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SNF PDPM Claims Issue
Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:
Director, Division of Provider Relations & Outreach
Provider Communications Group
Centers for Medicare & Medicaid Services
The Five Star Preview Reports are available as of February 18, 2020. 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 February's Five Star data on February 26, 2020.
Please direct your inquiries to BetterCare@cms.hhs.gov if the Help Line is not available
SUBJECT: Revisions to the State Operations Manual (SOM) Appendix A - Hospitals, Appendix AA – Psychiatric Hospitals, Appendix B – Home Health Agency, Appendix D - Portable X-Ray, Appendix G - Rural Health Clinics/Federally Qualified Health Centers, Appendix H- End Stage Renal Disease Facilities (ESRD), Appendix K – Comprehensive Outpatient Rehabilitation Facility, Appendix L - Ambulatory Surgical Centers, Appendix M – Hospice, Appendix U - Religious Nonmedical Healthcare Institutions, Appendix W - Critical Access Hospitals (CAHs), Appendix X - Organ Transplant Program and Appendix Z - Emergency Preparedness
I. SUMMARY OF CHANGES:
This Transmittal includes regulatory revisions based on recent federal regulation changes (CMS-3346-F; CMS-3334-F; CMS-3295-F; CMS3277-CN). In addition, several updates to the appendices have been made for technical correction and clarity. The psychiatric hospital tags have moved from Appendix AA to Appendix A. Appendix AA is being deleted as surveyors will now refer to Appendix A for the psychiatric special condition tags and guidance. Specific references to the United States Pharmacopeia (USP) have been removed from Appendices A, G, and W accordingly, as CMS requires compliance with applicable Federal and State law and adherence to accepted general standards of practice or guidelines for pharmaceutical services and medication administration issued by nationally recognized professional organizations. Appendix H updates the regulatory text based on requirements set forth in the 2008 Conditions for Coverage for ESRD Facilities and also includes revisions based on recent Federal regulation changes set forth in “Fire Safety Requirements for Certain Dialysis Facilities (CMS-3334-P).” Revisions to Appendix W also include renumbering the C-Tags; inserting regulations §485.601, §485.603, §485.604, and §485.606; and inserting the CAH Distinct Part Unit and Emergency Medical Treatment and Labor Act (EMTALA) C-Tags for reference. This transmittal will assure each of the appendices are updated to reflect the current regulatory language within the Medicare conditions. More substantive interpretive guidance revisions in several sections are pending and will be updated with a future release.
With the implementation of the Patient-Driven Payment Model (PDPM) now fully under way for the Skilled Nursing Facility Prospective Payment System (SNF PPS), the Centers for Medicare & Medicaid Services (CMS) has begun turning the attention of nurse assessment coordinators (NACs) toward a new slate of changes that will implement this October 1, 2020. In December, CMS posted the draft version 1.18.0 MDS item sets, and in January, the agency followed up with the release of the 43-page MDS 3.0 Item Set Change History for October 2020 Version 1.18.0, which lays out—item by item—what new or revised items will be added to which item sets, as well as what items will be deleted from which item sets.
Changes will occur in the following MDS sections:
Staff turnover is everyone’s problem, and in facilities across the United States, it’s a big one. One in four nursing assistants and one in five home health aides report that they are actively looking for another job, according to the Recruitment and Retention Guide For Employers by PHI.
Not only is turnover expensive, it negatively impacts residents. High turnover can result in less personalized care, an increased risk of infectious diseases among residents, and lowered quality of life and care.
It also makes everyone’s job harder. As every NAC knows, a rotating door of floor nurses, CNAs, and other NACs means constant trainings on the same processes and repetitive reminders about how things are done correctly as newbies get up to speed.
Here are three ways that the NAC can support staff retention and make everyone’s time in their long-term care facility better.
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.
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.
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.
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.
Posting Date 2020-02-06
Fiscal Year 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:
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