• At A Glance QM, QRP, and VBP Tool

    By AANAC - September 30, 2020
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  • AHRQ Establishes National Nursing Home COVID Action Network; Oct. 1 Informational Webinar (9/20)

    By AHRQ - September 29, 2020

    Register for Oct 1 (1:30 to 3 ET) informational webinar re: 16-week training program and $6,000 staff time compensation: https://echo.zoom.us/webinar/register/WN_y9fxzhDBSqKnRq_cca3xIw

    Press Release Date: September 29, 2020

    The Agency for Healthcare Research and Quality (AHRQ) is partnering with the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston to establish a National Nursing Home COVID Action Network. The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff.

    Nursing home residents are especially vulnerable to SARS-COV-2 (COVID-19) due to their age, their underlying frailty, and their communal living conditions. And nursing home staff who care for them are among the most needed and most at-risk essential workers. It is estimated that almost 56,000 nursing home residents and staff have died from COVID-19, representing more than one-quarter of the nation’s known COVID-19 deaths.

    "Protecting vulnerable older Americans in nursing homes is a central part of our fight against COVID-19, and we’ve learned that improving infection control in many nursing homes is not a matter of will but of skill," said HHS Secretary Alex Azar. "AHRQ is deploying its unique expertise in partnership with Project ECHO and IHI to help nursing homes protect both their residents and staff from the virus, slowing the spread and saving lives."

    "Expanding the use of proven safety practices will directly benefit nursing home residents and staff members and help save lives," said AHRQ Director Gopal Khanna, M.B.A. "AHRQ has a proven track record of producing science and research to address critical needs such as responding to COVID-19 and achieving 21st century care for all Americans. We are pleased to be working with the ECHO Institute and IHI on this new initiative."

    The new network is being created under an AHRQ contract worth up to $237 million that is part of the nearly $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. While $2.5 billion has already been distributed to help fund testing, personal protective equipment, and other supplies, another $2 billion is available for Medicare and Medicaid-certified nursing homes that show improvement in infection control.

    The ECHO Institute is recruiting academic medical centers and large health centers across the country to serve as training centers for local nursing homes. Over 15,000 nursing homes that are certified to participate in the Medicare and Medicaid programs will be able to participate in a 16-week training program using a standardized curriculum developed by the IHI. Nursing homes that actively participate are eligible to receive $6,000 in compensation to cover staff training time.

    While the curriculum will continue to be refined as new evidence emerges and the pandemic evolves, topics to be covered in the early weeks include:

    • Best Practices in the Use of Personal Protective Equipment for COVID-19.
    • Making the Environment Safe during COVID-19 through Infection Control Practices.
    • Minimizing the Spread of COVID-19.
    • COVID-19 Testing.
    • Clinical Management of Asymptomatic and Mild Cases of COVID-19.
    • Managing Social Isolation during COVID.

    Weekly virtual training sessions will be facilitated by small multidisciplinary teams of subject matter and quality improvement experts. Sessions will combine short lectures that provide immediately usable best practices with case-based group learning. Between sessions, a robust community of practice will foster peer-to-peer learning supported by additional expert consultation.

    "Collaborative education and shared learning is critical for our nonprofit nursing home members on the front line of this pandemic, under often challenging conditions," said Katie Smith Sloan, president and CEO of LeadingAge. "Access to mentors, local experts, community peers, and resources, with a focus on continuous improvement, will go a long way to help mitigate the virus’ spread and ensure the health and safety of older adults."

    Sanjeev Arora, M.D., Project ECHO’s director and founder, said he looks forward to leading the initiative in partnership with AHRQ. "At a time when the dissemination of best practices in health care is more critical than ever, we are honored to help address this urgent need for nursing homes," he said.

    Project ECHO (Extension for Community Healthcare Outcomes) was established to provide training and telementoring for health care professionals and staff across the nation and around the world. It includes over 250 training partners across the United States. AHRQ funded the initial establishment and evaluation of Project ECHO beginning in 2004. The new network’s training program will use the evidence-based process pioneered by Project ECHO and referred to as the ECHO Model, which is an interactive, case-based approach based on adult learning principles.

    "The ECHO model is a proven approach that brings experts and providers together to learn and solve clinical and operational challenges," said Mark Parkinson, President and CEO for the American Health Care Association/National Center for Assisted Living. "We strongly encourage providers to participate in the COVID Action Network to get access to experts and learn the latest best practices to prevent the spread of COVID-19."

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  • Proposed Healthcare-Associated Infections QM: Confidential Dry Run Reports Available in CASPER (9/20)

    By CMS - September 29, 2020

    The Confidential Dry Run Reports for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations Measure are now Available

    The Centers for Medicare & Medicaid Services (CMS) would like to announce the Confidential Dry Run Reports containing FY 2018 and FY 2019 performance scores for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations measure (SNF HAI measure) are now available. Performance scores are based on the draft measure specifications posted on CMS Measure Management Public Comment page. Providers can view these reports in their Certification and Survey Provider Enhanced Reports (CASPER) provider shared folders. These reports are accompanied by a Data Dictionary defining key measure terms.

    The purpose of these Confidential Dry Run Reports is to allow SNFs to become familiar with this measure and to inform them of their performance in comparison to their peers. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs and to statistically distinguish between SNFs that are either better than or worse than their peers in infection prevention and in infection management. SNFs may choose to incorporate this measure into their internal quality assurance activities to improve patient outcomes. Review and use of this measure information is strictly voluntary.

    Please send any questions or feedback on this measure via email to: SNFQualityQuestions@cms.hhs.gov.  


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  • MDS 3.0 Provider User's Guide Updated, Including Validation Rpt Error Messages (9/20)

    By QTSO - September 29, 2020
    Key information about how to submit MDS files and how to obtain and understand error messages on initial and final validation reports. 
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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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  • State PDPM Data Collection Map Tool

    By AANAC - September 28, 2020
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  • CMS COVID-19 Guidance: Emergency Preparedness Testing Exercise Requirements (9/20)

    By CMS - September 28, 2020

    CMS QSO Memo: Guidance related to the Emergency Preparedness Testing Exercise Requirements- Coronavirus Disease 2019 (COVID-19)

    Memo # QSO-20-41-ALL

    Posting Date 2020-09-28

    Fiscal Year 2020

    Summary

    • Emergency Preparedness Testing Exemption and Guidance - CMS regulations for Emergency Preparedness require specific testing exercises be conducted to validate the facility’s emergency program. During or after an actual emergency, the regulations allow for an exemption to the testing requirements based on real world actions taken by providers and suppliers.

    • This worksheet presents guidance for surveyors, as well as providers and suppliers, with relevant scenarios on meeting the testing requirements in light of many of the response activities associated with the COVID-19 Public Health Emergency (PHE).

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  • CMS QSO Life Safety Code Memo: Categorical Waiver – Corrugated Medical Tubing (9/20)

    By CMS - September 28, 2020
    Memo # QSO-20-40-LSC

    Posting Date 2020-09-24

    Fiscal Year 2020

    Summary

    • CMS regulation requires compliance with the 2012 edition of the NFPA Health Care Facilities Code (NFPA 99) for Ambulatory Surgical Centers, Critical Access Hospitals, End-Stage Renal Disease, Hospitals, Inpatient Hospice, Intermediate Care Facilities for Intellectuals with Disabilities, Long-term Care, Programs for All-Inclusive Care of the Elderly, and Religious Nonmedical Health Care Institutions facilities.

    • The 2012 NFPA 99 requires medical gas and vacuum system tubing to be rigid copper tubing and does not allow for the use of corrugated medical tubing (CMT).

    • In certain applications, the inability to use CMT may be considered an unreasonable hardship as the installation of CMT may be more efficient and economical.

    • CMS is issuing a categorical waiver to allow the use of CMT in new and existing health care facilities based on provisions provided in the 2018 NFPA 99.

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  • jRAVEN 1.7.4 Free MDS Submission Software Updated (9/20)

    By CMS - September 24, 2020

    The Resident Assessment Validation and Entry System (jRAVEN) was developed by the Centers for Medicare & Medicaid Services (CMS). jRAVEN is a free Java based software application which provides an option for facilities to collect and maintain MDS Assessment data for subsequent submission to the appropriate state and/or national data repository. jRAVEN displays the MDS Item Sets similar to the paper version of the forms. Please consult the jRAVEN Installation and User Guides for additional information.

    jRAVEN (version 1.7.4) is now available for download which contains the following updates:  

    1. Changes in support of the MDS Item Set v1.17.2, effective 10/1/2020
    2. Changes in support of the Data Specification Errata v3.00.5, issues 06 - 16
    3. The new MDS VUT, v3.4.0, also updated for issues 06 - 16 of Errata v3.00.5
    4. The new PDPM Grouper, v1.0006, updated to include the new ICD Code Tables
       

    Beginning October 1, 2020, states will have the option to direct their providers to have the PDPM Grouper score calculated on the standalone OBRA comprehensive and quarterly assessments. In support of this a new State PDPM OBRA flag has been defined that will be used to indicate if and when the provider will be having the PDPM payment score calculated on these standalone OBRA assessments. For more detailed information on how to set the new State PDPM OBRA flag in jRAVEN 1.7.4, please refer to the “Grouper Configuration” section of the jRAVEN User Guide 1.7.4 that is downloaded with the jRAVEN application and also available in the “References & Manuals” QTSO page for Nursing Home/Swing Bed Providers. Providers whose States require these items should follow the RAI User’s Manual coding guidance and refer to State-specific guidance for additional State-specific coding instructions. Please confirm with your State Medicaid Agency if your State will require the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment.

    Note that the State PDPM OBRA flag will also be displayed (read-only) on the assessment screen at the bottom of Section Z for assessments with target dates on and after October 1, 2020.

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  • COVID-19 Medicare FAQs Updated (9/20)

    By CMS - September 24, 2020
    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.

    The Centers for Medicare & Medicaid Services (CMS) released an additional list of Frequently Asked Questions (FAQs) to Medicare providers regarding the Department of Health & Human Services’ (HHS) Provider Relief Fund and the Small Business Administration’s Paycheck Protection Program payments, also referred to as coronavirus disease 2019 (COVID-19) relief payments.  The FAQs provide guidance to providers on how to report provider relief fund payments, uninsured charges reimbursed through the Uninsured Program administered by Health Resources and Services Administration, and Small Business Administration (SBA) Loan Forgiveness amounts. The FAQs also address that provider relief fund payments should not offset expenses on the Medicare Cost Report. 


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  • CMS QSO Memo Offers New Guidance for Nursing Home Visitations During COVID-19 Public Health Emergency (9/20)

    By CMS - September 19, 2020

    Memorandum Summary

    • CMS is committed to continuing to take critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

    • Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE. The guidance below provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.

    • Use of Civil Money Penalty (CMP) Funds: CMS will now approve the use of CMP funds to purchase tents for outdoor visitation and/or clear dividers (e.g., Plexiglas or similar products) to create physical barriers to reduce the risk of transmission during in-person visits.


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  • CMS Five-Star Ratings and COVID-19 Outbreaks: CDC Finds Associations (9/20)

    By CDC - September 18, 2020

    Summary

    What is already known about this topic?

    Nursing homes are high-risk settings for COVID-19 outbreaks. The Centers for Medicare & Medicaid Services (CMS) publishes star quality ratings of all CMS-certified nursing homes.

    What is added by this report?

    During March–June 2020, 14 (11%) of 123 West Virginia nursing homes experienced COVID-19 outbreaks. Compared with 1-star–rated (lowest rating) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star–rated facilities and 94% lower among 4- to 5-star–rated facilities.

    What are the implications for public health practice?

    CMS star ratings can serve as proxy indicators for COVID-19 outbreak risk; health departments could use them to identify priority nursing homes and inform the allocation of infection prevention and control resources.

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  • FY 2021 ICD-10 Code Lookup File for MDS Item I0020B

    By CMS - September 17, 2020
    The lookup files containing the allowable ICD codes for item I0020B have been updated for FY2021, and is posted as a ZIP file. 
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  • Final PDPM Grouper DLL V1.0006 Effective Oct. 1, 2020

    By CMS - September 17, 2020

    The FINAL version of the PDPM Grouper DLL V1.0006 has been posted, along with its source code and test cases.  This version supports the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets.  Note that the grouper will return 4-character codes for these OBRAs.

    It is important to include the control item STATE_PDPM_OBRA_CD (as defined in the V3.00.5 errata for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications) for assessments with target date on or after October 1, 2020.  

    Note that this FINAL version supports the ICD-10 codes that are defined in the data specifications as valid for item I0020B for FY2021.  Also, please note that the grouper expects valid FY2021 ICD-10 codes for I8000A-J when processing assessments with target date on or after October 1, 2020.  

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  • Independent Nursing Home COVID-19 Commission Findings (9/20)

    By CMS - September 16, 2020
    The Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE.  CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the coronavirus disease 2019 (COVID-19) in nursing homes. The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. Today’s announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.

    Nursing homes and other shared or congregate living facilities have been severely affected by COVID-19, as these facilities often house older individuals who suffer from multiple medical conditions, making them particularly susceptible to complications from the virus. To help CMS inform immediate and future actions as well as identify opportunities for improvement, the Commission was created to conduct an independent review and comprehensive assessments of confronting COVID-19. The Commission’s report contains best practices that emphasize and reinforce CMS strategies and initiatives to ensure nursing home residents are protected from COVID-19.

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