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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.
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.
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.
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.
This section includes fact sheets on a variety of PDPM related topics.
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.
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.
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.
PDPM Training Presentation
This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.
This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.
Topics covered include:
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:
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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