• QIES Help Desk Update (8/20)

    By QTSO - August 10, 2020

    Greetings QIES/iQIES Users,

    Beginning Monday, August 17th, the QIES/iQIES Level 1 Help Desk Support will now be handled by a new Help Desk team who will work diligently to resolve all QIES/iQIES-related inquiries. Our current Help Desk team will still be actively available to assist with escalated Level 2 Support. Should you have any questions or concerns, please call 1-800-339-9313 or email us at: iQIES@cms.hhs.gov.

    Thank you,

    QIES/iQIES Service & Support Team

    Last Modified on 8/10/2020


    From https://qtso.cms.gov/news-and-updates/qiesiqies-help-desk-update

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  • FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    By CMS - August 10, 2020

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

    16. Are nursing homes required to report results of any COVID-19 tests?

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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  • ABN (Form CMS-R-131) for Part B SNF Services - UPDATED: New Form Must Be Implemented by Jan. 1, 2021 (8/20)

    By CMS - August 09, 2020

    The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50

    Note: Skilled nursing facilities (SNFs) must use the ABN for items/services expected to be denied under Medicare Part B only.

    August 2020The ABN, Form CMS-R-131, and instructions have been approved by the Office of Management and Budget (OMB) for renewal.  Due to COVID-19 concerns, CMS has expanded the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023).  At this time, the renewed ABN will be mandatory for use on 1/1/2021.  The renewed form may be implemented prior to the mandatory deadline. 

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  • FY 2021 PDPM ICD-10 Mappings (8/20)

    By CMS - August 09, 2020

    The Mappings file contains: 

    • Mapping of the ICD-10-CM Recorded in Item I0020B of the MDS Assessment to PDPM Clinical Categories 
    • Mapping of Comorbidities Included in the PDPM SLP Component to ICD-10-CM Codes
    • Mapping of Comorbidities Included in the PDPM NTA Component to ICD-10-CM Codes
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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 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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  • Medicare Part B Physician Fee Schedule Proposed Rule (8/20)

    By CMS - August 03, 2020

    Proposed Rule: Medicare Program: CY 2021 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; etc.

    On August, 3 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. In addition to proposing several changes significant to Medicare Part B therapy, CMS is seeking comment on several policies that could impact nursing homes long-term. For example:

    Furnishing Telehealth Visits in Inpatient and Nursing Facility Settings, and Critical Care Consultations

    The long term care facility regulations at § 483.30(c) require that residents of SNFs receive an initial visit from a physician, and periodic personal visits subsequently by either a physician or other nonphysician practitioner (NPP). In the CY 2010 PFS final rule with comment period (74 FR 61762) we stated that these regulations ensure that at least a minimal degree of personal contact between a physician or a qualified NPP and a resident is maintained, both at the point of admission to the facility and periodically during the course of the resident’s stay. In that rule we stated that we believe that these federally-mandated visits should be conducted inperson, and not as Medicare telehealth services. We therefore revised § 410.78 to restrict physicians and practitioners from using telehealth to furnish the physician visits required under § 483.30(c).

    During the PHE for the COVID-19 pandemic, we waived the requirement in 42 CFR 483.30 for physicians and nonphysician practitioners to personally perform required visits for nursing home residents, and allowed visits to be conducted via telehealth (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).

    We are seeking public comment on whether it would be appropriate to maintain this flexibility on a permanent basis outside of the PHE for the COVID-19 pandemic. We invite public comment on whether the in-person visit requirement is necessary, or whether two-way, audio/video telecommunications technology would be sufficient in instances when, due to continued exposure risk, workforce capacity, or other factors, the clinician determines an inperson visit is not necessary.

    We have also received requests to revise our frequency limitations for telehealth subsequent inpatient and nursing facility visits. Currently, we limit the provision of subsequent inpatient visits via Medicare telehealth to once every 3 days and subsequent nursing facility visits to once every 30 days. We received a request to remove the frequency limitation on the subsequent inpatient services and a separate request to revise the subsequent nursing facility visits to once every 3 days, rather than 30 days.

    As we stated in the CY 2019 PFS final rule, we believed the potential acuity of illness of hospital inpatients is greater than that of patients who are likely to receive services that were on the Medicare telehealth services list at that time. We also stated that it would be appropriate to permit some subsequent hospital care services to be furnished through telehealth to ensure that hospitalized patients have frequent encounters with their admitting practitioner. In addition, we expressed our belief that the majority of these visits should be furnished in person to facilitate the comprehensive, coordinated, and personal care that medically volatile, acutely ill patients require on an ongoing basis. Because of our concerns regarding the potential acuity of illness of hospital inpatients, we finalized the addition of CPT codes 99231-99233 to the Medicare telehealth services list, but limited the provision of these subsequent hospital care services through telehealth to once every 3 days. We continue to believe that admitting practitioners should continue to make appropriate in-person visits to all patients who need such care during their hospitalization. Our concerns with, and position on, the provision of subsequent hospital care services via telehealth have not changed (83 FR 59493). Therefore, we are not proposing to modify our current policy.

    In the CY 2018 PFS final rule, we reiterated that we believed it would be appropriate to permit some subsequent nursing facility (NF) care services to be furnished through telehealth to ensure that complex nursing facility patients have frequent encounters with their admitting practitioner, but because of our concerns regarding the potential acuity and complexity of NF inpatients, we limited the provision of subsequent NF care services furnished through telehealth to once every 30 days. We also stated that we continued to have concerns regarding more routine use of telehealth given the potential acuity and complexity of NF inpatients, and therefore, we were not proposing to remove the frequency limitation for subsequent NF care services (83 FR 59494). We have received comments from stakeholders who stated that the once every 30-day frequency limitation for subsequent NF visits furnished via Medicare telehealth limits access to care for Medicare beneficiaries in the NF setting. Stakeholders stated that the use of Medicare telehealth is crucial to maintaining a continuum of care in this setting and that CMS should leave it up to clinicians to decide how frequently a visit may be furnished as a Medicare telehealth service rather than in person depending on the needs of specific patients. We are persuaded by the comments from these stakeholders, and therefore, are proposing to revise the frequency limitation from one visit every 30 days to one visit every 3 days. We believe this interval strikes the right balance between requiring in-person visits and allowing flexibility to furnish services via telehealth when clinically appropriate to do so. We are also seeking comment on whether frequency limitations broadly are burdensome and limit access to necessary care when services are available only through telehealth, and how best to ensure that patients are receiving necessary in-person care.


     Additional information from the CMS fact sheet:

    Therapy Assistants Furnishing Maintenance Therapy

    In this CY 2021 PFS proposed rule, we are proposing to make permanent our Part B policy for maintenance therapy services that we adopted on an interim basis for the PHE in the May 1st COVID-19 IFC that grants a physical therapist (PT) and occupational therapist (OT) the discretion to delegate the performance of maintenance therapy services, as clinically appropriate, to a therapy assistant – a physical therapist assistant (PTA) or an occupational therapy assistant (OTA).  We are making this proposal because we no longer believe all such maintenance therapy services require the PT or OT to personally perform them and to better align our Part B policy with that paid under Part A in skilled nursing facilities and the home health benefit where maintenance therapy services may be performed by a PT/OT or a PTA/OTA.  Our proposed policy would allow PTs/OTs to use the same discretion to delegate maintenance therapy services to PTAs/OTAs that they utilize for rehabilitative services.  We are also proposing to revise our subregulatory provisions to clarify that PTs and OTs no longer need to personally perform maintenance therapy services and to remove the prohibitions on PTAs and OTAs from furnishing such services.  Should the PHE end before January 1, 2021, the PT or OT would need to personally furnish the maintenance therapy services until the proposed policy change takes effect. 

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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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  • COVID-19 Medicare FAQs Updated (8/20)

    By CMS - July 26, 2020
    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.
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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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