• FY 2021 SNF PPS Final Rule: CMS Says Further COVID-19 Relief Beyond Rulemaking Scope

    By Caralyn Davis, Staff Writer - August 05, 2020


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  • FY 2021 SNF PPS Final Rule: CMS Says Further COVID-19 Relief Beyond Rulemaking Scope

    By Caralyn Davis, Staff Writer - August 04, 2020

    On July 31, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the final rule. CMS scaled back or cancelled many planned proposals in the FY 2021 SNF PPS Proposed Rule due to the ongoing coronavirus 2019 (COVID-19) public health emergency. However, that's as far as the agency is willing to go for now—citing commenters' requests for additional relief from COVID-19 as beyond the scope of this rulemaking. CMS also made a few key revisions to proposed changes, most notably to the ICD-10-CM code mappings used for case-mix classification in the Patient-Driven Payment Model (PDPM). 

    Here are some of the key updates that nurse assessment coordinators (NACs) should pay attention to.

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  • MDS Section J: Learn What ‘Major’ Surgery Means

    By Caralyn Davis, Staff Writer - August 04, 2020

    “Does this surgery count as a major surgery?” is one of the most frequently asked questions that nurse assessment coordinators (NACs) have about MDS items J2100 (Recent Surgery Requiring Active SNF Care) and J2300 – J5000 (Recent Surgeries Requiring Active SNF Care: Surgical Procedures), says Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.


    “It’s an important question because capturing a major surgery in J2100 and J2300 – J5000 can make a difference in the Medicare Part A payment that you receive for the physical therapy (PT) and occupational therapy (OT) components under the Patient-Driven Payment Model (PDPM),” says Maher. “A major surgery can move the resident from their default primary diagnosis clinical category established in I0020B (ICD Code/Primary Medical Condition) into a potentially higher-paying surgical clinical category for PT and OT.”

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  • The Documentation Toolkit: What It is and Why NACs Need It Now

    By AANAC - August 04, 2020

    Documentation is a critical part of the nurse assessment coordinator’s (NAC’s) role. It helps provide person-centered care, supports clinical decisions, facilitates communication between the nurse and the interdisciplinary team (IDT), prevents many legal issues, and helps with accurate reimbursement.

    AANAC’s sister association, the American Association of Directors of Nursing Services (AADNS), recently published the Documentation Toolkit for the Nurse Leader, which contains several helpful tools and resources to make lasting improvements to documentation in skilled nursing facilities (SNFs). Jane Belt, MS, RN QCP, RAC-MT, RAC-MTA, curriculum development specialist for AANAC, shares some insights into how NACs and other nurse leaders can use this tool to review their processes and keep at bay those harrowing reminders of “If it wasn’t documented, it wasn’t done.”

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  • FY 2021 SNF PPS Final Rule Released (7/20)

    By CMS - August 02, 2020

    On July 31, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1737-F] for Fiscal Year (FY) 2021 that updates the Medicare payment rates and the value-based purchasing program for skilled nursing facilities (SNFs). CMS is publishing this final rule consistent with the legal requirements to update Medicare payment policies for SNFs on an annual basis. In recognition of the significant impact of the COVID-19 public health emergency, and limited capacity of health care providers to review and provide comment on extensive proposals, CMS has limited annual SNF rulemaking required by statute to essential policies including Medicare payment to SNFs.

    The final rule includes routine technical rate-setting updates to the SNF prospective payment system (PPS) payment rates, and adopts the revised Office of Management and Budget (OMB) statistical area delineations.  In addition, the rule applies a 5 percent cap on wage index decreases from FY 2020 to FY 2021. In response to stakeholder feedback, we are also finalizing changes to the International Classification of Diseases, Version 10 (ICD-10) code mappings, effective October 1, 2020. Finally, this rule includes minor administrative changes related to the SNF Value-Based Purchasing (VBP) Program.

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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (7/20)

    By CMS - August 02, 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.

    CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. This manual provides in-depth descriptions of the ratings and the methods used to calculate them. 


    July 2020 Revisions: Temporary Changes due to COVID-19


    Staffing Rating Changes:

    Under the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, CMS waived the requirements at 42 CFR 483.70(q), which required nursing home providers to submit staffing data through the Payroll-Based Journal (PBJ) system. Because of the waiver, many facilities did not submit staffing data by the May 15, 2020 deadline, and thus, CMS will not be able to update the PBJ staffing measures and staffing domain star ratings at the next regularly scheduled update in July 2020. Therefore, staffing measures and ratings will be held constant and based on data submitted for October – December 2019.

    In addition, CMS recognizes that the waiver of the requirement prevented some facilities from improving their rating from their previous quarter’s submission. Specifically, facilities whose staffing rating was automatically downgraded to one-star due to missing the deadline for the previous submission, or for reporting four or more days in the quarter with no registered nurse, will not have the opportunity to correct and improve their staffing rating since the ratings will be held constant. Therefore, CMS will remove the one-star staffing rating downgrade, and instead, these facilities will have their ratings temporarily suppressed. Their staffing ratings will show “Not Available” for July, August, and September 2020.


    Quality Measure Rating Changes:

    Similar to the staffing data waiver, CMS waived requirements at 42 CFR 483.20 related to the timelines for completing and submitting resident assessment (minimum data set (MDS)) information. This information provides the underlying data used to calculate quality measures used on the Nursing Home Compare website and in the Five-Star Quality Ratings System. CMS believes that data from resident assessments conducted prior to January 1, 2020, can still be used to calculate quality measures (QMs). However, CMS is concerned that data from resident assessments conducted after January 1, 2020 were impacted by the waiver and the public health emergency. Therefore, beginning July 29, 2020, quality measures based on the data collection period ending December 31, 2019 will be held constant. Quality measures that were based on a data collection period prior to December 31, 2019 (e.g., ending September 30, 2019); however, will continue to be updated until the underlying data reaches December 31, 2019. We note that CMS is not holding the quality measure ratings constant, as a facility’s quality measure rating can still be updated by a quality measure with underlying data that is earlier than December 31, 2019.

    The MDS-based QMs will continue to cover 2019Q1 – 2019Q4. Four of the claims-based measures (long-stay and short-stay hospitalizations and ED visits) will be updated and will cover the time period January 1 – December 31, 2019. The short-stay QM, rate of successful return to home and community, will continue to cover October 1, 2016 – September 30, 2018.


    Health Inspection Rating Changes:

    Since the Nursing Home Compare (NHC) refresh in April 2020 and until further notice, the health inspection domain of the rating system is being held constant to include only data from surveys that occurred on or before March 3, 2020. Results of health inspections conducted on or after March 4, 2020, will be posted publicly, but not be used to calculate a nursing home's health inspection star ratings.

    CMS will continue to monitor inspections, including the restarting of certain inspections (i.e., surveys) per CMS memorandum QSO-20-31-ALL. CMS will restart the inspection ratings as soon as possible and will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website.


    January 2020 addition: Technical specifications for claims-based measures

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  • AAPACN Joins Other Healthcare Associations Urging Congress to Support the “SAFE TO WORK Act”

    By AAPACN - July 31, 2020

    AAPACN, along with dozens of healthcare organizations, urge Congress to support the timely, targeted, and temporary liability relief provisions contained in S. 4317, the “SAFE TO WORK Act.” These crucial protections would safeguard healthcare workers, providers, and facilities, as well as businesses, non-profit organizations, and educational institutions against unfair lawsuits so they can continue to contribute to a safe and effective economic recovery from the COVID-19 pandemic. This legislation is critically needed and should be enacted as soon as possible. To that end, we strongly urge you to support the inclusion of these provisions in a Phase IV COVID-19 relief package. Read more.

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  • AAPACN provides comments to the Coronavirus Commission

    By AAPACN - July 21, 2020
    On July 17, 2020,  AAPACN urged the Coronavirus Commission for Safety and Quality in Nursing Homes to provide sufficient resources to SNFs and to streamline and ensure coordination between CMS and state and local governments. Read full comments.
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  • The Role the MDS and Care Planning Play in Reducing the Risk of Legal Action

    By AANAC - July 21, 2020

    During the first day of the AAPACN Virtual Conference, Gina D'Angelo, BSN, MBA, RN, NHA, CLNC, DNS-CT, RAC-CT, clinical consultant, legal nurse consultant, testifying expert, and president of GD Solutions, LLC, presented “Avoid the Slippery (Legal) Slope of Improper Care Planning.” In this informative session, she discussed the serious potential issues neglect can pose for nursing homes, how care planning is at the center of those issues, and how failing to address the issues can lead to litigation.

    D’Angelo also provided an in-depth look at the steps involved in the process of an investigation—from where things can go wrong in care planning and charting and other breaches of care, to types of lawsuits, elements to proving a case, and how you can create an action plan to avoid the common pitfalls. Here are a few highlights for nurse assessment coordinators (NACs) to consider and incorporate now to avoid legal action due to mistakes in the care planning process.

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  • Hospital Diagnoses: Why You Need to Do a Deeper Dive

    By Caralyn Davis, Staff Writer - July 21, 2020

    Obtaining the most specific medical diagnosis benefits skilled nursing facilities (SNFs) on two fronts: receiving accurate reimbursement under the Patient-Driven Payment Model (PDPM) for Medicare Part A residents and improving the quality of care for all residents, says Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.


    “Often, to get a diagnosis to map from the MDS to a clinical category for the physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP) payment components under PDPM, you need a more specific diagnosis,” explains Maher. “However, it’s not all about payment. Even without the mapping problem, the resident’s medical record needs to be as accurate and complete as possible, and that includes having accurate diagnoses so that the interdisciplinary team can provide the correct treatment.”


    For example, if a resident goes to see an outside provider, the face sheet that the nursing home sends with that resident should be as accurate as possible, she points out. “If the resident had a heart attack, was the myocardial infarction a STEMI (ST-segment elevation myocardial infarction) or a non-STEMI? You don’t want to leave that type of diagnosis unspecified because including the most accurate diagnosis on the nursing home face sheet could affect that outside provider’s treatment decisions and the resident’s overall quality of care.”

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  • July 28 CDC COVID-19 Call: Diabetes: The Importance of Prevention, Management, and Support

    By CDC - July 20, 2020

    Coronavirus Disease 2019 (COVID-19) and Diabetes: The Importance of Prevention, Management, and Support

    You may participate in this COCA Call via Zoom

    During this COCA Call, presenters will focus on current information about the impact and increased risk for COVID-19 complications in people with diabetes and the importance of diabetes prevention, management, and support.

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  • COVID-19 MLN Matters Article Update Addresses Billing Re: SNF Benefit Period Waiver - UPDATED (7/20)

    By CMS - July 20, 2020


    MLN Matters Special Edition Article SE20011 Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) is updated. Learn about:

    ·  Updated Centers for Disease Control and Prevention guidelines for testing nursing home residents and patients

    ·  Update on applying the Skilled Nursing Facility (SNF) benefit period waiver

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  • FY 2021 ICD-10-CM Code Update and Official Coding Guidelines (7/20)

    By CDC - July 20, 2020

    The 2021 ICD-10-CM codes and official coding guidelines are to be used from October 1, 2020 through September 30, 2021.

    Note: This replaces the FY 2020 release. These files listed below represent the FY 2021 ICD-10-CM. The FY 2021 ICD-10-CM is available in both PDF (Adobe) and XML file formats. Most files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to nchsicd10cm@cdc.gov .

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  • FY 2022 SNF QRP Quick Reference Guide REVISED AGAIN (7/20)

    By CMS - July 20, 2020
    Quick Reference Guide for FY 2022 has been revised twice to address changes due to COVID-19.  The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. The second revision clarifies that  data collection for the measures Transfer of Health Information to the Patient PAC and the Transfer of Health Information to the Provider PAC:will be implemented two years after the end of the COVID-19 Public Health Emergency.
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  • COVID-19 Medicare FAQs Updated (7/20)

    By CMS - July 19, 2020
    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.
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