• CMS Proposes New Revisions to the Requirements for Participation

    By Caralyn Davis, Staff Writer - July 19, 2019

    The Centers for Medicare & Medicaid Services (CMS) has published a key proposed rule that would significantly impact the revised requirements for participation for Medicare- and/or Medicaid-certified long-term care facilities—and require implementation delays for some pending Phase 3 requirements. Proposals in the Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule would affect the requirements for participation related to resident rights, clinical care, documentation requirements, and survey. These changes would range from substantially reducing the detailed, specific requirements in the Quality Assurance and Performance Improvement (QAPI) regulations to removing the existing prescription renewal requirements for PRN antipsychotic medications to make them the same as the prescription renewal requirements for other psychotropic medications.

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  • CMS Proposed Rule Would Revise Medicare/Medicaid Requirements for Participation, Including Some Phase 3 Delays (7/19)

    By CMS - July 16, 2019

    Medicare and Medicaid Programs: Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency, and Transparency

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

    Areas of Major Provisions:

    a. Requirements for Participation

    Resident Rights (§483.10)

    Admission, Transfer, and Discharge Rights (§483.15)

    Nursing Services (§483.35)

    Behavioral Health (§483.40)

    Pharmacy Services (§483.45)

    Food and Nutrition Services (§483.60)

    Administration (§483.70)

    Quality Assurance and Performance Improvement (§483.75)

    Infection Control (§483.80)

    Compliance and Ethics Program (§483.85)

    Physical Environment (§483.90)

    Technical Corrections

    b. Survey, Certification, and Enforcement Procedures

    Informal Dispute Resolution and Independent Informal Dispute Resolution (§488.331 and §488.431)

    Civil Money Penalties: Waiver of Hearing, Reduction of Penalty Amount (§488.436)

    Phase 3 Implementation of Overlapping Regulatory Provisions

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  • NNHQIC Changes: You Must Download Your NNHQIC Goal Data by July 17

    By NNHQIC - July 15, 2019

    In September 2016, the Centers for Medicare & Medicaid Services (CMS) and its contractors continued the work of the Advancing Excellence in America’s Nursing Homes Campaign to make nursing homes better places to live, work and visit by promoting quality and performance improvement in nursing homes through individualized, person centered care. Subsequently, the Campaign continued and was renamed the National Nursing Home Quality Improvement Campaign. The Campaign was operated by Telligen through a contract with CMS. Telligen’s contract will end on July 17, 2019, and unfortunately, Telligen will no longer be able to operate the Campaign after that date.

    Many of the NNHQI Campaign tools and resources will continue to be available at the QIO Program website, https://qioprogram.org/nursing-home-resources. If you are using a Campaign Tracking Tool, you may continue to use that Tracking Tool, but you will not be able to use the Campaign website to trend your goal data over time.

    After Wednesday, July 17, there will not be any way to access your website account or view goal data that you have entered on the Campaign website, so we strongly recommend that long-term care providers download any goal data that they have entered on the Campaign website by July 17.

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  • Balancing Sections G and GG Requirements

    By Jessie McGill, RN, RAC-MT, RAC-MTA - July 10, 2019

    With the enormous focus on the transition from RUG-IV to PDPM, some may consider abandoning their section G Activities of Daily Living (ADLs) training materials, audits, and tools— but wait just a moment! Although section GG is stepping into the Medicare reimbursement spotlight, section G still plays a big role in other types of reimbursement and Quality Measures. To ensure success, the nurse assessment coordinator (NAC) must have a full understanding of the coding instructions, documentation requirements, impact on Quality Measures, and reimbursement for both section G and GG. Here are four key differences between the two sections and tips for successfully managing both.

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  • PDPM Lessons Learned From the Nursing RUGs

    By Caralyn Davis, Staff Writer - July 10, 2019

    On October 1 2019, the nursing case-mix groups used in the RUG-IV case-mix classification system will be streamlined and consolidated to form the nursing component of the Patient-Driven Payment Model (PDPM). By decreasing distinctions based on function for certain groups, the PDPM nursing component will use only 25 case-mix groups (ES3 – PA1) compared to the 43 RUG-IV nursing case-mix groups. For example, the RUG-IV groups HE2 and HD2 will be collapsed into the modified PDPM nursing case-mix group HDE2.

     

    However, the core process for assigning residents to a nursing case-mix group will remain basically the same, taking into account the use of extensive services, the presence of certain clinical conditions, the presence of depression, the provision of restorative nursing services, and the resident’s functional score (using section GG instead of section G). Consequently, nurse assessment coordinators (NACs) and other interdisciplinary team (IDT) members can learn some lessons about historically undercoded MDS items that could impact their ability to achieve the most accurate case-mix group for the PDPM nursing component, says Robin Hillier, CPA, STNA, LNHA, RAC-MT, president of RLH Consulting in Westerville, OH.

     

    Here are four items or sections worth revisiting:

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  • August 13 - 14 CMS SNF QRP Training Event: Register to Attend Online or In-person

    By CMS - July 04, 2019

    REGISTRATION OPEN – SNF QRP Provider In-Person Training Event, August 13 and 14, 2019

    The Centers for Medicare & Medicaid Services (CMS) will be hosting a 2-day Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) in-person ‘Train the Trainer’ event for providers on August 13 and 14, 2019, at the Four Seasons Hotel, 200 International Drive, Baltimore, MD 21202. This event will be open to all SNF providers, associations, and organizations.

    Like the May 2019 SNF QRP Provider Training, the primary focus of this 'Train-the-Trainer’ event will be to provide those responsible for training staff at SNFs with information about:

    ·        The transition to the Patient Driven Payment Model (PDPM) which becomes effective on October 1, 2019.

    ·        A review of SNF QRP changes and updates to the Minimum Data Set (MDS) 3.0 Version 1.16.0, which became effective October 1, 2018.

    ·        An overview of the eleven SNF QRP Quality Measures.

    An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification And Survey Provider Enhanced Reports (CASPER) system to develop quality improvement plans.

    During this event, presenters will incorporate additional information into their presentations based on questions received from participants during the May training.

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  • Beta PDPM Grouper DLL Released (7/19)

    By CMS - July 04, 2019

    A BETA version of the PDPM Grouper DLL has been posted, along with its source code.  Please read the READ ME FIRST.PDF within the ZIP file before attempting to use the grouper software.  Note that testing of the DLL is ongoing.  Please report any issues found to PDPM@cms.hhs.gov.

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  • PDPM Training and Technical Resources, Including Grouper Logic & ICD-10 Mappings (7/19)

    By CMS - July 02, 2019

    PDPM Training Presentation

    This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.

    PDPM Resources

    This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.

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  • PBJ Provider User Guide V3.0.1, Incl. Error Messages / Descriptions - UPDATED (6/19)

    By QTSO - July 01, 2019
    This manual explains how to connect to the Payroll-Based Journal (PBJ) system and submit data. It also defines error messages and descriptions, identifying errors by number, severity, error message, and error description. The description section includes potential corrective actions for providers to take to resolve the errors.
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  • Section GG Web-based Training Module UPDATED (6/19)

    By CMS - June 27, 2019

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course on how to properly code of Section GG. This 45-minute course is intended for providers in the following care settings: Skilled Nursing Facilities (SNFs), Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), and Home Health Agencies (HHAs); and is designed to be used on demand anywhere you can access a browser. The course is divided into the following four lessons and includes interactive exercises that allow you to test your knowledge in real life scenarios:

    • Lesson 1: Importance of Section GG for Post-Acute Care

    • Lesson 2: Section GG Assessment and Coding Principles

    • Lesson 3: Coding GG0130.Self-Care Items

    • Lesson 4: Coding GG0170.Mobility Items

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  • 2020 ICD-10-CM Diagnosis Code Files Available (6/19)

    By CMS - June 25, 2019
    The 2020 ICD-10-CM files  contain information on the ICD-10-CM updates for FY 2020. These 2020 ICD-10-CM codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020 and for patient encounters occurring from October 1, 2019 through September 30, 2020.
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  • CASPER Reporting User’s Guide for PBJ Providers UPDATED (6/19)

    By QTSO - June 21, 2019
    This user’s guide provides information and instructions pertaining to the CASPER Reporting application. Section 12, Payroll Based Journal (PBJ) Reports, addresses the staffing and census reports available to providers, including the Employee Report, the Census Report, the Staffing Summary Report, and the PBJ Submitter Final File Validation Report.
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (6/19)

    By QTSO - June 21, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • AAPACN CEO Attends NASEM Town Hall to Discuss Future of Nursing

    By AAPACN - June 18, 2019

    The National Academies of Sciences Engineering and Medicine (NASEM) hosted a Town Hall meeting in Chicago, IL on Friday, June 7 as part of the Future of Nursing: 2020-2030 project. The Future of Nursing project aims to “chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the U.S. population in the 21st century.” Together with their Future of Nursing Campaign for Action and information about the latest in science and technology, they will put together a final report to assess “the capacity of the profession to meet the anticipated health and social care demands from 2020 to 2030.”

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  • Variable Per-Diem Adjustments Will Spotlight Skilling Decisions

    By Caralyn Davis, Staff Writer - June 18, 2019

    This October 1, the Patient-Driven Payment Model (PDPM) will introduce variable per-diem payment adjustments to providers paid under the Skilled Nursing Facility Prospective Payment System (SNF PPS). PDPM has five case-mix-adjusted components that each have an associated payment based on the case-mix group classification: physical therapy (PT), occupational therapy (OT), speech-language pathology services (SLP), nursing, and nontherapy ancillaries (NTA). For the PT, OT, and NTA components, case-mix group payments will decrease over the course of a Part A patient’s stay according to the predetermined schedules and adjustment factors found in Table 20, PT and OT Variable Per Diem Adjustment Factors, and Table 21, NTA Variable Per Diem Adjustment Factors, on page 6-48 of the draft version 1.17 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.

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