• 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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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (7/20)

    By CDC - July 15, 2020

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection


    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators


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  • August 18 Is the Deadline for Submitting SNF QRP Reconsideration Requests for Calendar 2019 Data

    By CMS - July 14, 2020

    SNF Quality Reporting Program: Non-Compliance Notifications. Reconsiderations are due by August 18, 2020.

    CMS is providing notifications to Skilled Nursing Facilities (SNFs) that were determined to be out of compliance with SNF Quality Reporting Program (QRP) requirements for calendar year (CY) 2019, which will affect their fiscal year (FY) 2021 Annual Payment Update (APU). Non-compliance notifications will be distributed by the Medicare Administrative Contractors (MACs) and will also be placed into facilities’ CASPER folders in QIES on July 13, 2020. Either notification is official notice of non-compliance. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 18, 2020. If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notification letter and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

    Please note: Any reconsideration containing protected health information (PHI) will not be processed. All PHI must be removed in order for a reconsideration to be reviewed.

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  • CMS QSO Memo: Five-Star Updates, Staff Counts, FAQs, and Access to Ombudsman REVISED (7/20)

    By CMS - July 13, 2020


    Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, Frequently Asked Questions, and Access to Ombudsman (REVISED)

    Memo # QSO-20-28-NH REVISED

    Posting Date 2020-07-09

    Fiscal Year 2020


    • CMS is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the threat of the COVID-19.

    • Nursing Home Compare website & Nursing Home Five Star Quality Rating System: We are announcing that the inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers. • Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website. • Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.

    • Access to Ombudsman: We are reminding facilities that providing ombudsman access to residents is required per 42 CFR § 483.10(f)(4)(i) and per the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

    • Frequently Asked Questions (FAQ): We are releasing a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

    In addition to adding the new ombudsman section, “Q: What else can nursing homes do to help residents stay connected to their family, friends, and loved ones?” has been amended to discuss the need to comply with federal disability rights laws.

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  • CMS Will Increase Use of QIOs to Fight COVID-19 Hot Spots (7/20)

    By CMS - July 13, 2020

    The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

    Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

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