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CMS ePOC Procedures Guide for Facilities

1. Click to Modify Plan of Correction Can i request a waiver for this tag It s justified Plan of Correction Click to View Plan of Correction Budget constraints are irksome Plan of Correction Click to View Plan of Correction this is my poc for 322 23 Back Completion Date X5 07 06 2015 Status Approved Date 07 06 2015 Completion Date X5 06 30 2015 Status Rejected Date 06 14 2015 Completion Date X5 06 25 2015 Status Submitted Date 06 12 2015 Completion Date X5 06 24 2015 Status Submitted Date 06 16 2015 39 ASPEN Web ePOC Screens On LSC surveys deficiencies are grouped by building there is a grid for each building If a deficiency is cited for more than one building it is listed for each applicable building Fields Survey Detail on page 54 CMS HOME FOR RETIRED TECH PROFESSIONALS cen 115324 1155 WEST COLLEGE STREET BAINBRIDGE GA 39819 A Survey Detail Event Id 266Y23 Survey Date 03 15 2015 Status Open 420 Back 01 MAIN BUILDI K000 N A xD i b d Building 01 MAIN BUILDING 01 1304 No POC 1534 No POC ko00 INITIAL COMMENTS Plan of Correction Completion Date X5 02 WING BUILDI Building 01 1534 No POC MAIN BUILDING Observations Status 1759 No POC or Initial comments N A Date 06 12 2015 Y 13 Substandard qeinp e K052 NFPA 101 LIFE SAFETY CODE STANDARD Plan
2. Contents Deficiency free Surveys co0cccocconcccnconnonnnnn nan n nennen nean nennen eene 28 Re Posted S rveys ess a 29 ePOC Emails Le eeeereesee eene eene annu neant annuam eun annus u ausu nun 29 ASPEN Web ePOC Screens c eee eese eese nnn nnnm nnnm nnn nnn 31 ePOC Startup PaQ S coccnocnoccncnnnnncnannnncnnsnnsnannnnrnnrnnrnnsnnnrnsnnnrnnansannanars 32 ASPEN Web ePOC LOGIN sects ees octets RR RERO ERE ERR ERR TE Ke RAE 32 Select Application Sere ere Ree FER sland ya m RR NER Rx Ea x 33 ePOC Application Pages eeoesseese esee nnnm eae annu nnam 34 groom 34 fiai DEM 34 Facility INSEFUCHONS o icono aves ea aae na eT ria EF PERI EET VER EA FOE 35 SONS irre eatin wee densest nic Magara CELO M IE oO dle tates A M tenet Men 35 About ePOC eco deese Aids 36 Facility MH quen 36 Survey EISE uires decet sd enr ei noit poke TN TEELE veg ave eT ede cux 37 LOT T EL C 38 Survey Detail octo tite ie uana aaa 39 Attachments iss cedere exp da xk 41 Regulation text iere gere sare aee Eo Eu AN RENTRER EYE edt wacemag cree 41 Observations text cesses nennen anas nna nena neas nnn nn nnn 42 Plan of Correction texts ieres anaana nennen nennen nean nnn nnn 42 Plan of Correction entry page 00ccccccccocncnnnanannnnan menm 43 Attestation Ui ides ciere etre rer EE a 44 CMS 2567 FOl 1115s oui TERI ee vp YT E E A ETE 45 ASPEN Web ePOC Fields eter eua dou na nuu ka sauna
3. STATEMENT OF ISOLATED X1 PROVIDER SUPPLIER CLIA DEFICIENCIES WHICH CAUSE NO IDENTIFICATION NUMBER HARM WITH ONLY A POTENTIAL FOR MINIMAL HARM FOR SNFs AND NFs 335817 NAME OF PROVIDER OR SUPPLIER GARDEN CARE CENTER SUMMARY STATEMENT OF DEFICIENCIES F150 483 5 DEFINITION OF FACILITY SNF amp NF Definitions PRINTED 08 29 2013 AH A FORM X2 MULTIPLE CONSTRUCTION A BUILDING B WING STREET ADDRESS CITY STATE ZIP CODE 135 FRANKLIN AVENUE FRANKLIN SQUARE NY 11010 For purposes of this subpart Facility means a skilled nursing facility SNF or a nursing facility NF which meets the requirements of sections 1819 or 1919 a b c and d of the Act Facility may include a distinct part of an institution as specified in 440 40 of this chapter but does not include an institution for the mentally retarded or persons with related conditions described in 440 150 of this chapter For Medicare and Medicaid purposes including eligibility coverage certification and payment the facility is always the entity which participates in the program whether that entity is comprised of all of or a distinct part of a larger institution For Medicare a SNF see section 1819 a 1 and for Medicaid a NF see section 1919 a 1 may not be an institution for mental diseases as defined in 435 1009 Figure 31 This REQUIREMENT is not met as evidenced by A Form Final 7 17 15 ASPEN Web ePOC 10 2 D
4. amp REHAB ALLEGANY L L C 2178 NORTH FIFTH STREET ALLEGANY NY 14706 335449 ACHIEVE REHAB AND NURSING FACILITY 170 LAKE STREET LIBERTY NY 12754 335429 ADIRONDACK TRI COUNTY NURSING amp REHABILITATION CTR 112 SKI BOWL ROAD NORTH CREEK NY 12853 Figure 14 Facility List If you are associated with more than 25 facilities you can scroll to the bottom of the page and use page navigation keys to access the additional facilities First Previous 1 2 Next Last Figure 15 Facility List navigation keys 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Survey List The Survey List is organized into two sections The Search field allows you to filter the surveys displayed in the grid below The grid displays a list of the surveys for the facility Fields Survey List on page 51 A Survey List ATCHISON SENIOR VILLAGE ccn 175531 1419 N 6TH ST ATCHISON KS 66002 Survey List Search Showing 1 to 5 of 5 entries Buck Event Id SOD Sent Exit Date Type Status Category Def Submitted Approved POC Due Date Letters Reports i r WH2D11 05 15 2014 05 15 2014 Health Open A 4 o 0 4 05 25 2014 A sat SKN211 05 15 2014 05 15 2014 Health Open A 2 o 0 2 05 25 2014 3 SRKN11 05 15 2014 05 15 2014 Health Open A 3 1 1 2 05 25 2014 gs X92W11 03 21 2014 03 21 2014 Health Closed A 3 o 2 0 03 31 2014 A 5 L43B11 03 06 2014 03 06 2014 Health Open A 2 o 0 2 03 16 2014 4 0 Figure 16 Survey List Hove
5. Alert Facility button is pressed on ePOC Properties only for posted surveys and or selecting Yes on alert messages Def free Yes Sample Email Subject ePOC Letter Notification for State CO DDD711 ABC NURSING amp REHAB CENTER Survey Completed 05 13 2013 Facility Type SNF NF Survey Category RECERT REVST LICEN Survey Dates 05 13 2013 05 13 2013 Event ID DDD711 New or revised letters for the survey completed at your facility on the above referenced date have been posted on the ASPEN Web Electronic Plan of Correction ePOC website Please login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink to view these letters Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you 70 7 17 15 ASPEN Web ePOC 10 2 ePOC Email Notices Remove Posting from ePOC Website Recipient Facility Facility Types Nursing Home Frequency Within an hour after posting removed Def free Yes Sample Email Subject Statement of Deficiencies SOD Posting Removed for State CO DDD711 ABC NURSING amp REHAB CENTER Survey Completed 05 13 2013 Facility 111111 ABC NURSING amp REHAB CENTER Facility Type SNF NF Survey Category RECERT REVST LICEN Survey Dates 05 13 2013 05 13 2013 Event ID DDD711 The survey completed at your facility o
6. There may be occasions when the SA RO needs to make changes to a survey that has already been posted to ASPEN Web ePOC For example changes to tags on a survey may be needed due to IDR TIDR The SA RO will re post the survey to ASPEN Web ePOC once the changes are made Facility users receive the Survey Results Re Posted to Facility email notification when the survey is re posted It identifies tags that have been changed and the reason for the re posting More Survey Results Re Posted to Facility on page 62 ePOC Emails Automated e mail notifications facilitate communication between you and your SA RO during the ePOC process ePOC sends facility emails to active and inactive ePOC enrolled facility users i e users who have logged into ePOC within 180 days Descriptions and sample text of these email notices are included in the Supporting Materials chapter More ePOC Email Notices on page 61 Procedures Guide 7 17 15 29 ASPEN Web ePOC Procedures 30 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Screens This chapter contains screen shots and brief descriptions of pages you may use when working in ASPEN Web ePOC If you are viewing this document online take advantage of the hyperlinks you can click the cross reference at the top of a graphic to jump to detailed descriptions of the fields and buttons on that section of screen To find information about the fields contained in this section of the
7. been changed or removed likely due to Informal Dispute Resolution or Independent Information Dispute Resolution The Def Number of Deficiencies and deficiencies Approved Disapproved counts which include PNC A level and waived tags enable users to identify surveys already approved and surveys requiring attention Once acknowledged PNC and A level tags are counted as Approved The status of waived tags is automatically set to Approved upon posting to ASPEN Web ePOC 16 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Basics Filter the Survey List To apply a dynamic filter to the list of surveys you enter appropriate text in the Search field For example if you enter 18 in the Search box only those surveys that include 18 in any column are displayed If one survey s Exit Date contains 18 and another survey s POC Due Date contains 18 both surveys are displayed Navigate the Survey List You can filter and sort the Survey List to meet your needs By default surveys are sorted by SOD Sent Date from the most recent to the oldest To access and navigate the Survey List Open ASPEN Web ePOC The Facility List is displayed if you are a multi facility user The Survey List is displayed if you are a single facility user go to step 3 If you are a multi facility user click a facility s CCN to open the Survey List for that facility To change sort order click a column header For example click the Eve
8. e Home icon e Breadcrumb links e Menu click icon to display options The graphic below shows the toolbar as it appears on the Attestation page Fields Toolbar on page 49 Survey List Survey Detail Attest Home Breadcrumbs Menu Figure 9 ASPEN Web ePOC toolbar Menu The ePOC menu includes some or all of the options shown depending on the current page Fields Menu icon on page 49 Instructions Users About ePOC Tutorial Procedures Guide Release Notes Aspen Web Menu Log Out ALANNAH Figure 10 ePOC menu 34 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Facility Instructions The Instructions page displays guidance specific to provider type for drafting and submitting an acceptable Plan of Correction o Y Facility Instructions Nursing Home Facility Welcome to the Centers for Medicare and Medicaid Services Facility Site for electronic transmission of the Plan of Correction The information submitted following approval by the appropriate state agency may be placed on a public web site in order to provide consumers with information about the facility Acceptable Plan of Correction The plan of correction serves as the facility s allegation of compliance and without it CMS and or the State have no basis on which to verify compliance A plan of correction must be submitted within 10 calendar days from the date the facility receives its Form CMS 2567 If an acceptable plan of correction is no
9. icon Displays links to About ePOC Procedures Guide ASPEN Web Menu and Log Out Survey List A question mark displays to the right of certain fields Move the cursor over the to display a definition of the field Search Enter text to search in the survey list Search results update automatically as each character is entered Procedures Guide 7 17 15 51 ASPEN Web ePOC Fields Survey List grid Event Id Unique identifier assigned when the survey is created SOD Sent Date the SA RO posted the Statement of Deficiencies survey to the ASPEN ePOC website Exit Date End date of the survey Type Survey category Health or LSC Status Status of the survey Open or Closed Category Survey type code Move the cursor over the to display a list of survey types Def Indicates the number of existing deficiencies Submitted Indicates the number of existing deficiencies for which a POC has been submitted to the SA RO but not yet approved or rejected Approved Unapproved Indicates the number of existing deficiencies with POC approved not approved POC Due Date Date by which the facility must submit a Plan of Correction Letters Displays the number of letters if any posted for the survey Click the envelope icon to open the Letters page where you can view letters posted by the SA RO This includes survey letters as well as any letters generated for AEM cases related to the survey and for intakes link
10. of Correction Completion Rz Past noncompliance A fire alarm system required for life safety is installed tested and maintained in Date X5 s s D accordance with NFPA 70 National Electrical Code and NFPA 72 The system has an Click to View Plan of Correction d approved maintenance and testing pr MORE Status Building 01 Waivered tag no plan of correction required Approved MAIN BUILDING Observations et This tag is waived Date 06 12 2015 a NFPA 101 LIFE SAFETY CODE STANDARD Plan of Correction Completion B ko61 Required automatic sprinkler systems have valves supervised so that at least a E Date X5 EYES local alarm will sound when the valves are closed NFPA 72 9 7 2 1 Click to View Acknowledgement 07 06 2015 E Observations Status Building 01 MAINBU amp DING PNC Tag Approved 01 Date 07 06 2015 1304 111 8 68 03 4 Definitions Plan of Correction Completion Board means the Board of the Department of Community Health Date X5 S S E Click to Enter Plan of Correction a Observations Status Building 01 State Citation No POC MAIN BUILDING 01 Date 06 12 2015 Figure 20 Survey Detail LSC survey 40 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Attachments Opens when you click the paper clip icon in Survey Detail You can view and add attachments to the POC and view SA RO attachments to the survey You can remove attachments that originated from your facility unless the survey is closed normal
11. page Single facility users return to the survey list for that facility Menu icon in toolbar Displays links to Instructions page Users page About ePOC Procedures Guide ASPEN Web Menu and Log Out page Procedures Guide 7 17 15 55 ASPEN Web ePOC Fields 56 Survey Detail grid On LSC surveys deficiencies are grouped by building so there is a grid for each building Deficiency Tag number of the cited deficiency Immediate Jeopardy IJ Substandard Quality of Care SQC and Past Noncompliance PNC tags are flagged in both the deficiency list and grid Note On LSC surveys if a deficiency is cited for more than one building it is listed for each applicable building S S Scope severity level of the deficiency The S S label is displayed only if scope severity is applicable Building LSC surveys only ID and name of building to which the citation applies Initial Comments Comments entered via tag 0000 by the survey team during the survey Optional except on a deficiency free survey Regulation Up to 100 characters of regulation text for the current tag Observations Up to 100 characters of observations text i e surveyor evidence for the current tag Plan of Correction Acknowledgement link Opens the Plan of Correction entry page for the tag same as clicking the tag number The link label changes depending on the current status of the POC and type of citation e Click to Enter Plan of Correcti
12. prefer If you print this document use the Table of Contents to locate the information you need Links cross references to additional material in this document include page numbers simply go to the indicated page Conventions This guide uses the following conventions Bold In procedures names of screens screen sections windows you open and buttons menu options keys you press web Generic reference to the World Wide Web More Introduces a list of see also cross references Note Notes give you important information that may affect how you use a function Tip Tips give you useful hints suggestions or alternative approaches WARNING Warnings tell you actions to avoid that may cause harm or precautions you should take to avoid causing harm Procedures Guide 7 17 15 9 10 Introduction ePOC Tutorial A tutorial with brief instructions on how to use the ASPEN Web ePOC application runs automatically for users when they log into the ePOC website for the first time After that the tutorial can be accessed from the ePOC menu About ePOC I Procedu Guide Release Notes Aspen Web Menu Log Out ALANNAH Figure 2 Tutorial option on top level ePOC menu ta Certificate 4 Survey Detail x El Welcome to the ePOC Tut This tutorial provides a quick overview of the ASPEN Web Electronic Plan of Correction ePOC system You can view this tutorial at any time by choosin
13. screen click the cross reference at the top of the image Letter Date Description 10 17 2003 Cun plait lan Lele 10 17 2003 Corrrlairt Fadlty Letzer to go to the definition of those fields Letters Letters grid Letter Date Date the SOD letter was generated The letter date is a link click it to open the letter in your RTF viewer Letter Description Name of letter template used in ASPEN to generate the SOD letter Figure 6 Field Link example Procedures Guide 7 17 15 31 ASPEN Web ePOC Screens ePOC Startup Pages ASPEN Web ePOC Login Fields ASPEN Web ePOC Login on page 49 CATS QIES National System Login CENTERS for MEDICARE amp MEDICAID SERVICES Welcome to EPOC Please enter your User ID and Password User ID Password Unable to login Click here to reset your User ID Pass ord Figure 7 ePOC Login 32 7 17 15 ASPEN Web ePOC 10 2 ePOC Startup Pages Select Application This window appears after you log in to ASPEN Web on the web browser The options that appear i e the applications functions you can access depend on your security access level Here s an example m uj CMS T AEN Vas Select Application ePOC Web Application ePOC Exit Figure 8 Select Application window Procedures Guide 7 17 15 33 ASPEN Web ePOC Screens ePOC Application Pages Toolbar The ASPEN Web toolbar provides the following information and navigation aids
14. tag title or Observations link 58 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Facility Response panel POC Instructions button Click to toggle display of guidelines for POC text and Completion Date X5 Not displayed for A level or PNC tags Acknowledge Displayed only for PNC and A tags for which POCs are not required Select this button to acknowledge the tag which is then automatically approved A message in the Facility Response section indicates a POC is not required and the citation has been acknowledged POC Description Plan of Correction for the deficiency You can update the POC Description if POC Status is No POC Facility Draft or Rejected Read only after the POC is submitted and or approved Completion Date X5 Date by which the facility user states they will have implemented the POC and corrected the deficiency Must be greater than the Exit date Save as Pending Click to save the POC as pending but not submit it Completion Date X5 is not required Button available if POC status is No POC Facility Draft or Rejected Not available after the POC is submitted and or approved Submit as Final Select to initiate final submission of the POC Completion Date X5 and POC Description are required Button available if POC status is No POC Facility Draft or Rejected Not available after the POC is submitted and or approved Rejection Reasons Explanation Read only Displayed if POC Sta
15. 2003 10 17 2003 10 16 2003 10 16 2003 10 13 2003 10 13 2003 10 13 2003 Figure 18 Letters window 38 Fields Letters on page 53 Description Complaintant Letter Complaint Facility Letter Complaintant Letter Complaint Facility Letter Complainant Prompts Officer Complainant Prompts 7 17 15 ASPEN Web ePOC 10 2 Survey Detail ePOC Application Pages The Survey Detail page displays a grid with deficiency information for the survey and POC submittal information for each deficiency in the grid From this page you can generate the CMS 2567 CMS 2567B or A Form as applicable for the survey In the second column you can click MORE if present to display complete regulation or surveyor evidence text for the deficiency In the third column you can click MORE if present to display complete POC text for the deficiency Fields Survey Detail on page 54 CMS HOME FOR RETIRED TECH PROFESSIONALS ccn 115324 1155 WEST COLLEGE STREET BAINBRIDGE GA 39819 Survey Detail Deficiencies F155 Approved F272 Rejected F314 Submitted F322 Submitted F365 Approved F463 Submitted F495 Pending D Substandard Quality of Care Event Id F155 S S A F272 s s D F314 S S E F322 S S F VRPQ11 Survey Date 05 01 2015 Status Open 483 10 b 4 RIGHT TO REFUSE FORMULATE ADVANCE DIRECTIVES The resident has the right to refuse treatment to refuse to partic
16. ASPEN Web electronic PLAN OF CORRECTION ePOC 10 2 Procedures Guide Information in this procedures 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 Required Browser CMS supported MS Internet Explorer versions are posted on the QTSO Website https www gtso com under the Minimum System Requirements section Note This document can 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 Introd ctl l 2 iori ioi o kan na Fina lan RR VR ERR ERE ER tenewnnceeesauaweeewevenseneas 7 About this Procedures Guide eese eese nnne nnne nnn 7 View this Document Online esses nnnm mnm nnns 8 View a Printed Copy of this Document ssssssssssssssssrrrrrrrrrrsrrrsseserrrens 9 CONVENTIONS A cerit Re ve vex IERI M ERI RARE da Ne RES 9 ePOC Tutorial A OOO 10 Accessibility Features eese eere esee nennen annu neant 11 Ins this Guide oorr mx ae ol Me EPI re qan v Ay EE ER Posh whales 11 In ASPEN Web EPOC 1 enses A diee ite OR C de Osea een evi 11 ASPEN Web ePOC Procedures ee eese ensem 13 Core ePOC Process use esser esse esas nans e annuam ea ai RA uana anum eun 14 Access
17. ASPEN Web ePOC 10 2 ePOC Email Notices SOD Acknowledgment Required Recipient Facility cc SA RO Facility Types Nursing Home Frequency On POC Due Date when acknowledgment not done and every other day thereafter until acknowledgment occurs Def free Yes Sample Email Subject Statement of NO Deficiencies Acknowledgment Required for State CO BNBV12 ABC NURSING amp REHAB CENTER Survey Completed 05 13 2001 Facility 111111 ABC NURSING amp REHAB CENTER Facility Type SNF NF Survey Category RECERT REVST LICEN Survey Dates 05 13 2001 05 13 2001 Event ID DDD711 SOD Acknowledgment Due Date 04 28 2013 Please note that you are required to acknowledge the Statement of Deficiencies SOD for the above referenced survey even though no deficiencies were issued Your acknowledgment should be made immediately via the ASPEN Web Electronic Plan of Correction ePOC website on the Survey Detail page Please login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Procedures Guide 7 17 15 69 Supporting Materials Letter Notification This email is optionally generated by the SA RO Recipient Facility Facility Types Nursing Home Frequency Optional Within an hour after
18. C Approval by SA RO Recipient Facility Facility Types Nursing Home Frequency Within an hour after approval Def free No Sample Email Subject POC for Tag 0156 Approved for State CO DDD711 ABC LIFE CARE CENTER Survey Completed 05 06 2013 Facility 111111 ABC LIFE CARE CENTER Facility Type SNF NF Survey Category OTHER Survey Dates 05 06 2013 05 06 2013 Event ID DDD711 Your Plan of Correction POC for Tag 0156 NOTICE OF RIGHTS RULES SERVICES CHARGES was approved on 05 15 2013 Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you 7 17 15 ASPEN Web ePOC 10 2 ePOC Email Notices Final POC Approved Recipient Facility Facility Types Nursing Home Frequency Within an hour of SA RO approval of last tag Def free No Sample Email Subject Final POC Approved for State CO DDD711 ABC LIFE CARE CENTER Survey Completed 05 06 2013 Facility 111111 ABC LIFE CARE CENTER Facility Type SNF NF Survey Category OTHER Survey Dates 05 06 2013 05 06 2013 Event ID DDD711 The Plans of Correction for all tags on this survey have been approved by the SA RO on 05 15 2013 Please ensure that your Corrective Action Plans are implemented and follow the principles of a Quality Assessment and Performance Improvement QAPI plan as monitoring and follow up may be done by the SA RO Contact your state su
19. C Fields Survey Detail POC Submission Acknowledgement message Read only POC submission message appears only after one or more POCs are submitted by electronically signing the Attestation form Message lists POC s by tag number s and indicates if each was successfully submitted or not Acknowledgement message appears after a deficiency free survey is acknowledged and indicates the survey s event ID Deficiencies A list of all deficiencies on the survey with current POC status indicated for each deficiency Immediate Jeopardy IJ Substandard Quality of Care SQC and Past Noncompliance PNC tags are flagged in both the deficiency list and grid Event Id Unique identifier assigned when the survey is created Survey Date Exit date of the survey Status Current POC status of the survey Buttons Acknowledge SOD This button appears only for deficiency free surveys i e surveys with memo tags only 0000 and or 9999 Select to acknowledge the deficiency free survey which is then automatically approved and closed Submit All Pending This button appears when at least one POC is in Pending status Select to initiate submission of the pending POCs to the SA RO ePOC displays the Attestation form with a list of tags for which pending POCs will be submitted Tags that do not have completion dates are not submitted You can choose to proceed or halt the process at this point Submit All Pending can be used multiple time
20. C to SA RO one tag at a time or as a group You receive POC Submission email when POC is successfully submitted If SA RO approves a tag s POC you receive Approved email If SA RO rejects a tag s POC you receive a Rejected email listing the reasons for rejection and explanations if entered You may then revise and re submit the tag s POC Upon SA RO approval of all tags on the survey you receive Final Approval email 11 Print the CMS 2567 A Form Accessing ASPEN Web ePOC 14 In order to use the ASPEN Web ePOC application a facility must meet the following criteria e Must be a federally certified NH provider e Must be Open e Has a CMS Certification Number CCN assigned e Has active QIES and CMSNet accounts e Has completed ePOC registration e Has been activated by SA for ePOC participation To use the ASPEN Web ePOC application providers must first enroll Currently only Nursing Homes are eligible to use ePOC New users will register for QIES and ePOC access Existing users only need to enroll for ePOC access To open ASPEN Web ePOC you must log in through CMSNet to the QIES Systems for Providers welcome page 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Basics To open ASPEN Web ePOC Log into CMSNet Select the web bookmark CMS QIES Systems for Providers to launch the welcome page Select the ASPEN Access ePOC link from the bottom of the page Select the ASPEN Web link from the uppe
21. EPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE amp MEDICAID SERVICES POST CERTIFICATION REVISIT REPORT PROVIDERISUPPLIERICLIAMDENTIFICATION NUMBER MULTIPLE CONSTRUCTION ePOC Application Pages STREET ADORESS CITY STATE DP CODE 1155 WEST COLLEGE STREET BAINBRIDGE GA 33619 This report is completed by a qualified State surveyor for the Medicare Medicaid and or Clinical Laboratory Amendments program to show those deficiencies previously of Correction that have been corrected and the date such corrective action was accomplished Each deficiency should be fully identified using either the regulation or LSC ve 1D Prefix 0272 Reg 483 20 by 1 usc oo ID Prefix F0365 Reg 48335 dy3 Compisted LSC ID Prefix FO517 Reg 483 73 m 1 LSC ID Prefix Reg LSC ID Prefix Reg ic Improvement reported on the CMS 2567 Statement of Deficiencies and Plan provision number and the identification prefix code previously shown on the CMS 2587 prefix codes shown to the lef of each requirement on the survey report form REVIEWED BY SIGNATURE OF SURVEYOR STATE AGENCY O unmas Jurkovich Aaron p mm E FOLLOWUP TO SURVEY COMPLETED ON C CHECK FOR ANY UNCORRECTED DEFICIENCIES WAS A SUMMARY OF UNCORRECTED 05 01 2015 Form CMS 2567B 002 ES 11 08 Figure 32 CMS 2567B DEFICIENCIES CMS 2567 SENT TO THE FACILITY O YES ONO Evert iD VRPOTZ Procedures Guide 7 17 15 47 AS
22. OC Resubmitted for Tag EMail ooococcccccccccccnncnnnnnnncnnncnannnnnos 64 POC Rejected by SA RO Vieraina EEEE EPE anna se a seas rea sea nena nnn 65 POC Approval by SA RO a E EA A EEE nennen nnn nnn nnn 66 Final POC Approved odo REOR C 67 No Response Emal ore e nx rn ns dx e e p e i RE RE Re cn 68 SOD Acknowledgment Required cceceeceeeeee ee eects teeta teen eee mee 69 Letter Notification ccccceccesce eee e scene scenes eens nr nr nr rr rr rr 70 Remove Posting from ePOC Website cceceee eee ee teeta teen estes eeeeeeeees 71 Response Due Date Change ccceceee cece eens ee eee eee eee eee mene 72 ASPEN Web ePOC Keyboard Shortcuts eene 73 err A A A AA 73 GIG A O O ON 73 DropsdownLBblStS osito 73 Checkboxes ii ii 73 Procedures Guide 7 17 15 5 Contents 6 7 17 15 ASPEN Web ePOC 10 2 Introduction ASPEN Web electronic Plan of Correction ePOC runs in a web browser Internet Explorer 9 10 11 over the Centers for Medicare and Medicaid Services CMS intranet ePOC provides a means for users to electronically manage provider Plans of Correction About this Procedures Guide The ASPEN Web ePOC Procedures Guide gives users the information needed to manage POCs for surveys electronically via ePOC Review posted statement of deficiencies Review posted survey related letters Submit and e sign POC to state agency regional office knowledge and have participate
23. PEN Web ePOC Screens 48 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Fields For each field or button in a window or section of window the name is given followed by a description Their order corresponds to the order of the screen graphics in the previous chapter ePOC Screens Function buttons not included within a section are listed under the heading Buttons You will see a question mark to the right of some column titles Move the cursor over the to display a definition of the column ePOC Startup Pages ASPEN Web ePOC Login User ID Your assigned QIES user ID Password Your QIES user password Login button Logs you in and opens the Select Application window ePOC Application Pages Toolbar Home Returns a multi facility user to the Facility List page Single facility users return to the Survey List for that facility Breadcrumb links Breadcrumbs show your path to the current location You can click a link to go to that page Menu icon Click to display options which vary depending on current page Procedures Guide 7 17 15 49 ASPEN Web ePOC Fields Menu Options include some or all of the following depending on current page Instructions Opens the Facility Instructions page It provides instructions for completing POCs that are specific to provider type Users Opens the Users page It lists all ePOC enrolled users for the current facility About ePOC Opens page with version information including
24. Surveys on page 28 Timing Out If you do not enter POC text for a period of 15 minutes a message appears and you have the option of keeping the Plan of Correction page open for another 15 minutes or not If you do not respond within one minute the page is automatically closed Unsaved work is lost and the POC is released for editing by another user If you close the browser or back out of the page while editing a POC the ePOC application assumes you are still editing it In such a case the lock on that POC is released automatically after 17 minutes POC Backup ASPEN Web ePOC automatically backs up POC text every two minutes If the application closes unexpectedly you can recover unsaved POC text entered prior to the last backup When you log back into ASPEN Web ePOC and open the Plan of Correction entry page for the applicable tag a message appears and offers the option of restoring the unsaved Plan of Correction text If you choose OK the automatically saved text is entered in the POC Description field Procedures Guide 7 17 15 21 ASPEN Web ePOC Procedures 22 Print CMS 2567 To view print the CMS 2567 CMS 2567B or A Form In the Survey List click the Reports button printer icon associated with the survey Select 2567 2567B or A Form The available options depend on the survey For example 2567B is available only for revisit surveys with corrected tags Note The only way t
25. THER Survey Dates 03 22 2013 03 23 2013 Event ID DDD711 SOD Reposting Date 05 14 2013 62 7 17 15 ASPEN Web ePOC 10 2 ePOC Email Notices The results of survey completed at your facility on 03 23 2013 have been revised and re posted on the ASPEN Web Electronic Plan of Correction ePOC website Please login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink to review the changes made to the following citations and re submit the Plan of Correction information if needed Tag 0151 RIGHT TO EXERCISE RIGHTS FREE OF REPRISAL Tag 0156 NOTICE OF RIGHTS RULES SERVICES CHARGES lt Reason for Reposting text gt Please note that re posting of this survey will not delay the imposition of any possible federal remedies or sanctions Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Facility POC Initially Submitted Recipient Facility cc SA RO Facility Types Nursing Home Frequency Within an hour after facility first submits POC for a tag Def free No Sample Email Subject Facility POC Submission for Tag 0176 for State CO DDD711 ABC LUTHERAN HOSPITAL Survey Completed 08 27 2012 Facility 111111 ABC LUTHERAN HOSPITAL Facility Type SNF Survey Dates 08 27 2012 08 27 2012 Event ID DDD711 Procedures Guide 7 17 15 63 Sup
26. Version Build Date and Build for ASPEN Web ePOC Tutorial Opens the ePOC tutorial Procedures Guide Opens this ASPEN Web ePOC Procedures Guide Release Notes Opens the release notes for the current application version ASPEN Web Menu Returns you to the Select Application page Log Out USERNAME Logs the current user out of ASPEN Web ePOC Users User ID QIES ID assigned to the user Name Name of the user Facility List Search Enter text to search in the Facility List Search results update automatically as each character is entered 50 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Facility List grid CCN CMS Certification Number Identification number assigned by CMS Regional Offices to providers and suppliers who meet all federal requirements for participation in the Medicare program including the Medicare Conditions of Participation or the Conditions for Coverage and who have completed the 855 process The CCN is a link click it to open the Survey List page for the facility Name Name of the facility Address Location of a facility s physical street address City Name of the city where the facility is located State U S Postal State Code where the facility is located Zip Zip code where the facility is located Buttons Home icon Returns the user associated with multiple facilities to the Facility List page Single facility users return to the survey list for that facility Menu
27. and view files the SA RO attached to the survey A count of the attachments to each survey is given next to the paper clip icon above the Survey Detail grid When you click the paper clip the Attachments page opens with a list of attachments to the survey if any in alphabetical order by filename and a brief description of each From here you can review add and remove your attachments you can view SA RO attachments Supported document types are DOC DOCX XLS XLSX PDF JPG JPEG GIF TIFF and TXT File size is limited to 4MB per attachment A statement in the Add an Attachment section on the Attachments page emphasizes the need to protect patient confidentiality Upon approval of POCs for all tags on a survey all attachments are removed An asterisk is placed next to the count on the paper clip icon When clicked a message indicates how many attachments were deleted when the final POC was approved To attach a file Open Survey Detail for the survey Click the paper clip icon above the grid to open the Attachments page In the Add an Attachment section click the Browse button to locate the file and enter its name Enter a brief Description of the attachment Click the Attach button The attachment is added to the Attachments grid Repeat for additional attachments Click outside of or close the Attachments page to return to the Survey List To view an attachment On the Survey Detail page click the paper cli
28. board accessible e All error messages are accessible to screen readers e Although your browser s back arrow functionality is available from within ePOC to ensure refreshed current information displays use the ePOC application s Back button More ASPEN Web ePOC Keyboard Shortcuts on page 73 Procedures Guide 7 17 15 11 Introduction 12 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Procedures The ASPEN Web ePOC electronic Plan of Correction application offers providers a convenient centralized workplace for completing all steps in POC processing including e Reviewing Statements of Deficiencies SODs e Creating POCs e Submitting POCs The ePOC process is the same for all surveys with one or more deficiencies whether certification investigation Health Life Safety Code Federal Monitoring Survey or revisit POCs are not required for Past Non Compliance PNC and A level Scope Severity tags waived tags or for deficiency free surveys However acknowledgement of the SOD is required for all except waived tags The ePOC life cycle begins with the State Agency SA or Regional Office RO creating a survey and adding their findings The SA RO then posts the survey on the ASPEN Web ePOC website At this point an email notification is generated to all ePOC enrolled users at the facility After receiving the email notification facility users review the SOD and submit POCs for the deficiencies On the ePOC web
29. d in ePOC training This guide consists of this introduction and the following chapters e ASPEN Web ePOC Procedures Provides task based procedures using the ePOC process for supported provider types If you need more information links to additional material are included e ASPEN Web ePOC Screens Contains pictures and brief descriptions of ePOC related screens and windows in the browser application e ASPEN Web ePOC Fields and Buttons Presents descriptions of the fields and buttons in the ePOC related screens and windows in the browser application e Supporting Materials Contains supplemental information and reference items Procedures Guide 7 17 15 7 Introduction View this Document Online You must have Adobe Reader installed to view this document online You can download the latest version from http www adobe com products acrobat readstep2 html On any page you can click the Increase or Decrease button in the toolbar to adjust the page magnification to your comfort level Use the bookmarks in the left pane of Adobe Reader to locate and go click the bookmark to relevant information in this procedures guide la Bookmarks a X E Contents EHE Introduction S E About this Procedures Guide E Accessibility Features E ASPEN Web ePOC Procedures E ASPEN Web ePOC Screens E ASPEN Web ePOC Fields E E E EH E Supporting Materials Figure 1 Bookmarks You can also c
30. dcrumbs to the right of the Home icon show your path to the current location and are links to pages in that path To navigate using breadcrumbs Click a breadcrumb link to go to that page Use Menu Options Available options on the ePOC application menu depend on the current page To access items on the ePOC menu On the right side of the ASPEN Web ePOC toolbar click the menu icon Select the Instructions option to view the Facility Instructions page Select the Users option to view the Users page Select the About ePOC option to view ePOC version information Select the Tutorial option to view the ePOC tutorial Select the Procedures Guide option to open this procedures guide Select the Release Notes option to view the release notes for the current application version Select the ASPEN Web Menu option to return to the Select Application page Select the Log Out option to log out of the ASPEN Web ePOC application More Screen Toolbar on page 34 Screen Facility Instructions on page 35 Screen Users on page 35 Screen About ePOC on page 36 ePOC Tutorial on page 10 24 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Basics Optional ePOC Items Survey Letters If the SA RO posts letters with the survey SOD you can view them via the Survey List This includes any letters generated for ASPEN Enforcement Manager AEM cases related to the survey and for intakes linked to the survey A count of the letters post
31. e and sign an attestation You cannot enter POC text for e Comment tags 0000 and 9999 e A level Scope Severity tags e Past Non Compliance PNC tags e Waived tags You must however acknowledge A level and PNC tags When the SA RO rejects a POC the reasons for rejection and explanations if entered are shown below the POC Description panel on the POC entry page You can review the rejection information revise the POC and re submit it For waiver requests you can respond with POC text and or enter something like request waiver or request extension of waiver The SA RO can choose to accept or reject the POC and or waiver request Procedures Guide 7 17 15 19 ASPEN Web ePOC Procedures 20 Enter POC Text Multiple users can work on a single survey in the ePOC application However only one user at a time can enter or modify the POC text for a citation There is no limit to the amount of POC text you can enter If you copy and paste text from another word processor there may be problems with special characters Be sure to carefully review text pasted in from an external word processor and remove any odd characters POC Instructions above the POC Description guide the user on entry of a POC Description and Completion Date X5 Click on the POC Instructions title to expand or collapse the instruction text Instructional text does not display for A level or PNC tags To enter Plan of Correction text Open the Su
32. e right to privacy in written communications including the right to have access to stationery postage and writing implements at the resident s own expense This REQUIREMENT is not met as evidenced by The resident has the right to privacy in written communications including the right to have access to stationery postage and writing implements at the resident s own expense Figure 29 CMS 2567 Not Final Procedures Guide 7 17 15 45 ASPEN Web ePOC Screens 46 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE amp MEDICAID SERVICES ey OF DEFICIENCIES AND PLAN OF CORRECTION F000 INITIAL COMMENTS inital comments F152 483 10 a 3 8 4 RIGHTS EXERCISED BY SS D REPRESENTATIVE In the case of a resident adjudged incompetent under the laws of a State by a court of the rights of the resident competent jurisdiction are exercised by the person appointed under State law to act on the resident s behalf In the case of a resident who has not been judged incompetent by the State court any legal designated in accordance with State law may exercise the resident s rights to the extent nrovided hv State law X2 MULTIPLE CONSTRUCTION A BULONG B vano STREET ADORESS CITY STATE DP CODE OC ICIENCY F152 Past noncompliance no plan of correction Figure 30 CMS 2567 Pending Acknowledgement PNC tag DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE amp MEDICAID SERVICES
33. ectives and applicable State law Figure 22 Regulation Procedures Guide 7 17 15 41 ASPEN Web ePOC Screens 42 Observations text Displays complete observations text e surveyor evidence for the deficiency when you click MORE on the Survey Detail page The resident has the right to refuse treatment to refuse to participate in experimental research and to formulate an advance directive as specified in paragraph 8 of this section The facility must comply with the requirements specified in subpart I of part 489 of this chapter related to maintaining written policies and procedures regarding advance directives These requirements include provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and at the individual s option formulate an advance directive This includes a written description of the facility s policies to implement advance directives and applicable State law Figure 23 Observation Text Plan of Correction text Displays the complete Plan of Correction text for the deficiency when you click MORE on the Survey Detail page Plan of Correction You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description fie
34. ed for each survey is given next to the envelope icon When you click the envelope icon letters are listed in descending order based on date created with a brief description i e ASPEN letter name of each The letter date is a link you can click it to open the letter in its entirety in your default RTF viewer e g Microsoft Word If the SA RO adds or removes letters after posting a survey to the ePOC website letter information and availability is updated immediately The SA RO may choose to alert the facility about a new or revised letter which generates a Letter Notification for Facility email To review a survey letter L Open the Survey List In the Letters column note the letter count for each listed survey To review a letter click the envelope icon for the applicable survey On the Letters page locate the letter you want to view and click its Letter Date then click Open to view the letter as an RTF file Exit the letter then click outside of or close the Letters page to return to the Survey List More Procedure Navigate the Survey List on page 17 Screen Survey List on page 37 Screen Letters on page 38 Remove Posting from ePOC Website on page 71 Procedures Guide 7 17 15 25 ASPEN Web ePOC Procedures 26 Attachments To support the POC s for the tag s on a survey you can attach or remove supplemental documentation at any time prior to final POC approval You can also open
35. ed to the survey 52 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Reports CMS 2567 generates the Statement of Deficiencies and Plan of Correction which lists uncorrected non A level tags CMS 2567B generates the Post Certification Revisit Report which shows corrected deficiencies A Form generates the Statement of Isolated Deficiencies for the survey which includes any uncorrected A level scope severity deficiencies The available options depend on the survey For example CMS 2567B is available only for revisit surveys with corrected tags Note The only way to view corrected deficiencies is to print the CMS 2567B If all deficiencies are corrected a message tells you no POC is required Page navigation keys For multi facility users associated with more than 25 facilities navigation keys at the bottom of the page First Next etc allow access to additional facilities Buttons Home icon Returns a multi facility user to the Facility List page Single facility users return to the survey list for that facility Menu icon Displays links to Instructions Facility page Users page About ePOC ASPEN Web Menu and Log Out page Back Returns you to the previous page Letters Letter Date Date the letter was generated The letter date is a link click it to open the letter in your RTF viewer Letter Description Name of ASPEN letter generated by SA RO Procedures Guide 7 17 15 53 ASPEN Web ePO
36. g the Tutorial option from the menu For complete instructions on using ePOC choose the Procedures Guide option from the menu MN z 4 Type here to filter the gt Quick Y Survey List v Navigation n Search Enter seach criteria Showing 1 to 24 of 24 entries Back Event Id SOD Sent Exit Date Type POC Due Date Letters Reports Click gt wanen 07 10 2014 07 10 2014 Health v 07 20 2014 al here to N3NH22 05 10 2014 03 10 2014 Ufe Safety Code n ojo 05 20 2014 e o view a e Click here to view letters survey for this survey v A Figure 3 First page of ePOC tutorial 7 17 15 ASPEN Web ePOC 10 2 Accessibility Features Accessibility Features This ASPEN Web ePOC Procedures Guide and ePOC user interface include a number of 508 compliant accessibility features which are detailed below In this Guide e Alternative text alt text is defined for all graphics which screen readers can read In the Screens chapter there are links cross references to the field column descriptions for the indicated screen or section of screen e All graphics have captions e Information is not conveyed by means of color alone e Reading order is optimized so content is read correctly by screen readers e Tables are generally not used for formatting so text is accessible to screen readers In ASPEN Web ePOC e All fields are included in the tabbing sequence e Keyboard shortcuts exist for application options making ePOC key
37. gement required for the primary type Sample Email Subject Statement of Deficiencies SOD Posted for State CO DDD711 ABC HEALTH CARE CENTER Survey Completed 05 15 2013 Facility 111111 ABC HEALTH CARE CENTER Facility Type SNF NF Survey Category CMPIVT Survey Dates 05 15 2013 05 15 2013 Event ID DDD711 Procedures Guide 7 17 15 61 Supporting Materials Plan of Correction POC Due Date 05 25 2013 The Statement of Deficiencies for the survey completed at your facility on the above referenced date has been posted on the ASPEN Web Electronic Plan of Correction ePOC website Please login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink to review the deficiencies and to enter Plan of Correction POC information if required Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Survey Results Re Posted to Facility Recipient Facility cc SA RO Facility Types Nursing Home Frequency Within an hour after survey reposting in ASPEN Def free Yes if Acknowledgement required for the primary type Sample Email Subject Statement of Deficiencies SOD Re posted for State CO DDD711 ABC HEALTH CARE CENTER Survey Completed 03 23 2013 Facility 111111 ABC HEALTH CARE CENTER Facility Type SNF NF Survey Category CMPIVT O
38. he survey You cannot delete SA RO attachments Add an Attachment File Browse Select the Browse button to locate the file and enter its name Description Enter a short description of the attachment Attach Select button to attach the file to the survey Procedures Guide 7 17 15 57 ASPEN Web ePOC Fields Plan of Correction entry page Tag Tag number of the cited deficiency Event Id Unique identifier assigned when the survey was created Survey Exit Read only Exit date of the survey POC Due Read only Date by which the facility users must submit the POC Survey Posting Read only Date the survey was posted to ASPEN Web ePOC POC Status Read only Status of the POC Facilities can submit their POC information on a tag by tag basis or for the entire survey Options are e No POC Deficiency is newly released to the facility e Facility Draft Pending Indicates the facility user saved preliminary draft POC information Draft POC information is not visible to SA or RO users e Submitted Facility user submitted the tag s POC for SA RO review e Rejected The POC was rejected Rejection reasons are displayed at the bottom of the page e Approved POC approved by SA RO Back Returns you to the previous page Statement of Deficiency panel Read only Tag information regulation text and Observations for the deficiency The regulation text and Observations are expandable and collapsible by clicking on the
39. ility by phone e Figure 11 Facility Instructions Users The Users page lists all ePOC enrolled users for the current facility Fields Users on page 50 User ID Name MAUREEN Maureen Hartigan JOHNB John Beavers DAVE Dave Wilcox CHRISB Chris BARTLE CHERYL Cheryl Adams TIML TIM LYON RICH RICH CHOPYAK RODB Rod Blackard Figure 12 Users Procedures Guide 7 17 15 35 ASPEN Web ePOC Screens 36 About ePOC Displays version information for the ASPEN Web ePOC application ASPEN Web Electronic Plan of Correction Version 10 2 0 Build Date Jun 24 2015 12 59 35 Build 251 Figure 13 About ePOC Facility List For facility users associated with multiple facilities i e users enrolled for multiple ePOC activated facilities the Facility List appears and displays an alphabetical list of up to 25 of those facilities The Facility List window is organized into two sections The Search option allows you to enter search terms to filter the facilities in the grid below The grid displays a list of facilities Fields Facility List on page 50 E y Facility List Search Showing 1 to 5 of 5 entries Q CN Name Address City State Zip 335023 A HOLLY PATTERSON EXTENDED CARE FACILITY 875 JERUSALEM AVENUE UNIONDALE NY 11553 335532 AARON MANOR REHABILITATION amp NURSING CENTER 100 ST CAMILLUS WAY FAIRPORT NY 14450 335610 ABSOLUT CTR FOR NURSING
40. in the grid If Regulation Observations or final Plan of Correction text for a tag is truncated in the grid select MORE to display the complete text Click a tag number or a Plan of Correction Acknowledgement link in the grid to open the Plan of Correction entry page for that tag 18 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Basics 5 To view the CMS 2567 CMS 2567B or A Form click the Reports button printer icon above the grid and select 2567 2567B or A Form More Procedure Navigate the Survey List on page 17 Screen Survey Detail on page 39 Screen Regulation text on page 41 Screen Observations text on page 42 Screen Plan of Correction text on page 42 Procedure Compose a Plan of Correction Procedure Print CMS 2567 on page 22 Screen CMS 2567 Forms on page 45 Compose a Plan of Correction You can enter POC text on the Plan of Correction page for the tag selected in the Survey Detail grid The Statement of Deficiency column contains the tag information regulation text and observation text The regulation text and Observations are expandable and collapsible by clicking on the tag title or Observations link Any POC text already entered displays in the Facility Response column After entering POC text you can submit the POC to your SA RO as final or save it as pending if you want to add or edit text When you submit a POC as final you must enter a Completion Dat
41. ing ASPEN Web ePOCooonccoococoonnncacnnracnnracnnracanranrnnanracanrananensss 14 ASPEN Web ePOC Basics eeeeeeeeseene enean anna nnn 15 View the Facility MI EE 15 Filter the Facility List eesssseeseseeeenn nemen 15 Navigate the Facility List essssssssssseeen mmm 16 View the Survey List sessseeseeeeeee nennen mena mene ner 16 Filter the Survey LiSt ici isset ee A dea 17 Navigate the Survey List essem 17 View Survey Detail cessseeseeeeeee nennen nne meram ne nasa nennen 18 Compose a Plan of Correction cccceeceeee eee ee cents eens enne 19 Enter POC SA deeper oeteesscevnedyenedevnideanctededie 20 TIMING QUE ci 21 POC BAckUpP iii diia 21 Print CMS 2567 ii Ai SN 22 Submit and AttestiPOCS o casino io cien 22 Toolbar and MeNU occccoccnonconnnonncn nro rn nn rr rr rr rr rr 23 Return to Home page sssssssssssssess eme mene emen eese 24 Use Breadcrumbs to Navigate ssssssssesesememee 24 Use Menu Options i icreii etii ensi pierre env liy recvi pc Y Rcv vade iiiivyi 24 Optional ePOC Items cien ai 25 Survey Letters tire eise E A ARIAS 25 Attachments eee opti level en x ee RR Y WATER E ERA ev rA Ee 26 ePOC Special Cases oe eeeeeeese esee nenne annu annu euius nana unn 27 A level and PNG tags eid t eder A RA E RR ERARPEMEMRRERA ERR ERRA 27 WalVed tags iix RR RE ici 28 Procedures Guide 7 17 15 3
42. ipate in experimental research and to formulate an advance directive as specified in paragraph 8 of this section The facility MORE Observations The programmer wanted to go outside but that is not allowed 483 20 b 1 COMPREHENSIVE ASSESSMENTS The facility must conduct initially and periodically 2 comprehensive accurate standardized reproducible assessment of each resident s functional capacity A facility must make a comprehensive a MORE Observations The tech professional should be able to have a cubical next to his spouse s cubical 483 25 c TREATMENT SVCS TO PREVENT HEAL PRESSURE SORES Based on the comprehensive assessment of a resident the facility must ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual s cli MORE Observations The tech professional was denied a request for a 4th monitor due to budget constraints 483 25 g 2 NG TREATMENT SERVICES RESTORE EATING SKILLS Based on the comprehensive assessment of a resident the facility must ensure that 1 A resident who has been able to eat enough alone or with assistance is not fed by naso gastric tube unless MORE Observations Programmers keep leaving old lunches in the fridge for significant periods of time Figure 19 Survey Detail Health survey Procedures Guide 7 17 15 Submit All Pending Plan of Correction Click to View Acknowledgement Plan of Correction
43. ity conducted by Fe deae od Survey sana any The provider or supplier s planned action s to correct the deficiency which plan of correction in effect with respect to the facility should include a thorough description of specific and realistic steps that will be taken to address the deficiency The facility must make the results available for examination and must An expected completion date which must be approved by the State as post in a place readily accessible to residents and must post a notice acceptable based on the level of deficiency if corrective actions are complete of their availability provide the date they were completed Observations A resident has the right to examine the results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of correction in effect with respect to the facility The facility must make the results available for examination and must post in a place readily accessible to residents and must post a notice of their availability Completion Date X5 12 03 2014 Save as Pending Submit as Final Rejection Reasons Explanation Does not contain elements detailing how the facility will correct the deficiency as it relates to the individual _ A lt KA lt M AAA _en _ _ _ _ _ Figure 25 Plan of Correction sabeg uoneoijddy DOda ASPEN Web ePOC Screens You cannot enter POC text on the POC Entry page fo
44. ld You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description field You can enter up to 250 characters into this POC Description field Figure 24 POC text 7 17 15 ASPEN Web ePOC 10 2 apind seJnpa2oJd ST ZT L tr Plan of Correction entry page In the Deficiency column on the Survey Detail page click the tag number to display this page in order to draft save and submit the POC response and to enter the Completion X5 Date If a POC is rejected the reasons for rejection display at the bottom of the page You can expand collapse the Tag text Observations and POC Instructions by clicking on their titles Fields Plan of Correction entry page on page 58 E fa Survey List Survey Detail gt Plan of Correction DESSERT HEALTH AND RESET AT HOBBY LLC ccn 122202 105 EAST COTTAGE DRIVE DOLBY KS 62201 Plan of Correction Event Id 3GIGi1 Survey Exit 12 01 2014 POC Due 12 11 2014 Survey Posting 12 01 2014 POC Status Rejected Back Statement of Deficiency Facility Response Tag 0167 483 10 g 1 RIGHT TO SURVEY RESULTS READILY gt POC Instructions ACCESSIBLE LONG TERM CARE FACILITIES POC Description E deus AE p EL pra most des The Plan of Correction POC must include the following Survey of the Faci
45. lick the Contents bookmark and then click links in the table of contents to go to relevant topics Tip For best viewing quality in Adobe Reader go to Edit Preferences Page Display path may vary somewhat depending on version Select the applicable Smooth Text option If you need more information links to relevant additional material in this document are included Click a link to directly access the related information In the Procedures chapter there are three types of links cross references to additional material They are grouped at the end of a procedure or descriptive section More Procedure Compose a Plan of Correction on page 19 Screen Survey List on page 37 Core ePOC Process on page 14 e Click the first link to go the indicated procedure e Click the second link to go to a graphic and description of the indicated screen or section of screen e Click the third link to go to descriptive information about the indicated topic 8 7 17 15 ASPEN Web ePOC 10 2 About this Procedures Guide In the Screens chapter there is another type of link cross reference to additional material Fields Survey List on page 51 e Click the link to go the field descriptions for the indicated screen There may also be cross references in the Fields and Supporting Materials chapters View a Printed Copy of this Document While it is designed to be used easily online you can print this document if you
46. ly after the POC for all tags has been approved You cannot delete SA RO attachments Note All attachments are removed upon final approval Fields Attachments on page 57 Note Attachment of supporting materials does not qualify as a Plan of Correction POC response Enter POC responses on the Survey Details page if required File Name Description Delete Add an Attachment To protect patient confidentiality please only attach documents that are necessary to support the Plan of Correction File nm Browse Description Enter a short description of the attachment Attach Figure 21 Attachments window Regulation text Displays the complete regulation text for the deficiency when you click MORE on the Survey Detail page Regulation The resident has the right to refuse treatment to refuse to participate in experimental research and to formulate an advance directive as specified in paragraph 8 of this section The facility must comply with the requirements specified in subpart I of part 489 of this chapter related to maintaining written policies and procedures regarding advance directives These requirements include provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and at the individual s option formulate an advance directive This includes a written description of the facility s policies to implement advance dir
47. n nau na Eu RE RE YR ER ER 49 ePOC Startup PaQ S cccccocnncnncnnncnonancnnonnsnnsnnnnnnrnnrnnrnnsnnnrnnrnnrnnannrananaas 49 ASPEN Web ePOC Login a are er eani erence ee eee memes 49 ePOC Application Pages eereereeeene nnne nn annue unam 49 TOO DAP errem 49 Mena ada 50 Us Sai a ia 50 Facility Listin a A A A RE YA EX Xe eR engl a 50 Facility List gride ori ot ie edid 51 lare TUE ea 51 Io A Ee A ANA Gals EA deca IA 51 Survey List Oia id lets 52 Ehe 53 Lettere ree rada 53 Survey Detail da 54 Attachments eee exerce A a EAEN 57 Attachments grid 2 6 A Rr anda Peeve teas ia ah 57 Add an Attachment ad 57 Plan of Correction entry page 00ccccccccocncnnnannnnnnan cnn narrar nr rn cenar en n nnn 58 Statement of Deficiency panel eesseeseeeen nemen 58 Facility Response panel csssssssssseeen meme emen nnns 59 Rejection Reasons Explanation eessseeeenen mmn 59 AttestatiON tai veta canis alive ERR RARE REN ind edie BRE rV Ra FPE R 60 4 7 17 15 ASPEN Web ePOC 10 2 Contents Supporting Materials isaac as needs 61 ePOC Email Notices cccsccccecseeeeseeeeeeeeeseeeeeseeeseeeesseesseeseseeeeeneeeeenaee 61 Survey Results Posted to Facility esses 61 Survey Results Re Posted to Facility eeeseeseseeeenen nnn 62 Facility POC Initially Submitted sse mmm 63 Facility P
48. n the above referenced date has been removed from the ASPEN Web Electronic Plan of Correction ePOC website for the following reason Resolution process cannot be handled in this way Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Procedures Guide 7 17 15 71 Supporting Materials Response Due Date Change Recipient Facility cc SA RO Facility Types Nursing Home Frequency Within 1 hour of changing the POC Due Date Email is not generated if the survey is currently stopped Def free Yes Sample Email Subject Response Due Date Change for State CO DDD711 ABC HEALTH CARE CENTER Survey Completed 03 23 2013 Facility 111111 ABC HEALTH CARE CENTER Facility Type SNF NF Survey Category CMPIVT OTHER Survey Dates 03 22 2013 03 23 2013 Due Date 4 03 2013 Event ID DDD711 The response due date for your Plan of Correction POC information or acknowledgment has changed from 04 02 2013 to 04 04 2013 for the survey completed at your facility on 03 23 2013 By the revised due date please review the deficiencies and enter Plan of Correction POC information if required on the ASPEN Web Electronic Plan of Correction ePOC website Login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink Contact your state survey agency o
49. nt Id column header to sort by Event ID To filter the list enter the appropriate alphanumeric text in the Search field To access the Survey Detail page for a survey where you can view information about uncorrected deficiencies click the survey s Event Id To view the CMS 2567 CMS 2567B or A Form for a survey click the button in the Reports column and select 2567 2567B or A Form The available options depend on the survey For example 2567B is available only for revisit surveys with corrected tags Note The only way to view corrected deficiencies is to print the 2567B If all deficiencies are corrected a message tells you no POC is required A watermark will appear on the CMS 2567 and A forms as follows e POC Not Final included until POCs for all deficiencies are approved e Pending Acknowledgement included until all tags are acknowledged on a survey with tags 0000 9999 only or all tags are A level or PNC If the survey is closed there is no watermark More Procedure Accessing ASPEN Web ePOC on page 14 Screen Survey List on page 37 Procedures Guide 7 17 15 17 ASPEN Web ePOC Procedures View Survey Detail The Survey Detail page opens when a survey Event ID is selected from the Survey List It displays all deficiencies cited on that survey for which the SA RO needs a response including PNC A level and comment tags 0000 and 9999 Tags removed due to IDR TIDR and corrected
50. o view corrected deficiencies is to print the 2567B If all deficiencies are corrected a message tells you no POC is required A watermark will appear on the CMS 2567 and A forms as follows e POC Not Final included until POCs for all deficiencies are approved e Pending Acknowledgement included until all tags are acknowledged on a survey with tags 0000 9999 only or all tags are A level or PNC If the survey is closed there is no watermark More Screen CMS 2567 Forms on page 45 Submit and Attest POCs When you submit a POC as final the Attestation of POC Submittal Terms and Conditions page is displayed You can sign this attestation electronically You have the option of submitting all pending POCs as final and signing the attestation for all the POCs at once As soon as POCs are submitted POC Status for the applicable tags changes to Submitted The Attestation page lists the deficiencies for which the attester is submitting POCs If you are not ready to sign the attestation you can back out of the Attestation page To submit and attest POC s On the Plan of Correction entry page click Submit as Final for the current POC Or On the Survey Detail page click Submit All Pending to submit all pending POCs On the Attestation of POC Submittal Terms and Condition page review the list of POC s you are submitting 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Basics To submit the POC s select the Elec
51. on if no POC text is entered yet e Click to Modify Plan of Correction if draft POC text is entered e Click to View Plan of Correction if POC has been submitted approved e Click to Acknowledge if citation is S S A or PNC and not acknowledged yet e Click to View Acknowledgement if citation is acknowledged S S A or PNC A link does not appear for comment tags 0000 9999 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Plan of Correction text Up to 250 characters of POC text if any entered by the facility MORE A MORE link at the end of Regulation Observations or final Plan of Correction text indicates there is additional text Click it to open the Regulation Observations or Plan of Correction window respectively so you can read all the regulation observations final POC text for the tag Note The MORE link is not displayed for pending POCs Completion Date Date by which the provider states the deficiency will be corrected Status Current POC status of the deficiency Available options are No POC Submitted Pending Approved and Rejected Date Date the current POC status was assigned Attachments Attachments grid File Name File name of the attachment Supported document types are DOC DOCX XLS XLSX PDF JPG JPEG GIF TIFF and TXT File size is limited to 4MB per attachment Description Short description of the attachment Delete Select to remove the attachment from t
52. p icon above the grid to open the Attachments page The filename of each attachment is a link Click the File Name of the attachment you want to view Choose Open in the message that appears The attachment opens in the appropriate application Close the attachment to return to the Attachments page Click outside of or close the Attachments page to return to the Survey List 7 17 15 ASPEN Web ePOC 10 2 ePOC Special Cases To delete an attachment 1 Onthe Survey Detail page click the paper clip icon above the grid to open the Attachments page In the Delete column click the X for the attachment you want to delete The attachment is deleted You cannot delete SA RO attachments WARNING There is no confirmation message so be sure you want to delete the attachment Click outside of or close the Attachments page to return to the Survey List More Procedure View Survey Detail on page 18 Screen Survey Detail on page 39 Screen Attachments on page 41 ePOC Special Cases Though not common several special situations may arise during the POC process ASPEN Web ePOC is designed to accommodate these cases A level and PNC tags A level Scope Severity and PNC deficiencies for federal or state surveys are included on the Survey Detail page POCs are not permitted for these tags however acknowledgement of the SOD is required Attestation is not required ePOC displays instructions for A level Scope Seve
53. porting Materials 64 Your Plan of Correction POC for Tag 0176 RESIDENT SELF ADMINISTER DRUGS IF DEEMED SAFE was received via the ASPEN Web Electronic Plan of Submission website on 04 09 2013 If you feel this POC was submitted in error please contact your state survey agency or CMS Regional office immediately Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Facility POC Resubmitted for Tag Email Recipient Facility cc SA RO Facility Types Nursing Home Frequency Within an hour after facility submits a revised POC for a rejected tag Generates as many times as facility resubmits POC for a rejected tag Def free No Sample Email Subject Facility POC Resubmitted for Tag 0176 for State CO DDD711 ABC LUTHERAN HOSPITAL Survey Completed 02 27 2013 Facility 111111 ABC LUTHERAN HOSPITAL Facility Type SNF Survey Dates 02 27 2013 02 27 2013 Event ID DDD711 Your revised Plan of Correction POC for Tag 0176 RESIDENT SELF ADMINISTER DRUGS IF DEEMED SAFE was received via the ASPEN Web Electronic Plan of Correction website on 04 19 2013 If you feel this POC was submitted in error please immediately contact your state survey agency or your CMS Regional office if this was a federal survey Please do not reply to this message Thank you 7 17 15 ASPEN Web ePOC 10 2 ePOC Email Notices POC Rejec
54. r A Level Scope Severity tags or PNC tags instead click the Acknowledge button in the Facility Response section Facility Response Since this citation has a scope severity level of A entry of a Plan of Correction is not required Select the Acknowledge button to continue Acknowledge Figure 26 Facility Response if S S A Facility Response Since this citation has Past Non Compliance PNC entry of a Plan of Correction is not required Select the Acknovdedge button to continue Acknowledge Figure 27 Facility Response if PNC tag Once acknowledged a message in the Facility Response section indicates a POC is not required and the citation has been acknowledged Attestation The Attestation page displays after you click Submit as Final on the POC Entry page and after you click Submit All Pending on the Survey Detail page You can electronically sign the Plan of Correction for your facility on this page Fields Attestation on page 60 DESERET HEALTH AND REHAB AT COLBY LLC cen 175202 105 EAST COLLEGE DRIVE COLBY KS 67701 Attestation of POC Submittal Terms and Conditions A Plan of Correction for the following tag is being submitted Tag 0224 PROHIBIT MISTREATMENT NEGLECT MISAPPROPRIATN Long Term Care Facilities Completion Date 45 11 13 2013 As an authorized signer for a Plan of Correction POC form for DESERET HEALTH AND REHAB AT COLBY LLC you may sign this affirmation The authority to sign this at
55. r CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Indicates whether the email is generated for a deficiency free survey i e a survey with tags 0000 and 9999 only 72 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Keyboard Shortcuts ASPEN Web ePOC Keyboard Shortcuts Keyboard shortcuts are combinations of two or more keys that when pressed can perform the same task as using a mouse or other pointing device General Press this Tab Shift Tab Shift F10 Spacebar Enter Esc Grids Press this Tab Shift Tab Enter Enter Drop down Lists Press this Tab Shift Tab Up Down Arrows Checkboxes Press this Tab Shift Tab Space Procedures Guide To do this Move forward through fields sections Move backward through fields sections Right click Select button and Select Clear Checkmark Select a link or activate a button Exits some pop up windows To do this Move into out of up and down the list While header of list is focused enter will sort the list by that column heading Select a link or activate a button To do this Move into out of the field Move vertically i e up and down in the list To do this Move into out of the field Select Clear Checkbox 7 17 15 73 Supporting Materials 74 7 17 15 ASPEN Web ePOC 10 2
56. r left corner of the ASPEN Access page Enter your ePOC login ID and password Note If the ePOC session is about to expire the system issues a warning with the option to continue without interruption If you do not respond to the message the session expires and the you will have to log in again More For complete information about registering and accessing ASPEN Web ePOC see https www qtso com download mds StepstoAccessEPOCApplication pdf ASPEN Web ePOC Basics View the Facility List After you successfully log in the ePOC application determines if you are associated with multiple facilities i e enrolled for multiple ePOC activated facilities If so the Facility List is displayed when you first open the ePOC application It lists up to 25 facilities for which you are enrolled If you are associated with more than 25 facilities you can scroll to the bottom of the page and use page navigation keys to access the additional facilities You can select the pertinent facility from the list to display the surveys for just that facility If you want to switch facilities the Home button returns you to the Facility List Note Single facility users do not see this page Filter the Facility List To apply a dynamic filter to the list of facilities you simply enter text in the Search field For example if you enter 18 in the Search box only those facilities that include 18 in any column are displayed If one facilit
57. reen CMS 2567 Forms on page 45 Waived tags Tags on an investigation or certification kit marked as waived by the SA RO are included on the Survey Detail page The status of waived tags is automatically set to Approved upon posting to ASPEN Web ePOC POCs are not permitted and acknowledgement of the SOD is not required for these tags The CMS 2567 report displays waived tags but they are not included in ePOC tardiness reports and emails For tags posted prior to a waiver request you must submit a POC It can be POC text and or enter something like request waiver or request extension of waiver The SA RO can choose to accept or reject the POC and or waiver request If a newly waived tag is included on a re posted survey its status will be set to Approved regardless of its prior POC text or status Deficiency free Surveys A POC is not required for surveys without deficiencies The facility user is required only to read the information in the comment memo tags 0000 and 9999 and acknowledge the SOD Once acknowledged the deficiency free survey s POC status changes to Closed To acknowledge a deficiency free survey Open the Survey Detail page for a deficiency free survey Click Acknowledge SOD above the grid on the right An Acknowledgement message appears at the top of the page and the survey Status above the grid on the left is now Closed 7 17 15 ASPEN Web ePOC 10 2 ePOC Emails Re Posted Surveys
58. ring your mouse pointer over the question mark icon in the Category column displays a pop up list of survey categories e fo Survey List ATCHISON SENIOR VILLAGE ccu 175531 1419 N 6TH ST ATCHISON KS 66002 Survey List Search Showing 1 to 5 of 5 entries Back Event Id SOD Sent Exit Date Type Status CategoryW Def Submitted Approved POC Due Date Letters Reports A Unapproved Recertification WH2D11 05 15 2014 05 15 2014 Health Open A E Initial Certification o 4 05 25 2014 n JA Complaint Investig D Follow up Revisit IC Federal Monitoring F Inspection of Care BRKN11 05 15 2014 05 15 2014 Health Open A G Validation i2 05 25 2014 y SKN211 05 15 2014 05 15 2014 Health Open A 0 2 05 25 2014 i3 H Life Safety Code Sanctions Hearing 1 X92W11 03 21 2014 03 21 2014 Health Closed A ee Gia eee 3 0 03 31 2014 i Ju L Change of Owner L43811 2014 03 06 2014 Health Open A B Dumping Investig 0 2 03 16 2014 gs ran M Other 1 Initial Licensure 2 Re Licensure 3 Licensure Complaint S Add of Specialties W CW Project Figure 17 Survey List with Category list displayed Procedures Guide 7 17 15 37 ASPEN Web ePOC Screens Letters Opens when you click the envelope icon for a survey in the Survey List You can view letters posted by SA RO in their entirety as an RTF document in your RTF viewer e g Microsoft Word Letter Date 10 17
59. rity shown below and PNC tags in the Facility Response section on the Plan of Correction entry page Facility Response Since this citation has a scope severity level of A entry of a Plan of Correction is not required Select the Acknovdedge button to continue Figure 5 POC not required for A level tags When acknowledged these tags are automatically approved If an A level or PNC tag is the last tag submitted and the POCs for all other tags are already approved the Final POC Approved email is sent A level or PNC tags that are not acknowledged are included in ePOC tardiness reports and emails The CMS 2567 report includes PNC tags A level Scope Severity tags are printed on the separate A Form Procedures Guide 7 17 15 27 ASPEN Web ePOC Procedures 28 To acknowledge an A level or PNC tag Open the Survey Detail page for a survey with A level and or PNC tags Click an A level or PNC tag or associated Acknowledgement link in the grid to open the Plan of Correction entry page In the Facility Response section click the Acknowledge button You return to the Survey Detail page where the Status of the A level or PNC tag is now Approved In the Facility Response section on the Plan of Correction page a message indicates a POC is not required and the citation has been acknowledged More Procedure View Survey Detail on page 18 Screen Survey Detail on page 39 Screen Plan of Correction entry page on page 43 Sc
60. rvey Detail page To open the Plan of Correction entry page for a tag click the tag number or Plan of Correction Acknowledgement link in the grid In the Facility Response panel enter POC text in the POC Description box You can enter an unlimited amount of text Note You cannot enter POC text for A level PNC or waived tags For A level and PNC tags click the Acknowledge button in the Facility Response section The status of waived tags is automatically set to Approved Enter or select from the calendar the Completion Date X5 Click the Save as Pending or Submit as Final button If you select Save as Pending the status of the tag changes to Pending If you select Submit as Final the Attestation of POC Submittal Terms and Conditions page opens 7 17 15 ASPEN Web ePOC 10 2 ASPEN Web ePOC Basics If the Completion Date is more than 6 months after the Survey Exit date an overridable message is displayed when you select Submit as Final The completion date 5 for this tag is more than six months after the survey exit date Select Ok to continue using this completion date or Cancel to change the date OK Cancel Figure 4 Completion Date message More Procedure View Survey Detail on page 18 Screen Survey Detail on page 39 Screen Plan of Correction entry page on page 43 Procedure Submit and Attest POCs just below Procedure A level and PNC tags on page 27 Procedure Deficiency free
61. rvey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Procedures Guide 7 17 15 67 Supporting Materials 68 No Response Email Recipient Facility cc SA RO Facility Types Nursing Home Frequency 10 calendar days after release to provider and every other day thereafter 3 calendar days after rejection every other day thereafter Def free No Sample Email Subject Plan of Correction POC Overdue for State CO DDD711 ABC REHAB AND SKILLED NURSING Survey Completed 04 18 2013 Facility 111111 ABC REHAB AND SKILLED NURSING Facility Type SNF NF Survey Category REVST FEDMON Survey Dates 04 18 2013 04 18 2013 Event ID DDD711 Statement of Deficiencies SOD Posted Date 04 18 2013 Please note that Plans of Correction POC for the referenced survey above are overdue for the following citation tags Please submit the POC s immediately on the ASPEN Web Electronic Plan of Correction ePOC website Please login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink Citation 0151 RIGHT TO EXERCISE RIGHTS FREE OF REPRISAL Citation 0154 INFORMED OF HEALTH STATUS CARE amp TREATMENTS Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you 7 17 15
62. s if needed 54 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages Attachments paper clip with count Displays the total number of attachments to the survey in support of POC s originating from your facility plus SA RO attachments Click the paper clip icon to open the Attachments page where you can review add and remove your attachments and view SA RO attachments All attachments are removed upon final approval i e when the last tag s POC is approved An asterisk is placed next to the count on the paper clip icon 2 3 Figure 33 Attachments count with asterisk When clicked a message indicates how many attachments were deleted when the final POC was approved 2567 2567B A Form CMS 2567 generates the Statement of Deficiencies and Plan of Correction which lists uncorrected non A level tags CMS 2567B generates the Post Certification Revisit Report which shows corrected deficiencies A Form generates the Statement of Isolated Deficiencies for the survey which includes any uncorrected A level scope severity deficiencies The available options depend on the survey For example CMS 2567B is available only for revisit surveys with corrected tags Note The only way to view corrected deficiencies is to print the CMS 2567B If all deficiencies are corrected a message tells you no POC is required Back Returns you to the previous page Home icon in toolbar Returns a multi facility user to the Facility List
63. site the ePOC enrolled users at the facility can e Review all cited deficiencies displayed on the website e Review letters added to the survey by the SA RO e Attach documents to support their POCs Note Active ePOC users have logged in within 90 days Inactive users have not logged into ePOC within 91 180 days Users who have not logged in for more than 180 days are disabled To enhance communication and monitor timeliness providers receive timely automated email notification throughout the ePOC process After the POCs for all deficiencies cited on the survey are approved you can print the CMS 2567 form s for posting on the premises Note ASPEN Web ePOC supports MS Internet Explorer versions 9 10 and 11 Procedures Guide 7 17 15 13 ASPEN Web ePOC Procedures Core ePOC Process When the SA RO posts a survey to ASPEN Web ePOC all ePOC enrolled users at the facility receive the Survey Posted email with information identifying the survey The facility users then perform the basic ePOC process outlined below The procedures that follow provide detailed instructions for completing the relevant steps Log into QIES ASPEN Web ePOC application 2 Select pertinent facility if applicable i e you are enrolled for multiple ePOC activated facilities Select pertinent survey record based on exit date and unique Event ID Review Statement of Deficiency information For each tag enter POC text and completion date Submit PO
64. t received within this timeframe the State notifies the facility that it is recommending to the RO and or the State Medicaid Agency that remedies be imposed effective when notice requirements are met The requirement for a plan of correction is in 42 CFR 488 402 d Further 42 CFR 488 456 b ii requires CMS or the State to terminate the provider agreement of a facility that does not submit an acceptable plan of correction Except in cases of past noncompliance facilities having deficiencies other than those at scope and severity level A must submit an acceptable plan of correction The requirement for a plan of correction is in 42 CFR 488 402 d An acceptable plan of correction must Address how corrective action will be accomplished for those residents found to have been affected by the deficient practice Address how the facility will identify other residents having the potential to be affected by the same deficient practice Address what measures will be put into place or systemic changes made to ensure that the deficient practice will not recur Indicate how the facility plans to monitor its performance to make sure that solutions are sustained and Include dates when corrective action will be completed The corrective action completion dates must be acceptable to the State If the plan of correction is unacceptable for any reason the State will notify the facility in writing If the plan of correction is acceptable the State will notify the fac
65. tags are not displayed The deficiencies are listed at the upper left and details about each tag number title regulation text POC text POC status etc are presented in the grid You can go directly to a tag in the Survey Detail grid or access it via the deficiencies list in the upper left of the page You can also generate the CMS 2567 CMS 2567B or A Formas applicable Immediate Jeopardy IJ Substandard Quality of Care SQC and Past Noncompliance PNC tags are flagged in both the deficiency list and grid to bring them to your attention On LSC surveys deficiencies are grouped by building there is a grid for each building If a deficiency is cited for more than one building it is listed for each applicable building If there are tags in Pending status POC was saved as a draft but not submitted the Submit All Pending button appears When selected all pending tags with a Completion X5 date are submitted The user is notified of any tags that do not have an X5 date If a survey is deficiency free 0000 and or 9999 tags only the Acknowledge SOD button is available to acknowledge viewing the survey To access and navigate the Survey Detail page Open the Survey List and select the Event Id of a survey to open the Survey Detail page Go directly to the tag in the grid to bring a tag into view in the grid when there are many tags scroll down to it Or Click the tag in the Deficiencies list to display it
66. ted by SA RO Recipient Facility Facility Types Nursing Home Frequency Within an hour after rejection Def free No Sample Email Subject POC for Tag 0151 Rejected for State CO DDD7111 ABC HEALTH CARE CENTER Survey Completed 03 23 2013 Facility 111111 ABC HEALTH CARE CENTER Facility Type SNF NF Survey Category CMPIVT OTHER Survey Dates 03 22 2013 03 23 2013 Event ID DDD711 Your Plan of Correction POC for Tag 0151 RIGHT TO EXERCISE RIGHTS FREE OF REPRISAL was rejected on 05 14 2013 for the following reason s Does not contain elements detailing how the facility will correct the deficiency as it relates to the individual Does not indicate how the facility will act to protect residents in similar situations Does not include the measures the facility will take or the systems it will alter to ensure that the problem does not recur Other Awaiting proof of concept Please submit a revised POC via the ASPEN Web Electronic Plan of Correction ePOC website Please login to the CMSNET VPN click on the bookmark labeled CMS QIES Systems for Providers then click on the Aspen Access ePOC hyperlink as soon as possible or by a date that may be specified in comments in ePOC Contact your state survey agency or CMS regional office as appropriate with questions regarding this matter Please do not reply to this message Thank you Procedures Guide 7 17 15 65 Supporting Materials 66 PO
67. testation on your behalf may not be delegated to an unauthorized person By electronically submitting this Plan of Correction POC for the facility today 11 13 2013 you attest that you understand that submitting this POC in this manner is the legal equivalent of having placed your handwritten signature on the submitted record document and by this affirmation you attest to the truth of the information contained therein under federal requirements to submit a Plan of Correction Review these requirements carefully Electronic Signature Do you accept the terms of the Attestation of POC Submittal I CHERYLW agree to the Attestation of POC Submittal I certify that I intend my electronic signature to be the legally binding equivalent of my traditional handwritten signature Continue Back E Signature Instructions To e sign the Plan of Correction POC information follow the steps below 1 Review all POC information prior to e signing 2 Review the Attestation of POC Submittal Terms and Conditions 3 Acceptance of the Attestation of POC Submittal Terms and Conditions is a requirement to e sign Figure 28 Attestation 44 7 17 15 ASPEN Web ePOC 10 2 ePOC Application Pages CMS 2567 Forms The CMS 2567 details the deficiencies found on the survey of the facility it includes PNC waived and memo comment tags 0000 9999 A level Scope Severity tags are printed on a separate A Form The 2567B lists corrected tags on re
68. tronic Signature checkbox and click Continue The Survey Detail page opens A POC for lt tag gt successfully submitted message for each submitted POC appears at the top of the page and the status of the POC s is now Submitted The submitted POCs are read only unless and until they are rejected by the SA RO If you do not want to sign the attestation yet click Back ePOC saves the POC s as pending and you return to the previous page More Procedure Enter POC Text on page 20 Procedure View Survey Detail on page 18 Screen Attestation on page 44 Toolbar and Menu The toolbar on ASPEN Web ePOC application pages provides the following navigation aids and links to useful information depending on the current page e Home icon e Breadcrumbs e Menu The menu is included in the toolbar on several ePOC pages and has some or all of the following options depending on the current page e Instructions e Users e About ePOC e Tutorial e Procedures Guide e Release Notes e ASPEN Web Menu e Log Out UserName More Screen Toolbar on page 34 Procedures Guide 7 17 15 23 ASPEN Web ePOC Procedures Return to Home page The Home icon returns multi facility users to the Facility List page single facility users return to the Survey List for the facility To return to your Home page On the left side of the ASPEN Web ePOC toolbar click the Home icon Use Breadcrumbs to Navigate Brea
69. tus is Rejected Lists reasons the SA RO rejected the POC Procedures Guide 7 17 15 59 ASPEN Web ePOC Fields Attestation Upon final submission ePOC displays an Attestation of POC Submittal statement It lists the tags deficiencies and completion dates for which the attester is submitting a POC Electronic Signature checkbox Select this checkbox to electronically sign the attestation for the listed POC s Leave blank or deselect the checkbox and click Back to save as pending but not submit the POC s Continue When pressed and Electronic Signature checkbox is selected submits the listed POC s and returns to the Survey Detail page where a message lists the POC s and indicates if submission was successful 60 7 17 15 ASPEN Web ePOC 10 2 Supporting Materials The following reference items are included in this chapter e ePOC email descriptions and text e ASPEN Web ePOC keyboard shortcuts ePOC Email Notices This section contains descriptions and text of the automatically generated ePOC email notices that facility users may receive ePOC sends facility emails to active and inactive ePOC enrolled facility users i e users who have logged into ePOC within 180 days The Letter Notification email is optionally generated by the SA RO Survey Results Posted to Facility Recipient Facility Facility Types Nursing Home Frequency Within an hour after release to provider in ASPEN Def free Yes if Acknowled
70. visit surveys The Plan of Correction column for PNC and waived tags indicates no POC is needed The Plan of Correction column does not appear on the A Form for A level tags A watermark will appear on the CMS 2567 and A forms as follows e POC Not Final included until POCs for all deficiencies are approved e Pending Acknowledgement included until all tags are acknowledged on a survey with tags 0000 9999 only or all tags are A level or PNC When all POCs are approved tags acknowledged the watermark is removed and you can print the CMS 2567 form s for posting on the premises Note A watermark does not appear for closed surveys DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED 12 10 2013 FORM APPROVED CENTERS FOR MEDICARE amp MEDICAID SERVICES ppp STATEMENT OF DEFICIENCIES X1 PROVIDER SUPPLIERICLIA PQ MULTIPLE CONSTRUCTION X3 DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER COMPLETED A BUILDING B WING c 175303 P amp 12 04 2013 NAME OF PROVIDER OR SUPPLIER STREET ADORESS CITY STATE ZIP CODE 3501 DIRR AVE PARSONS PRESBYTERIAN MANOR PARSONS KS 67357 x4 10 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER S PLAN OF CORRECTION X5 PREFIX EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION CROSS REFERENCED TO THE APPROPRIATE DEFICIENCY 483 10 2 ACCESS TO STATIONERY POSTAGE PENS ETC The resident has th
71. y s CCN contains 18 and another facility s address contains 18 both facilities are displayed Procedures Guide 7 17 15 15 ASPEN Web ePOC Procedures Navigate the Facility List You can filter and sort the Facility List to meet your needs By default facilities are sorted alphabetically by name To access and navigate the Facility List Open ASPEN Web ePOC The Facility List is displayed if you are a multi facility user To change sort order click a column header For example click the CCN column header to sort by CCN To filter the list enter the appropriate alphanumeric text in the Search field To access the Survey List for a facility click its CCN More Procedure Accessing ASPEN Web ePOC on page 14 Screen Facility List on page 36 View the Survey List For multi facility users the Survey List is displayed when a facility is selected from the Facility List For single facility users the Survey List opens immediately after login to ASPEN Web ePOC It displays the 25 most recent surveys for the facility If more than 25 surveys exist page navigation keys allow access to the additional surveys The Survey List displays all surveys for the facility regardless of survey type that have been successfully posted to the ePOC website by the SA RO It includes federal and state starting and revisit Health and LSC surveys Deficiency counts exclude comment memo tags 0000 and 9999 and tags that have

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