• At A Glance QM, QRP, and VBP Tool

    By AANAC - September 30, 2020
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (9/20)

    By QTSO - September 29, 2020
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • SNF Healthcare-Associated Infections (HAI) Measure: Public Comments Due by Oct. 14

    By CMS - September 14, 2020

    The Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is seeking input from the public as part of the measure development process. CMS has posted Draft Measure Specifications: SNF Healthcare-Associated Infections Requiring Hospitalizations for the SNF QRP (SNF HAI measure).  This document contains conceptual and technical measure information and provides a link to the Final Technical Expert Panel Summary Report: Development of a Healthcare-Associated Infections Quality Measure for the SNF QRP for the public’s review.  Please review both of these documents and give us your feedback via the email:  SNFQualityQuestions@cms.hhs.gov.  

    CMS would also like to announce the SNF HAI measure will be a part of the Measures Under Consideration list later this year and it is our intention to present this measure for pre-rulemaking review at the Measure Applications Partnership Post-Acute Care/Long-Term Care Workgroup meeting in December.  CMS will be providing Confidential Dry Run Reports to alert each SNF of their SNF HAI performance score based on these draft measure specifications later this summer.

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  • SNF QRP Measure Calculations and Reporting User's Manual Plus Version 3.0.1 Addendum (9/20)

    By CMS - September 10, 2020

     

    The SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available.

    This ZIP file includes:

    1. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum provides measure-related changes specified in a change table format in lieu of a complete update to the overall manual. Use this addendum to update the v3.0 manual.
    2. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 Risk Adjustment Appendix File contains current and historical intercept values, coefficient values, and the risk-adjustment schedule for each risk-adjusted quality measure reported under the SNF QRP. 
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  • $2 Billion Provider Relief Fund Nursing Home Incentive Payment Plans (9/20)

    By HHS - September 03, 2020

     Under the leadership of President Trump, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the latest update in the previously announced $5 billion in planned support to nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Other resources are also being dedicated to support training, mentorship and safety improvements in nursing homes.

    "The Trump Administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes," said HHS Secretary Alex Azar. "By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives."

    Nursing homes have been particularly hard hit by this pandemic. By tying continued relief payments to patient outcomes, the Trump Administration is demonstrating its commitment to preserving the lives and safety of America's seniors, who are especially vulnerable to COVID-19. Nursing homes will not have to apply to receive a share of this $2 billion incentive payment allocation; HHS will be measuring nursing home performance through required nursing home data submissions and distributing payments based on these data.

    Qualifications

    In order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from the Centers for Medicare & Medicaid Services (CMS). HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one of three data sources that will be used to establish eligibility and collect necessary provider data to inform payment: Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS).

    Performance and Payment Cycle

    The incentive payment program is scheduled to be divided into four performance periods (September, October, November, December), lasting a month each with $500 million available to nursing homes in each period. All nursing homes or skilled nursing facilities meeting the previously noted qualifications will be eligible for each of the four performance periods. Nursing homes will be assessed based on a full month's worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month's performance period.

    Methodology

    Using data from the Centers for Disease Control and Prevention (CDC), HHS will measure nursing homes against a baseline level of infection in the community where a given facility is located. CDC's Community Profile Reports (CPRs) include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity. Against this baseline, facilities will have their performance measured on two outcomes:

    • Ability to keep new COVID infection rates low among residents.
    • Ability to keep COVID mortality low among residents.

    To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) LTCF COVID-19 module. CMS issued guidance in early May requiring that certified nursing facilities submit data to the NHSN COVID-19 Module.  Data from this module will be used to assess nursing home performance and determine incentive payments.

    HHS will continue to provide more updates as it works to assist providers in slowing the spread of infection while simultaneously offering financial support to these frontline heroes combating the pandemic. Funding for this nursing home incentive effort was made possible from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act.  Incentive payments will be subject to the same Terms and Conditions applicable to the initial infection control payments announced last week (available here - PDF).

    For updates and to learn more about the Provider Relief Program, visit: hhs.gov/providerrelief.

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  • Beneficiary Notice Guidelines Tool

    By AANAC - July 07, 2020
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  • May 8: CMS Interim Final Rule Requirements re: COVID-19 Reporting and the SNF QRP Go Into Effect (5/20)

    By CMS - May 04, 2020

    Note that the COVID-19 reporting and SNF QRP reporting changes both will go into effect on May 8 since the effective date is the publication date.

    Medicare and Medicaid Programs, Basic Health Program, and Exchanges: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program

    ACTION: Interim final rule with comment period.

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     


    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

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  • CMS Relaxes SNF QRP Data Submission Requirement Changes, SNF VBP Data Changes Due to COVID-19 (3/20)

    By CMS - March 23, 2020

    CMS is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. These actions are part of CMS’s response to 2019 Novel Coronavirus (COVID-19).

     

    Specifically, CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines that will impact both the SNF QRP and the SNF VBP.

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  • PAC/SNF QRP Web-Based Training From CMS on Oct. 1, 2020 Changes

    By CMS - February 04, 2020

    The Centers for Medicare & Medicaid Services (CMS) is offering a quick web-based training to walk providers through upcoming changes to the Quality Reporting Programs (QRPs) for the following post-acute care settings along with an overview of existing and upcoming training activities designed to support providers in successfully complying with associated reporting requirements:

    o    Home Health

    o    Inpatient Rehabilitation Facility (IRF)

    o    Long-Term Care Hospital (LTCH)

    o    Skilled Nursing Facility (SNF)


    This web-based training will:

    • Demonstrate how the quality measures used in the Home Health, IRF, LTCH, and SNF QRPs tie to CMS’ Meaningful Measures Initiative;  
    • Provide a detailed list of data elements that have already been incorporated into the post-acute care QRPs along with those being implemented in the IRF, LTCH, and SNF care settings on October 1, 2020, and the Home Health care setting on January 1, 2021;
    • Provide links to training resources to support providers in implementing existing reporting requirements associated with the QRPs; and
    • Offer a preview of upcoming training activities to support the implementation of new reporting requirements, including dates, so that providers can begin to plan to incorporate these important training events into their busy schedules.

    If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk for your care setting.

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  • SNF PPS Fact Sheet From Medicare Learning Network - Revised (1/20)

    By CMS - February 03, 2020
    The basics of SNF PPS and consolidated billing.
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  • CMS Section GG Training Videos: GG0130A, GG0110, GG0170C, GG0130B, Decision Tree for GG0130/GG0170 (10/19)

    By CMS - October 18, 2019

    These apply to all four QRP programs, including the SNF QRP:

    • Coding GG0130A. Eating (6:19)The Centers for Medicare & Medicaid Services is releasing a short video tutorial to assist providers with coding GG0130A. Eating. This 6-minute video is designed to provided targeted guidance using simulated patient scenarios.
    • GG0110 Prior Device Use with Information From Multiple Sources. This 4-minute video demonstrates how a caregiver can utilize information collected from multiple scenarios to accurately code GG0110. Prior Device Use. 
    • Decision Tree for Coding Section GG0130. Self-Care and GG0170. Mobility. This 12-minute video demonstrates how to apply the six-point coding scale to GG0130. Self-Care and GG0170. Mobility using GG0170D. Sit to stand as an example.
    • Coding GG0170C. Lying to sitting on side of bed This 4-minute video demonstrates how to distinguish between Code 02, Substantial/maximal assistance and Code 03, Partial/moderate assistance when coding GG0170C. Lying to sitting on side of bed.
    • Coding GG0130B. Oral HygieneThis 4-minute video demonstrates how to distinguish between Code 05, Set-up or clean-up assistance and Code 04, Supervision or touching assistance when coding GG0130B. Oral Hygiene. 
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  • Skilled or Not? Tool - REVISED

    By AANAC - October 02, 2019
    Understanding the technical and skilled level of care requirements for Medicare Part A is always a challenge. We’ve broken down the process with this exclusive tool.


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  • MDS Items Impacting Reimbursement for RUG-IV, PDPM, and SNF QRP

    By AANAC - September 25, 2019
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  • PDPM At-a-Glance Tool

    By AANAC - August 07, 2019
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  • FY 2021 SNF QRP Table for Reporting Assessment-Based Measures (6/19)

    By CMS - June 11, 2019
    The SNF QRP Table for Reporting Assessment-Based Measures for the FY 2021 SNF QRP APU is now available for download on the Skilled Nursing Facility (SNF) Quality Reporting Program Measures and Technical Information webpage. This table indicates the MDS data elements that are used in determining the APU minimum submission threshold for the FY 2021 SNF QRP determination.
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