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The Centers for Medicare & Medicaid Services (CMS) has released two additional pieces of the puzzle to help nurse assessment coordinators (NACs) understand what MDS and other RAI changes will be implemented on Oct. 1, 2018. In November 2017, CMS posted the draft MDS item sets v1.16.0. Now the agency has released the draft MDS submission specs v2.02.0 and the MDS 3.0 care area trigger (CAT) specifications v1.03.0.
The picture will remain somewhat fuzzy until CMS releases the corresponding update to the RAI Manual, which will include the all-important coding instructions. However, taken together, the available documentation offers critical information about what’s coming, including MDS item changes, CAT changes, and new error messages for MDS submissions to the QIES ASAP system.
The Resident Classification System Version I (RCS-I) was introduced in May 2017 in the CMS Advance Notice of Proposed Rulemaking. The RCS-I would replace the skilled nursing facility Medicare A payment system, RUGs-IV, with a vastly different set of payment criteria. CMS collected public comments in late August and then went radio-silent, leaving long-term care professionals to speculate about what is going to happen. All indications seem to point toward the same conclusion: RCS-I is coming … but when?
In any case, there is no need to sit idly by waiting for an announcement. We can get a jump on this monumental change and start taking it in piece by piece. Here are five big-bucket items you need to know to understand the fundamentals of RCS-I.
Nursing homes across the United States routinely give antipsychotic drugs to residents with dementia to control their behavior, despite rules against the misuse of drugs as “chemical restraints,” Human Rights Watch said in a report and video released today. This abusive practice remains widespread, even though the use of antipsychotic drugs on older people with dementia is associated with a nearly doubled risk of death.
The 157-page report, “‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” estimates that every week in US nursing facilities, more than 179,000 people, mostly older and living with dementia, are given antipsychotic drugs without an appropriate diagnosis. Facilities administer these drugs in many cases without obtaining informed consent from residents or their families.
The report is based on visits by Human Rights Watch researchers to more than 100 nursing facilities in six states and more than 300 interviews with people living in facilities, their families, staff, long-term care and disability experts, government officials, and advocates.
During this call, gain insight on the phase two changes for person-centered care planning and discharge planning. Also, learn about the new Alzheimer’s Association Dementia Care Practice Recommendations. Additionally, CMS shares updates on the progress of the National Partnership to Improve Dementia Care in Nursing Homes. A question and answer session follows the presentations.
A new version (V2.02.0) of the MDS 3.0 Data Specifications was posted. This version is scheduled to become effective October 1, 2018. This DRAFT version incorporates the changes identified for the DRAFT version (v1.16.0) of the MDS 3.0 item sets. Note that there are significant changes to Section GG, I, J and M.
In addition, a new version (V1.03.0) of the MDS 3.0 CAT Specifications was posted. This version is also scheduled to become effective October 1, 2018. The specification for CAT 16 (Pressure Ulcer) has been updated in accordance with the changes in V2.02.0 of the MDS 3.0 Data Specifications.
CMS updated these Long-term care survey process (LTCSP) FAQs on Feb. 6, 2018. Topics covered:
A. 483.10 Resident Rights; B. 483.12 Freedom from Abuse, Neglect, and Exploitation; C. 483.15 Admission, Transfer, and Discharge; D. 483.20 Resident Assessments; E. 483.21 Comprehensive Resident Centered Care Plans; F. 483.24 Quality of Life; G. 483.25 Quality of Care; H. 483.30 Physician Services; I. 483.35 Nursing Services; J. 483.40 Behavioral Health Services; K. 483.45 Pharmacy Services; L. 483.50 Laboratory, Radiology, and Other Diagnostic Services; M. 483.55 Dental Services; N. 483.60 Food and Nutrition Services; O. 483.65 Specialized Rehabilitative Services; P. 483.70 Administration, F838 Facility Assessment; Q. 483.75 Quality Assurance and Performance Improvement (QAPI); R. 483.80 Infection Control; S. 483.85 Compliance and Ethics Program; T. 483.90 Physical Environment; U. 483.95 Training Requirements; V. LTC Survey Process Training; W. LTC survey Process; and Z. General Questions.
CMS has released a newly revised SNFABN along with newly developed, concise and separate instructions for form completion. The revised SNFABN has the requirements from the denial letters and looks very similar to the ABN with 3 different options.
CMS will be discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (NEMB-SNF). Since the NEMB-SNF was used as a voluntary notice for care that is never covered by Medicare, CMS will continue to encourage SNFs to issue the revised SNFABN in this voluntary capacity. Chapter 30, Section 70 of the Medicare Claims Processing Manual revisions will be forthcoming.
The revised SNFABN will be mandatory for use on May 7, 2018.
The reports and report package in the MDS 3.0 QM Reports category are now available for your use.
The MDS 3.0 Facility Level Quality Measure Report has been updated to include the following new measures:
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