Level I Monitoring Data Entry

LEVEL I GUIDANCE
February 1, 2016

PACE Level I Reporting Guidance
Table of Contents

Introduction __________________________________________________________2
Quality Improvement___________________________________________________2
Level I Reporting Definition______________________________________________2
Level I Reporting Incident Requirements Table____________________________3-9
References_____________________________________________________________10

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PACE Level I Reporting Guidance
INTRODUCTION: PACE DATA ENTRY GUIDANCE
In order to comply with the PACE regulations, §460.140, §460.200(b)(1), §460.200 (c), and §460.202
PACE Organizations (POs) must meet external quality assessment and reporting requirements as
specified by the Centers for Medicare and Medicaid Services (CMS) and the State Administering
Agency (SAA). PACE Level I quality data elements are reported to CMS using the Health Plan
Management System (HPMS), an information system and data exchange mechanism for Medicare
Advantage Organizations (MAO) and POs. This guidance provides POs with an overview of
requirements to report both aggregate and individual level data to monitor and improve quality of care
and participant outcomes. For questions concerning Level I reporting POs should contact their CMS
account manager initially and as a second option please send questions to the DMAO portal.lmi.org and
copy their CMS account manager.

QUALITY IMPROVEMENT (QI)
Level I data should be reviewed for Quality Improvement (QI) using a standardized methodology (e.g.,
Plan, Do, Check, Act known as PDCA) to:
• Institute QI-driven change in policies, procedures, systems, or training as appropriate;
• Evaluate the effectiveness of the intervention;
• Track and trend for areas that need improvement and sustainable improvement;
• Reevaluate until improvement is sustained;
• Report and discuss findings at least annually to oversight committees including the PO’s governing
body; and
• Document for review during CMS/State Administering Agency audit as evidence of a performance
improvement activity.

LEVEL I REPORTING REQUIREMENTS
Level I reporting requirements refer to those data elements used for monitoring that are regularly
reported by POs via the HPMS PACE monitoring module. POs will have 30-days after the each quarter
ends to enter date before the entry is considered late. For appeals and grievances POs will have seven
days after the 30-day grace period to enter data. For instructions related to late date entries, data
modifications and request for data entry extensions, please follow the HPMS User guide.

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PACE Level I Reporting Guidance
LEVEL I REPORTING INCIDENT REQUIREMENTS
Incident Type

Level I Reporting

Collection Frequency

Definition
Census Data

HPMS Data Entry Reporting
Requirements

Census is defined as

Census data is collected

For each new enrollment and

the number of

quarterly.

disenrollment POs reports the data

participants currently

following information:

receiving care.

-New Enrollments that includes
Medicare, Dual eligible Medicaid,
Private Pay.
-Disenrollment Total that includes
Medicare, Dual eligible Medicaid,
Private Pay.

Grievances

A grievance is defined

Grievances data are

For each grievance the PO reports

as a complaint, either

collected quarterly. The

the following data information:

written or oral,

PO can continue to enter

-The source of the grievance;

expressing

grievances information

-The location that the grievance

dissatisfaction with the

for seven days after the

originated;

service delivery or the

end of the quarter.

-The type of grievance;

quality of care

Grievances are entered

-The specific issue related to the

furnished.

under one of the three

grievance; and

categories: Resolved or

-The resolution to the grievance.

an Alternative Solution.
Alternative Solution
means that the PO has
chosen an alternative
option that addresses
grievances safely and
appropriately. CMS
expects that all
grievances are addressed
and a resolution is
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PACE Level I Reporting Guidance
Incident Type

Level I Reporting

Collection Frequency

Definition

HPMS Data Entry Reporting
Requirements

obtained. (Some
grievances may not be
resolved to the
participants/caregiver
satisfaction, however, a
resolution must be
obtained.)

Appeals

An appeal is a

Appeals are collected

For each appeal the PO reports the

participant's action

quarterly. The PO can

following data information:

taken with respect to

continue to enter appeals

-The source of the appeal;

the PO’s non-coverage

information for seven

-The type of appeal; and

of, or nonpayment for,

days after the end of the

-The resolution to the appeal.

a service including

quarter.

denials, reductions, or

Appeals are entered into

termination of services.

HPMS once the appeal
has been resolved or
denied.

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PACE Level I Reporting Guidance
Incident Type

Level I Reporting

Collection Frequency

Definition
Immunizations

HPMS Data Entry Reporting
Requirements

Pneumococcal &

Pneumococcal:

Pneumococcal & Influenza:

Influenza

Pneumococcal data is

For each participant the PO provides

Immunizations are

collected quarterly.

the following vaccine data

reported for all

Influenza:

information:

participants enrolled

Influenza immunizations

-The total number of participants

during the reporting

screening, immunization,

enrolled during the reporting period

period. Refer to

and data collection

(including all disenrolled and

http://www.cdc.gov/va

period begins quarter

deceased participants);

ccines/schedules/index.

1(Q1) - October 1 and

-The total eligible to receive

html for immunization

ends March 31st of the

immunization;

administration

following calendar year.

-The number of vaccines

schedule. CMS expect

Influenza data is

administered by the PO to eligible

POs to immunize

collected annually

participants; -The total number

participants’ according

following the end of the

eligible participants who did not

to the CDC guidelines.

data collection period.

receive the Pneumococcal/Influenza

Pneumococcal:

for the following reasons: medically

http://www.cdc.gov/va

contraindicated, prior immunization,

ccines/vpd-

refused, vaccine unavailable, missed

vac/pneumo/vacc-in-

opportunity (vaccine available but

short.htm.

was not administered); and

Influenza:

-The number of participants who

http://www.cdc.gov/va

received the vaccine and reported or

ccines/vpd-

had a reaction.

vac/flu/default.htm

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PACE Level I Reporting Guidance
Incident Type

Level I Reporting

Collection Frequency

Definition

HPMS Data Entry Reporting
Requirements

Minimum Levels of
Performance:
Each PACE
Organization is
expected to achieve an
immunization rate of
eighty percent (80%)
for both influenza and
pneumococcal
vaccinations for the
participant population
that is appropriate.
Falls Without

A PACE participant

Falls without injury is

For each participant Fall Without

Injury

fall can be defined as a

collected quarterly.

Injury POs provides the following

sudden, unanticipated

data information:

descent in which a

-The date the fall occurred;

participant comes to

-The time the fall occurred;

rest on the floor or

-Location where the fall occurred;

some other surface,

-Precipitating /contributing factors;

person, or object

-The actions taken by the PO.

(intentional falls should
not be counted). Falls
without injury refers to
falls that requires only
first aid treatment, or
minimal treatment (i.e.
ace bandaged for a
sprain) and do not
require a

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PACE Level I Reporting Guidance
Incident Type

Level I Reporting

Collection Frequency

Definition

HPMS Data Entry Reporting
Requirements

hospitalization greater
than 24 hours. (Ex.
falls that are caused
scrapes, cuts and or
bruises).
Medication

Medication

Administration Administration Errors

Medication

For each Medication Administration

administration error

Errors without an Adverse Effect the

Errors

Without an Adverse

without an adverse effect

PO provides the following data

Without an

Effect are when

are collected quarterly.

information:

Adverse Effect

medication errors occur

-The date the medication error

in violation of the

occurred;

physician’s order, this

-The location where the medication

includes errors made by

error occurred;

the PO, PO’s

-The type of medication

contracted staff and or

administration error;

participant or

-Precipitating /contributing factors;

caregivers. Also,

and

medication

-The actions taken by the PO.

administration errors
without adverse effect
is an incident that has
the potential of being
harmful without
actually causing an
adverse effect.

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PACE Level I Reporting Guidance
Incident Type

Level I Reporting

Collection Frequency

Definition

HPMS Data Entry Reporting
Requirements

Kennedy

This data element is

This data element is

This data element is under review.

Terminal

under review. Enter

under review. Enter “NO

Enter “NO DATA TO REPORT” in

Ulcer (KTU)

“NO DATA TO

DATA TO REPORT” in

order for the data entry process to be

REPORT” in order for

order for the data entry

complete.

the data entry process

process to be complete.

to be complete.
Burns

Burns 1st degree or less. Burns 1st Degree is

For each participant Burn 1st Degree

An injury to tissue by

or less the PO provides the following

collected quarterly.

heat, friction,

data information:

electricity, radiation, or

-The date the burn occurred;

chemicals.

-The location (ex. home );
-The location of the burn on the
body;
-Precipitating /contributing factors;
and
-The actions taken by the PO.

Emergency

Emergency room visit

Emergency Room visits

For each participant Emergency

Room Visits

is an Emergency room

collected quarterly.

Room visit the PO provides the

visit that is less than 24

following data information:

hours.

-Emergency room visit date;
-Primary admitting diagnosis;
-Discharge diagnosis;
-Admission to hospital (only provide
a Yes or No answer);
-Participant living situation at the
time of admission;
-Participant Outcomes;

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PACE Level I Reporting Guidance
Incident Type

Level I Reporting

Collection Frequency

Definition

HPMS Data Entry Reporting
Requirements
-If the participant had repeat ER
visits; and
- All visits within the current
Reporting Period

Other

If there is an incident

Incidents

that occurred that

--

--

would be consider an
“other” or does not fall
into one of the
categories above,
contact your account
manager to discuss the
incident prior to
entering the
information into
HPMS.

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PACE Level I Reporting Guidance
References
Agency for Healthcare Research and Quality
• Clinical practice guidelines
• Preventing medical errors
• Quality care
• Safe care

http://www.ahrq.gov

Centers for Disease Control and Prevention
• Immunizations

http://www.cdc.gov

Centers for Medicare & Medicaid Services
• Quality initiatives and research

http://www.cms.gov

PACE regulations (42 CFR 460)

http://www.ecfr.gov

Pharmacy Related Resources:
• Institute for Safe Medication Practices

http://www.ismp.org/

•

National Association of Boards of Pharmacy
Links to State Boards

http://www.nabp.net/

•

American Society of Consultant Pharmacists
(LTC Pharmacists)

http://www.ascp.com/

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