• 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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  • Don’t Delay Using Health Literacy in Your Care Planning and Discharge Planning Process

    By Jessie McGill, RN, RAC-MT, RAC-MTA - September 15, 2020

    Mrs. Elderberry is ready to go home. It’s been five long weeks of rehabilitation following a broken hip from that clumsy slip on a rug. Home. She’s wondering if her son actually watered her house plants that she proudly kept vibrant for years. Home. The nurse called her attention back to the medication list they were reviewing and asked which pharmacy she preferred. Mrs. Elderberry recited the name of the drugstore down the street and silently thought about enjoying coffee with the neighbor ladies. Maybe she could host this Sunday? Home. The nurse asked if she had any questions regarding her medications. She smiled and said no, thinking her son could explain it more clearly once she was home.


    Discharge planning is an essential piece of a successful return to the community. However, assessing the resident’s health literacy is another critical piece that is necessary for effective planning. The U.S. Department of Health and Human Services (HHS) defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make an appropriate health decision. While the assessment of health literacy is not yet a required part of the resident assessment process in skilled nursing facilities (SNFs), it should still be incorporated into the care planning and discharge planning process.


    In the SNF Prospective Payment System (PPS) Fiscal Year (FY) 2020 Final Rule, the Centers of Medicare and Medicaid Services (CMS) finalized health literacy as a Standardized Patient Assessment Data Element (SPADE). It stated, “low health literacy can interfere with communication between the provider and resident or patient and the ability for residents and patients or their caregivers to understand and follow treatment plans, including medication management. Poor health literacy is linked to lower levels of knowledge about health, worse health outcomes, and the receipt of fewer preventive services, but higher medical costs and rates of emergency department use.”

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  • FY 2021 ICD-10 Coding Updates: How to Prepare

    By Caralyn Davis, Staff Writer - September 15, 2020

    On Oct. 1, the revised fiscal year (FY) 2021 ICD-10-CM code sets and FY 2021 ICD-10-CM Official Guidelines for Coding and Reporting go into effect. Understanding these annual updates is crucial. ICD-10 coding accuracy has always been key to submitting clean claims and sharing relevant diagnoses with other healthcare providers to ensure quality of care. However, it has grown even more important since the implementation of the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment System (SNF PPS), which uses ICD-10 codes in MDS items I0020B (ICD Code/Resident’s Primary Medical Condition) and I8000 (Additional Active Diagnoses) to classify residents into case-mix groups—not to mention the ICD-10 codes that risk-adjust certain quality measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP).


    Here’s what nurse assessment coordinators (NACs) and other coders should know to be ready to implement the FY 2021 ICD-10 codes:


    COVID-19 guideline revisions

    “The biggest change to the Coding Guidelines is that there is a whole section on COVID-19 coding guidelines,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding and compliance at AHIMA in Chicago. “This section duplicates some of the interim COVID-19 coding guidelines that were released in April. However, it also expands and clarifies some of those interim guidelines.”


    Changes to the COVID-19 guidelines from April include the following:

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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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  • COVID-19 Testing and Reporting Requirements: Summary Slide Deck (9/20)

    By CMS - September 10, 2020

    CMS slide deck summarizing resident and staff testing  and reporting requirements, considerations for using and interpreting antigen tests, and educational resources and training available to nursing homes.

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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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  • Resource: Discharge Planning During the COVID-19 Pandemic (9/20)

    By HHS - September 09, 2020

    HHS' Assistant Secretary for Preparedness and Response recently published Discharge Planning and Care Coordination during the COVID-19 Pandemic, a resource developed in partnership with ACL and the Centers for Medicare & Medicaid Services.


    This tool is designed to support nurses, social workers, case managers, and others conducting discharge planning for adults with disabilities after COVID-19 treatment.

    The resource:

    • Describes legal protections for people with disabilities including the Olmstead decision;
    • Explains the CMIST (Communication, Maintaining Health, Independence, Services and Support, Transportation) framework and person-centered planning;
    • Provides considerations for three potential discharge scenarios to facilitate person-centered discharge planning and care coordination to the most integrated setting; and
    • Highlights state and federal resources, including the aging and disability networks, to assist care coordinators and discharge planners.
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  • COVID-19 County Positivity Rates: Monitor to Adjust Staff Testing (9/20)

    By CMS - September 08, 2020
    COVID-19 Testing 
    As part of CMS’ commitment to protecting nursing home residents, and to boost the surveillance of COVID-19, nursing homes are now required to conduct testing of residents and staff.  More information about these requirements and guidelines can be found here.  These guidelines include testing staff on a certain frequency based on the COVID-19 positivity rate for the county the nursing home resides in.  Rates of county positivity are posted here. (Archive is here.) Facilities should monitor these rates every other week and adjust staff testing accordingly.
    Supporting COVID-19 Testing
    The Department of Health and Human Services, Office of the Assistant Secretary for Health (OASH), recently announced that we will begin providing nursing homes with a Point of Care (POC) rapid response testing instrument to bolster each facility’s ability to prevent the spread of COVID-19. The data collected through the NHSN system directly supports this initiative by helping to prioritize the nursing homes with testing needs and an increasing number of cases. For the methodology describing how facilities are prioritized, and a listing of the facilities, please click here. A list of frequently asked questions (FAQs) is also available here.

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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.


    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.


    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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  • 5 Tips on Managing an Organized MDS Department

    By Jessica Kunkler, MA - September 01, 2020

    Managing an organized MDS department is difficult even in the best of times. Under the stresses of a pandemic, it can be much harder, but difficult days make a well-run department all the more important.


    When COVID-19 hit Kristie Bacher’s, RN, BS, RAC-CTA, RAC-CT, CPC, QCP, facility, the MDS Department went into overdrive, getting creative with the delegation work responsibilities, offering work from home flexibilities, and putting forth the necessary extra effort to keep residents connected with loved ones in untraditional ways.  

    Here are five ways to organize your MDS department, according to experts Kristie Bacher, RN, BS, RAC-CTA, RAC-CT, CPC, QCP, MDS manager in New York State, and Jessie McGill, RN, RAC-MT, curriculum development specialist at AAPACN, so that when challenging times come, your department is ready.


    1. Encourage communication and fluid accountability.

    The completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) both require an interdisciplinary process. Team members should understand how their responsibilities fit with others’ responsibilities and actively communicate about contingencies, according to McGill.

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  • MDS Section L and Care Planning: Insights From a Speech-Language Pathologist

    By Caralyn Davis, Staff Writer - September 01, 2020

    MDS item L0200 (Dental) often gets limited attention even though it fuels the Dental Care care area assessment (CAA), one of 20 CAAs that can be triggered in response to MDS coding (i.e., care area triggers or CATs) and then must be analyzed by the interdisciplinary team (IDT) to help develop individualized resident care plans. The following excerpt adapted from chapter 4, “Care Area Assessment Process and Care Planning,” of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual explains the importance of the Dental Care CAA and shows the CAT logic:

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  • Sept 22 CMS National Partnership to Improve Dementia Care and QAPI Call to Address COVID-19: Register Now

    By CMS - August 31, 2020
    Date 2020-09-22

    Event Dementia Care Call

    Topic Dementia Care in Nursing Homes

    When: Tuesday, September 22, 2020, from 1:30 to 3 pm ET

    Registration:  Register for Medicare Learning Network events.

    Event Materials:

    ·         Presentation: Available prior to the event

    ·         Audio recording and transcript: Available approximately 2 weeks after the event

    National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement

    During this call, learn about the unique challenges facing nursing home residents living with dementia during the COVID-19 pandemic and best practices to support them. A question and answer session follows the presentations.

    ·         Cathleen Lawrence and Dara Graham, CMS

    ·         Kara Jacobs Slifka, MD, MPH, Centers for Disease Control and Prevention

    ·         Douglas Pace, Alzheimer’s Association

    Target Audience: Consumer and advocacy groups; nursing home providers; surveyor community; prescribers; professional associations; and other interested stakeholders.

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  • LTCSP Survey Resources: Surveyor Tools Updated (8/20)

    By CMS - August 31, 2020


    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).


    COVID-19 Focused Survey folder

    Updated the following:

    • CMS Memorandum QSO-20-38-NH Added a new requirement related to the testing of residents and staff for COVID-19 (F886) and provides surveyor guidance.

    • COVID-19 Focused Survey for Nursing Homes

    Added two critical elements (CE)- #10 CE Infection Preventionist (IP) and #11 Staff and Resident Testing.

    Added instructions for selecting a sample of residents and staff. Provided updates based on CMS’ Nursing Home Reopening Guidance (QSO-20-30-NH) and CDC recommendations.

    • COVID-19 Focused Survey Protocol Revised to incorporate changes related to the nursing home testing requirements.

    • Entrance Conference Worksheet Revised to include documentation related to the nursing home testing requirements.

    • Mapping document Added the following tags: F847, F848, F882, F884, F885, F886 • F-Tag Job Aid- Added tags F882 and F886. 

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