessments and the Use of Dashes' video released in June is now available in the Downloads section here:  MDS 3.0 Training Materials 


This should be useful to anyone who has still been unable to access the YouTube video.

Your KARES Team is continuing to enhance the KARES web application to develop a product that will service your needs and provide the best user experience possible.  With these enhancements, we will be changing the implementation (Pilot) start date from mid-October to the first week of December 2013.
Along with these new updates to the KARES web application, the KARES team would like to welcome their new Grant Manager, Al Ervin, who came on board this month to continue leading the path for the KARES program.  Welcome aboard Al!
The proposed KARES regulation (902 KAR 1:190) is tentatively scheduled to be heard before the Administrative Regulation and Review Subcommittee on October 8, 2013, followed by the Interim Joint Committee on Health and Welfare which is expected to meet on November 20, 2013.  Upon anticipated approval by the Health and Welfare Committee, the regulation will be officially adopted, adding one more way for you to help protect the citizens of our great Commonwealth.
As always, continue to check the OIG KARES website for important updates which may be viewed at the following link:


For any questions, comments, or concerns you may reach the KARES team at (502) 564-2159 or 


Thank you again for your support of the KARES Program!

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Survey and Certification Letters

Below you'll find links to survey and certification letters issued by the Centers for Medicare and Medicaid Services (CMS) pertaining to Long Term Care facilities.  Please take a look and determine how these may impact your facility.

Below are the S&C memos for this month: 


S&C 13-55-LSC  

August 13, 2013 Deadline - Installation of Automatic Sprinkler Systems in Nursing Homes


S&C 13-56-NH 

Minimum Data Set (MDS) 3.0 Discharge Assessments that Have Not Been Completed and/or Submitted


Escrow and Independent Informal Dispute Resolution (Independent IDR) Process for Nursing Homes - Applicable to All Civil Money Penalties (CMP) 


S&C 13-58-LSC 

2000 Edition National Fire Protection Association (NFPA) 101 Life Safety Code (LSC) Waivers


S&C 13-60-ALL 

Acquisitions of Providers/Suppliers with Rejection of Automatic Assignment of the Medicare Provider Agreement:  Implications for Timing of Surveys and Participation Effective Date


Kentucky Department for Public Health's Preparedness Branch

September is National Preparedness Month and we should all be asking ourselves, "Am I prepared?"  Part of being able to answer yes to that question is getting informed.  OIG would like to take this opportunity to share a valuable state resource for emergency preparedness.  


The Directory for Kentucky's Emergency Support Function #8 -Public Health and Medical Services (ESF 8) 


This Directory provides resources and contact information of key personnel from Primary and Support Agencies.  Including the Emergency Operations contact information and the 24/7 Emergency Contacts. 


The ESF 8 is responsible for preparing for, responding to and recovering from an emergency or disaster in coordination with local, state, and federal partners.  For additional information visit the Kentucky Department for Public Health's Preparedness Branch website.  



Cabinet for Health and Family Services

Office of Inspector General

Division of Health Care



Leadership Team 

 Mary Reinle Begley, Inspector General


Unbridled Spirit  
The Office of Inspector General is Kentucky's regulatory agency for licensing all health care, day care, long-term care, and child adoption/placing facilities and agencies in the Commonwealth. 
If you would like more information, please visit our website
If you have an idea for a future article, please contact Jami Biggs.