• Proposed FY 2020 SNF QRP QM Data Specifications and SPADE MDS Items (4/19)

    By CMS - April 19, 2019

    Specifications for the quality measures and standardized patient assessment data elements for the SNF QRP as proposed in the FY 2020 SNF PPS Proposed Rule are now posted.

    In addition, the new and modified sections of the MDS, along with a change table, effective October 1, 2020 for the measures and standardized patient assessment data elements proposed for the SNF QRP in the FY 2020 SNF PPS Proposed Rule are available.

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  • FY 2020 SNF PPS Proposed Rule (4/19)

    By CMS - April 19, 2019

    Proposed Fiscal Year 2020 Payment and Policy Changes for Medicare Skilled Nursing Facilities (CMS-1718-P)

    On April 19, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1718-P] for Fiscal Year (FY) 2020 that updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs). This proposed rule is part of our continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices.  Additionally, effective October 1, 2019, CMS will begin using a new case-mix model, the Patient Driven Payment Model (PDPM), which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment.

    This fact sheet discusses three major provisions of the proposed rule: the proposed changes to SNF payment policy under the SNF Prospective Payment System (PPS), the SNF Value-Based Purchasing Program (VBP), and the SNF Quality Reporting Program (QRP).  This proposed rule includes policies that would continue a commitment to shift Medicare payments from volume to value, with the continued implementation of the PDPM, SNF VBP, and SNF QRP to improve program interoperability, operational quality and safety.

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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - April 18, 2019
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  • Five-Star Technical User's Guide UPDATED AGAIN (4/19)

    By CMS - April 17, 2019

    CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated twice in April 2019.

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  • Five-Star Preview Reports Available; Help Line Open 4/22 - 5/3

    By QTSO - April 17, 2019

    The Five Star Preview Reports will be available on April 17, 2019. To access these reports, select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting system, select the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where st is the 2-character postal code of the state in which your facility is located and facid is the state-assigned Facility ID of your facility.

    Nursing Home Compare will update with April's Five Star data on April 24, 2019.

    Important Note: The 5 Star Help line (800-839-9290) will be available April 22, through May 3, 2019. Please direct your inquiries to BetterCare@cms.hhs.gov if the Help Line is not available.

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  • FInal v1.17.1 MDS Item Sets for Oct. 1, 2019 Implementation (4/19)

    By CMS - April 12, 2019
    A new final version of the 2019 MDS item sets (v1.17.1) has been posted. This version is scheduled to become effective October 1, 2019. The draft item sets include the new IPA and OSA.
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  • PDPM FAQs and Fact Sheets_Revised (4/19)

    By CMS - April 12, 2019

    Fact Sheets

    This section includes fact sheets on a variety of PDPM related topics.

    • Administrative Level of Care Presumption under the PDPM
    • PDPM Payments for SNF Patients with HIV/AIDS
    • Concurrent and Group Therapy Limit
    • PDPM Functional and Cognitive Scoring
    • Interrupted Stay Policy
    • MDS Changes
    • NTA Comorbidity Score
    • PDPM Patient Classification
    • Variable Per Diem Adjustment

    PDPM Frequently Asked Questions

    This section contains frequently asked questions (FAQs) related to PDPM policy and implementation. The PDPM FAQs were updated on 4-4 and then again on 4-11.

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  • PDPM HIPPS Codes: How They Will Be Determined

    By Caralyn Davis, Staff Writer - April 10, 2019

    When the Patient-Driven Payment Model (PDPM) implements as the case-mix classification system for the skilled nursing facility prospective payment system (SNF PPS) on Oct. 1, 2019, SNFs will have to code a new set of health insurance prospective payment system (HIPPS) codes in MDS item Z0100A (Medicare Part A HIPPS code) and on the Part A claim to identify a SNF resident’s payment classification, pointed out officials with the Centers for Medicare & Medicaid Services (CMS) during the Dec. 11 SNF PPS: PDPM National Provider Call. Note: Access the call slides, as well as a transcript and recording, here.


    The RUG-IV system uses a 5-character HIPPS code. “The first three characters represent the patient’s RUG classification, while the last two characters represent the assessment used to classify the patient,” said officials.

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  • SNF QRP APU Timeline: From Data Submission to Reconsideration

    By Caralyn Davis, Staff Writer - April 10, 2019

    The Skilled Nursing Facility Quality Reporting Program (SNF QRP) is an annual program, meaning SNFs must continuously strive to avoid each fiscal year’s two percent SNF QRP data submission penalty for failing to meet the data submission threshold requirement, also known as the annual payment update (APU) requirement, as well as to ensure the accuracy of their SNF QRP quality measures (QMs) for public reporting.

    The way that the SNF QRP is set up, SNFs often have to work on two program years simultaneously. This overlap happens because there is a lag of four and one-half months between the close of a reporting quarter and its data submission deadline. For example, providers currently are finalizing calendar fourth-quarter 2018 MDS data to meet the last reporting deadline, for the FY 2020 (Oct. 1, 2019 – Sept. 30, 2020) program year. Since Jan. 1, SNFs also have been submitting calendar 2019 MDS data in preparation for the upcoming reporting deadlines for the FY 2021 (Oct. 1, 2020 – Sept. 30, 2021) submission requirements.


    Providers need to understand the timeline of what happens when so they can have systems in place to identify and address potential problems timely. Key points in the timeline are discussed below and pulled together into the chart, “Key Dates Impacting Each Fiscal Year’s APU Payment Determinations,” at the end of this article.

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  • FY 2021 SNF QRP Program Requirements Fact Sheet (4/19)

    By CMS - April 10, 2019
    The SNF QRP Requirements for the Fiscal Year 2021 Program Year Fact Sheet is now available for download on the SNF Quality Reporting Program Data Submission Deadlines webpage. This Fact Sheet contains information about requirements for the SNF QRP for the FY 2021 program year, which reflects data collected from 1/1/19–12/31/19.
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  • Appendix B, RAI Manual / State RAI Coordinator Contact List Updated (4/19)

    By CMS - April 10, 2019
    The March 28 update of Appendix B to the RAI Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, RAI Panel members, and Regional Office contacts.
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  • PDPM Training and Technical Resources, Including Grouper Logic & ICD-10 Crosswalks (4/19)

    By CMS - April 05, 2019

    PDPM Training Presentation

    This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.

    PDPM Resources

    This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.

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    By CMS - April 05, 2019

    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 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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  • SNF QRP Review and Correct Reports Now Available (4/19)

    By CMS - April 05, 2019

    The enhanced Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) review and correct reports are now available, on demand in the Certification and Survey Provider Enhanced Reporting (CASPER) application. In addition to enhanced sorting functionality, this report now includes patient level data and automated CSV file creation functionality that contains patient level results. Providers can access these reports by selecting the CASPER Reporting link on the “Welcome to the CMS QIES Systems for Providers” webpage.

    NOTE: You must log into the CMS Network using your CMSNet user ID and password in order to access the “Welcome to the CMS QIES Systems for Providers” webpage.

    In addition to the sorting enhancements and inclusion of resident level data, these reports:

    • Contain quality measure information at the facility level
    • Allow providers to obtain aggregate performance for the past four quarters (when data is available)
    • Include data submitted prior to the applicable quarterly data submission deadlines
    • Display whether the data correction period for a given CY quarter is “open” or “closed.
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  • New Q4FY18 SNF PEPPER Access Instructions and Registration Info for May 2 Web Presentation (4/19)

    By PEPPER - April 05, 2019

    On April 5, the new Q4FY18 Skilled Nursing Facility (SNF) PEPPER was released. Find information here: https://pepper.cbrpepper.org/About-PEPPER/Distribution-Schedule-Get-Your-PEPPER

    The CMS contractor will also hold a web session to review the release.

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