• FY 2022 SNF QRP Quick Reference Guide (2/20)

    By CMS - February 18, 2020
    Quick Reference Guide for FY 2022 is now available. The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links.
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  • FY 2021 SNF QRP Quick Reference Guide (2/20)

    By CMS - February 18, 2020

    Quick Reference Guide for FY 2021 is now available. The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links.

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  • CMS Proposes PASRR Changes (2/20)

    By CMS - February 18, 2020

    DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431, 433, 435, 441, and 483 [CMS-2418-P] RIN 0938-AT95 Medicaid Program; Preadmission Screening and Resident Review

    AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION: Proposed rule.

    SUMMARY: This proposed rule would modernize the requirements for Preadmission Screening and Resident Review (PASRR), currently referred to in regulation as Preadmission Screening and Annual Resident Review, by incorporating statutory changes, reflecting updates to diagnostic criteria for mental illness and intellectual disability, reducing duplicative requirements and other administrative burdens on State PASRR programs, and making the process more streamlined and person-centered.

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  • CMS QSO Memo Explains 2 New Toolkits to Ensure Safety and Quality in Nursing Homes (2/20)

    By CMS - February 18, 2020

    CMS developed optional toolkits to aid nursing home teams with reducing adverse events and improving dementia care. These toolkits were the result of CMS work with nursing home Breakthrough Communities—a learning collaborative design where a subset of nursing homes joined learning sessions and team calls to learn about quality improvement concepts.

    Memorandum Summary

    The Centers for Medicare & Medicaid Services (CMS) is announcing the release of two toolkits that align with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes.

    • Developing a Restful Environment Action Manual (DREAM) Toolkit – CMS has created a toolkit that offers education and person-centered, practical interventions that nursing home administrators, directors of nursing, and bedside staff can implement to promote high-quality sleep for residents living with dementia.

    • Head-to-Toe Infection Prevention (H2T) Toolkit – CMS has created a toolkit that offers educational materials and practical interventions for bedside staff designed to prevent common infections by improving activities of daily living (ADL) care.

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  • CMS QSO Memo re: Coronavirus and Healthcare Facility Expectations (2/20)

    By CMS - February 10, 2020

    Memo #20-09-ALL

    Posting Date 2020-02-06

    Fiscal Year 2020

    Summary

    • Information Regarding Patients with Possible Coronavirus Illness: the U.S. Centers for Disease Control and Prevention (CDC) has issued information on the respiratory illness caused by the 2019 Novel Coronavirus (2019-nCoV). Links to these documents are provided.
    • Healthcare Facility Expectations: CMS strongly urges the review of CDC’s guidance and encourages facilities to review their own infection prevention and control policies and practices to prevent the spread of infection.
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  • Do You Know Who Your New QIN-QIO Is? (2/20)

    By Staff - February 05, 2020

    In November 2019, the Centers for Medicare & Medicaid Services quietly implemented the 12th Statement of Work for the Quality Improvement Network Quality Improvement Organizations (QIN-QIOs).

    This five-year contract includes a shift in how/where the QIN-QIOs operate. There are now 14 Medicare-funded QIN-QIOs nationwide. For example, IPRO is a lead contractor partnering with two other QIOs to cover 11 states and the District of Columbia. IPRO will direct activities in New York, New Jersey, and Ohio; Healthcentric Advisors will cover all six New England states (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island); and Qlarant will handle Maryland, Delaware, and the District of Columbia.

    "QIN-QIOs serving under the 12th Statement of Work will provide customized quality improvement to nursing homes and providers, serving rural communities and the most vulnerable populations. Through this body of work, CMS is focusing on results, protecting taxpayer dollars, and most importantly, ensuring the safety and quality of care delivered to every Medicare beneficiary," says HealthCentric Advisors.

     The QIN-QIOs will address nursing home and community coalition quality improvement in the following areas:

    • Improving Behavioral Health Outcomes – Including Opioid Misuse
    • Increasing Patient Safety
    • Increasing Chronic Disease Self-Management
    • Increasing the Quality of Care Transitions
    • Improving Nursing Home Quality
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  • MDS 3.0 Quality Measures (QM) User's Manual V13.0 (2/20)

    By CMS - February 05, 2020

    The MDS 3.0 QM User’s Manual V13.0 and Quality Measure Reporting Module Table V1.8 have been posted. The MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V13.0 can be found in the Downloads section of this webpage and the MDS 3.0 QM User’s Manual V12.1 has been moved to the Quality Measures Archive webpage.

    The Quality Measure Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module, with a unique CMS identification number specified for each QM. The Quality Measure Reporting Module Table V1.8 can be found in the Downloads section of this webpage and the Quality Measure Reporting Module Table V1.7 has been moved to the Quality Measures Archive webpage.

    Two files related to the MDS 3.0 QM User’s Manual have been posted:

    1. MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V13.0 is included in the zip file titled User Manuals - Updated 01-21-2020 (ZIP).
    2. Quality Measure Identification Number by CMS Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. A unique CMS identification number is specified for each QM.

    The MDS 3.0 QM User’s Manual V13.0 and Quality Measure Reporting Module Table V1.8 have been posted. The MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V13.0 can be found in the Downloads section of this webpage and the MDS 3.0 QM User’s Manual V12.1 has been moved to the Quality Measures Archive webpage. The Quality Measure Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module, with a unique CMS identification number specified for each QM. The Quality Measure Reporting Module Table V1.8 can be found in the Downloads section of this webpage and the Quality Measure Reporting Module Table V1.7 has been moved to the Quality Measures Archive webpage.

    Two files related to the MDS 3.0 QM User’s Manual have been posted:

    1. MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V13.0 is included in the zip file titled User Manuals - Updated 01-21-2020 (ZIP).
    2. Quality Measure Identification Number by CMS Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. A unique CMS identification number is specified for each QM.
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  • PAC/SNF QRP Web-Based Training From CMS on Oct. 1, 2020 Changes

    By CMS - February 04, 2020

    The Centers for Medicare & Medicaid Services (CMS) is offering a quick web-based training to walk providers through upcoming changes to the Quality Reporting Programs (QRPs) for the following post-acute care settings along with an overview of existing and upcoming training activities designed to support providers in successfully complying with associated reporting requirements:

    o    Home Health

    o    Inpatient Rehabilitation Facility (IRF)

    o    Long-Term Care Hospital (LTCH)

    o    Skilled Nursing Facility (SNF)


    This web-based training will:

    • Demonstrate how the quality measures used in the Home Health, IRF, LTCH, and SNF QRPs tie to CMS’ Meaningful Measures Initiative;  
    • Provide a detailed list of data elements that have already been incorporated into the post-acute care QRPs along with those being implemented in the IRF, LTCH, and SNF care settings on October 1, 2020, and the Home Health care setting on January 1, 2021;
    • Provide links to training resources to support providers in implementing existing reporting requirements associated with the QRPs; and
    • Offer a preview of upcoming training activities to support the implementation of new reporting requirements, including dates, so that providers can begin to plan to incorporate these important training events into their busy schedules.

    If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk for your care setting.

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  • ICD-10 Code Lookup Tool / National Center for Health Statistics (2/20)

    By MX - February 04, 2020

    What is the ICD-10-CM Browser Tool [ Beta Version]

    The National Center for Health Statistics ICD-10-CM Browser tool is a user-friendly web-based query application allows users to search for codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and provides instructional information needed to understand the usage of ICD-10-CM codes. The application provides access to multiple fiscal year version sets that are available with real-time comprehensive results via the search capabilities.

    The National Center for Health Statistics updates ICD-10-CM on an annual basis.  In addition to the new browser tool, ICD-10-CM and all approved updates to the classification are still available on this webpage for public use.

    Features include:

    Online user’s guide

    Preface

    • The Official ICD–10–CM Coding Guidelines
    • ICD–10–CM Tabular List of Diseases and Injuries
    • ICD–10–CM Index to Diseases and Injuries
    • ICD–10–CM External Cause of Injuries Index
    • ICD–10–CM Table of Neoplasms
    • ICD–10–CM Table of Drugs and Chemicals

    Functionality features include:

    • Search Index for main term or subterms
    • Search by ICD–10–CM code
    • Pop-up instructional notes
    • Ability to toggle from the Index to the Tabular list.
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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (2/20)

    By CMS - February 04, 2020

    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 October 2019.


    October 2019 Revisions

    In October 2019, several changes were made to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes affected the health inspection and quality measure domains. This section provides details on these changes.

    Ratings changes for facilities that receive the abuse icon: To make it easier for consumers to identify facilities with instances of non-compliance related to abuse, starting in October 2019, CMS added an icon to highlight facilities that meet either of the following criteria: 

    1. Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or on a complaint survey within the past 12 months. 
    2. Repeat abuse citations: Facilities cited for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the previous (i.e., second most recent) standard survey or on a complaint survey in the prior 12 months (i.e., from 13 to 24 months ago). 

    Nursing homes that receive the abuse icon have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that receives the abuse icon can have is four stars. 

    Removal of quality measures related to pain: CMS removed two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These measures are: 

    • Percentage of short-stay residents who report moderate to severe pain. 
    • Percentage of long-stay residents who report moderate to severe pain. 

    As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings changed. These changes were made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. 

    January 2020 addition: Technical specifications for claims-based measures

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  • Section G: Going, Going, Almost Gone – October 2020

    By Jessie McGill, RN, RAC-MT, RAC-MTA - February 04, 2020

    The Activities of Daily Living (ADLs) in section G of the MDS are interwoven throughout the Care Area Assessments (CAAs), Quality Measures, and reimbursement—and have been for years. Yet CMS took nurse assessment coordinators (NACs) by surprise when the draft MDS item sets released in early January 2020 revealed that section G will be removed from all OBRA and PPS assessments as of October 1, 2020. In fact, section G will only appear on the Optional State Assessment (OSA) item set.

    Today, facilities must confront Section G’s future removal, an upcoming development that raises more questions than answers. Many NACs are asking how this huge change will impact the accuracy of the functional data collected, which in turn affects CAAs, care plans, Quality Measures (QMs), and possibly even Medicaid reimbursement. While we do not know how the details of how this transition will play out, we can identify how this change will impact different items and programs. We can also begin to explore how facilities can prepare for this change.

    How can section GG replace section G?

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  • Get Back to Nursing Basics to Determine Skilled Services

    By Caralyn Davis, Staff Writer - February 04, 2020

    With the rush to understand the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS), it’s easy to get caught up in meeting the technical criteria for payment—and not pay enough attention to the clinical criteria for meeting a Medicare skilled level of care, says Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, an MDS/policy consultant for Triad Health Care LLC in Providence, RI.

     

    “PDPM puts the focus on the primary medical condition that is coded in MDS item I0020B using an ICD-10-CM diagnosis code,” explains LaBay. “However, there is a general misunderstanding about what the ICD-10 code in I0020B means. Some nurse assessment coordinators (NACs) look at an ICD-10 code and ask, ‘Is this a skilled diagnosis?’ That’s the wrong question, and you need to avoid falling into the trap of thinking that an ICD-10 code in I0020B that does not return to provider (RTP) means you have a skilled service.”

     

    The primary medical diagnosis in I0020B only sets the payment. “Specifically, it determines a resident’s default clinical category for PDPM’s physical therapy (PT), occupational therapy (OT), and a portion of the speech-language pathology (SLP) payment components,” she notes.

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  • SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 (Calendar Year 2020) SNF QRP APU

    By CMS - February 03, 2020
    The SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 SNF QRP APU is now available. This table indicates the MDS data elements CMS will use for FY 2022 SNF QRP APU determinations.
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  • SNF PPS Fact Sheet From Medicare Learning Network - Revised (1/20)

    By CMS - February 03, 2020
    The basics of SNF PPS and consolidated billing.
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  • Oct. 1, 2020 DRAFT MDS 3.0 v1.18.0 Item Sets, Plus Detailed Change Document (1/20)

    By CMS - January 27, 2020
    A new DRAFT version of the 2020 MDS item sets (v1.18.0) was posted. This version is scheduled to become effective October 1, 2020. Please note that Section G has been removed from all Federal item sets. The MDS 3.0 Item Set Change History for October 2020 report also has been released.
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