• FY 2019 SNF VBP Annual Performance Scores: Correction Requests Due Aug. 31

    By MLN Connects - August 10, 2018
    Annual Performance Score Reports for the FY 2019 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program year are now available. SNFs with eligible stays during the CY 2017 performance period can retrieve reports via the Certification and Survey Provider Enhanced Reporting (CASPER) System. Review and submit correction requests for your performance score and ranking information by August 31 at 11:59 pm.
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  • FY 2019 SNF PPS Final Rule Posted

    By CMS - July 31, 2018
    Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program

    This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility ValueBased Purchasing (VBP) Program. 

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  • July 31/August 1 SNF QRP Pre-Training Materials & Updated Agenda Are Now Available (7/18)

    By CMS - July 27, 2018

    Training materials for the upcoming 2-day Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training event on July 31, and Wednesday, August 1, at the Four Seasons Hotel Baltimore (200 International Drive, Baltimore, MD 21202), are now available under the Downloads section below. Training materials include PowerPoint presentations and related materials to complete exercises that will be used during the event. Paper copies of presentations will not be available at the training, so it is recommended that you download and/or print the training materials if you would like to reference them during the training.

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  • SNF QRP FY 2020 Fact Sheet (7/18)

    By CMS - July 22, 2018
    The SNF QRP Reporting Requirements for FY2020 Reporting Year Fact Sheet is now available. This Fact Sheet contains information about requirements for the SNF QRP for the FY 2020 program year, which reflects data collected from 1/1/18–12/31/18. 
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  • AANAC Responds to FY 2019 SNF PPS Proposed Rule: Is Now the Time for PDPM?

    By Jessie McGill, RN, RAC-MT - July 10, 2018
    CMS took the long-term care profession by surprise in April when the SNF PPS Proposed Rule revealed the Patient-Driven Payment Model (PDPM). With a proposed implementation date of October 1, 2019, PDPM would replace RUG-IV without a phase-in or blended transition. CMS provided a 60-day comment period for the public to express concerns, support, and other feedback on the proposed rule, and AANAC responded. Following weeks of collaboration with our sister organization, AADNS, and with the Expert Advisory Panel members from both organizations, members, and other stakeholder groups, AANAC and AADNS jointly submitted 25 pages of comments to CMS. (For purposes of brevity in this article, the issuer of those comments is referred to as AANAC, but the collaborative effort should be understood.)
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  • CMS SNF VBP FAQs (7/18)

    By CMS - July 02, 2018

    Topics covered include:

    • What is the Skilled Nursing Facility Value-Based Purchasing Program?
    • What SNFs are included in the SNF VBP Program?
    • What measure is currently being used in the SNF VBP Program?
    • What is the difference between a planned readmission and an unplanned readmission?
    • When does the SNFRM 30-day readmissions period begin and end?
    • Are the measures in the SNF VBP Program the same as the measures in the SNF Quality Reporting Program (QRP) and on the Nursing Home Compare website?
    • How are performance scores calculated?
    • Will SNFs be able to calculate their achievement and improvement points?
    • How are incentive payments determined?
    • How will SNFs be notified of their performance in the Program?
    • What is Phase One of the Review and Corrections process?
    • How can I correct an error in my patient-level data?
    • What is Phase Two of the Review and Corrections process?
    • Where can I find more information or ask questions about the SNF VBP Program?
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  • Proposed SNF Patient-Driven Payment Model (PDPM) for Medicare Part A: Technical Resources UPDATED (6/18)

    By CMS - June 20, 2018

    In May 2017, CMS released an Advanced Notice of Proposed Rulemaking (ANPRM) which outlined a new case-mix model, the Resident Classification System, Version I (RCS-I), that would be used to replace the existing RUG-IV case-mix model, used to classify residents in a covered Part A stay into payment groups under the SNF PPS. Since the ANPRM, we continued our stakeholder engagement efforts to address the concerns and questions raised by commenters with RCS-I. This resulted in significant changes to the RCS-I model, which have prompted us to rename the proposed model discussed in the FY 2019 SNF PPS Notice of Proposed Rulemaking (NPRM) the SNF Patient Driven Payment Model (PDPM). 

    June 2018 Update: A few typographical and usability issues were recently identified by certain stakeholders with SNF PDPM the classification logic (SNF PDPM Classification Walkthrough, Grouper Tool, and NTA Comorbidity Mapping).  In order to address these issues, CMS has posted revised versions of the three files below. Stakeholders should use these revised SNF PDPM files to inform their comments on the proposed rule.
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  • Expedited Determinations Clarified

    By Caralyn Davis, Staff Writer - June 20, 2018

    Financial liability notification requirements are front and center right now thanks to the implementation of the revised Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) for traditional fee-for-service Medicare Part A skilled care. However, providers still have to fulfill the completely separate notification requirements of the two-stage expedited-determination process for residents who haven’t exhausted their benefits, but whose skilled care is about to end under Medicare Part A, Medicare Part B, or Medicare Advantage, says Stacy Baker, OTR/L, RAC-CT, director of audit services for Proactive Medical Review & Consulting in Evansville, IN. That point recently has been driven home in two ways:


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  • Early August: Look for SNF VBP Annual Performance Scores and Phase 2 Program Review and Corrections (6/18)

    By CMS - June 15, 2018
    Phase Two of the Review and Corrections process will begin when annual performance score reports are made available in the Certification And Survey Provider Enhanced Reports (CASPER) system in early August 2018. Phase Two will allow SNFs 30-days to submit correction requests to their SNF VBP performance score and rank only for the FY 2019 Program year. Over the next several months, CMS aims to provide additional resources and training on the Review and Corrections process and how to submit proper Phase One and Phase Two requests.
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  • PDPM At-a-Glance Tool

    By AANAC - May 15, 2018
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  • Q&A: Are providers allowed to “save” Medicare days for times when the resident has a more pressing skilled need?

    By Jennifer LaBay, RN, RAC-MT - May 14, 2018
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  • SNF VBP Minimum Eligible Stay Threshold Analysis (5/18)

    By CMS - May 07, 2018
    This memo provides analysis to inform the policy consideration of a minimum eligible stay threshold for the quality measure used in the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program— the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510). Specifically, we estimated the reliability of the measure as calculated for various eligible stay thresholds. We also identified the number of SNFs to which the scoring adjustment proposal would be applied at various thresholds.
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  • SNF/LTC ODF News: Section GG Takes Center Stage

    By Caralyn Davis, Staff Writer - May 03, 2018
    The functional scores used to classify patients under the proposed Patient-Driven Payment Model (PDPM) are based on Section GG of the MDS, pointed out officials with the Centers for Medicare & Medicaid Services (CMS) in a review of key aspects of the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule during the May 1 Skilled Nursing Facility/Long-term Care Open Door Forum. This would mark a significant change for providers because the current RUG-IV model uses Section G, as did the Resident Classification System, Version I (RCS-I) model when CMS presented it last year as an initial possibility for revamping the case-mix classification system used in the SNF PPS.
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  • SNF QRP 4Q 2017 Help Desk FAQs (5/18)

    By CMS - May 02, 2018
    A new Question and Answer (Q+A) document is now available in the “Downloads” section of the SNF Quality Reporting Program FAQs webpage. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the fourth quarter (October - December) of 2017.
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  • May 15 SNF QRP Data Submission Deadline: Do These Final Checks

    By Caralyn Davis, Staff Writer - May 01, 2018

    May 15 is a big deadline for the Skilled Nursing Facility Quality Reporting Program (SNF QRP). “According to the Centers for Medicare & Medicaid Services (CMS), this is our last opportunity to do a correction for an entire year’s worth of MDS data,” points out Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.

    “Moving forward, we will only have the opportunity to correct MDSs with errors related to SNF QRP for one quarter at a time,” says Maher. “There won’t be this allowance to review and correct for a whole year.”

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