• How Can Deficiency Data Be Used to Get Ahead of Surveyors?

    By Jane Belt, MS, RN, RAC-MT, RAC-MTA, QCP - April 24, 2019

    Meeting and discussing with hundreds of nurse assessment coordinators (NACs) and fielding a wide array of questions about the Resident Assessment Instrument (RAI) process, the Minimum Data Set (MDS), Care Area Assessments (CAAs), and person-centered care plans over the years, it seemed a relatively easy assignment to discuss using deficiency data to provide useful information for the NAC. Survey data also abounds with the full text of statement of deficiencies posted monthly on the Centers for Medicare & Medicaid Services’ (CMS’s) Five-Star Quality Rating System website. With the help of a data analyst, we sifted through over 3,000 records. We looked at the numbers, determined the types of citations most often encountered by the NACs, and identified key issues and trends. To say the least, the data forced this writer to take a new approach and figure out a new angle to tackle the task, , as the cited deficiencies seemed to be much of the information that we have read before when looking at the most frequently cited F-tags. So what does the NAC need to consider in order to avoid the common pitfalls that we often see when the surveyors comb through the records?

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  • The OSA May Be Active Long-Term for Medicaid Case-Mix

    By Caralyn Davis, Staff Writer - April 24, 2019

    Revisions in the April 11 update of Patient-Driven Payment Model: Frequently Asked Questions (FAQs) suggest that the Optional State Assessment (OSA) is no longer a temporary assessment, meaning that it may remain active—and its use may actually expand—in some states for longer than the one fiscal-year (FY) transition period originally set by the Centers for Medicare & Medicaid Services (CMS). Therefore, it’s more vital than ever for nurse assessment coordinators (NACs) in Medicaid case-mix states to understand the OSA and how the October 1 transition of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) to the Patient-Driven Payment Model (PDPM) case-mix classification system from the RUG-IV system can impact their Medicaid nursing facility (NF) payments.

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  • PDPM At-a-Glance Tool

    By AANAC - April 24, 2019
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  • SNF QRP and SPADEs are Center-Stage in FY 2020 SNF PPS Proposed Rule

    By Caralyn Davis, Staff Writer - April 23, 2019

    On April 19, the Centers for Medicare & Medicaid Services (CMS) publicly posted the fiscal year (FY) 2020 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule (CMS-1718-P). While the proposed rule updates the Medicare Part A federal per-diem payment rates, those changes are somewhat overshadowed by multiple proposed policy changes focusing on these key areas:

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  • 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. 

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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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