• FY 2021 ICD-10-CM Code Update (7/20)

    By CDC - July 01, 2020

    The 2021 ICD-10-CM codes 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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  • COVID-19 Waivers: CMS Article Answers Q's About 3-Day Hospital Stay & Benefit Period Ending/Renewal (6/20)

    By CMS - June 29, 2020

    3-day inpatient qualifying hospital stay waiver

    Benefit period ending/renewal waiver

    New MLN Matters article reviews in detail which residents each waiver applies to, including some useful examples for the benefit period waiver. Also provides extensive billing instructions.

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  • ABN (Form CMS-R-131) for Part B SNF Services - UPDATED: New Form Must Be Implemented by Aug. 31, 2020 (6/20)

    By CMS - June 27, 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.

    June 2020: The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal.  The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020.

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  • SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 (Calendar 2020) SNF QRP APU - REVISED (6/20)

    By CMS - June 26, 2020

    On January 30, 2020, CMS published the FY 2022 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Annual Payment Update (APU) Table for Reporting Assessment-Based Measures and Standardized Patient Assessment Data Elements (SPADES).

    Since that time, CMS has delayed the release of the SNF Minimum Data Set (MDS) Version 1.18.0 needed to support the Transfer of Health (TOH) Information Quality Measures and the new or revised SPADEs due to the COVID-19 Public Health Emergency.

    CMS has revised the SNF QRP APU table to reflect the updated Data Collection periods and applicable version number.  The table has also been updated with new footers to provide additional clarity on the use of the dash (-) for specific items. The revised table can be found in the Downloads section below with the title SNF QRP Table for Reporting Assessment-Based Measures for the FY 2022 SNF QRP APU.

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  • Final MDS 3.0 Item Sets and Data Specifications, Plus New Specs Erratata, for Oct. 1, 2020 (7/20)

    By CMS - June 26, 2020

    In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications.  These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1.  This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.

    The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.4 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.4) Final 04-30-2020 in the Downloads section below. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file:  MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip also posted in the Downloads section below.

    Please confirm with your State Medicaid Agency if your State will be requiring the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment.

    June 25, 2020 update:  An updated errata (V3.00.5) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  Two issues were identified.  These changes will go into production on October 1, 2020.  As a result, two edits will be revised.  These changes will facilitate calculation of PDPM HIPPS codes on OBRA assessments for states that wish to have this calculation performed. 

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  • Calendar Q2 2020 PBJ Staffing Data Due Aug. 14, 2020 and Five-Star/Nursing Home Compare Updates From CMS (6/20)

    By CMS - June 26, 2020

    Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

    Memo #QSO 20-34-NH

    Posting Date 2020-06-25

    Fiscal Year 2020

    Summary

    The Centers for Medicare & Medicaid Services (CMS) is committed to transparency about changes in publicly reported information on nursing homes during the COVID-19 public health emergency. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

    • Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.

    o Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.

    • Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant.

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  • AAPACN Advocacy Agenda Supports the LTPAC Nursing Profession During the COVID-19 Crisis

    By Tracey Moorhead - June 25, 2020

    Without a doubt, COVID-19 has been the nearly singular focus for AAPACN and our members over the last few months. We have closely communicated with members to understand the needs and challenges of long-term and post-acute care professionals during this time and developed a lengthy roster of tools, tips, and alerts for you. AAPACN has also maintained a strong advocacy and policy presence at the federal level in support of our members and the nursing profession. You might be surprised to know that many federal policy issues continued to move forward and, in many cases, garnered more attention and action during the COVID-19 pandemic.

    AAPACN actively advocates at the federal level for policy priorities important to our members.  Even before COVID-19, these priorities included building and maintaining a strong LTPAC workforce; ensuring educational opportunities for LTPAC nurses; supporting nursing research initiatives; and advocating for common-sense regulatory compliance policies. Each of these issues is impacted and underscored by the challenges of COVID-19.

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  • CMS COVID-19 Emergency Declarations and Specific SNF/NF Flexibilities UPDATED (6/20)

    By CMS - June 25, 2020

    COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (6/25/20)

    Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities) (PDF) UPDATED (6/15/20)
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  • SNF QRP Data Reporting Requirements Back in Full Force July 1, 2020

    By CMS - June 25, 2020

    Reminder

    ·         Quality Reporting Programs are expected to report their quality data to meet requirements starting Quarter 3, which begins July 1, 2020. 

    The March 27, 2020 Medicare Learning Network Newsletter (MLN) Exceptions and Extensions for Quality Reporting Program (QRP) Requirements that includes Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals (hereafter referred to as post-acute care (PAC) programs) applies only to Quarter 4 of 2019 (October 1-December 31, 2019) and Quarters 1 and 2 of 2020 (January 1-June 30, 2020).  Providers are expected to report data and meet the QRP requirements beginning with Quarter 3, 2020 that starts July 1, 2020.

     As stated in that March 27, 2020 MLN Newsletter, “In some instances, these exceptions and extensions are granted because the data collected may be greatly impacted by the response to COVID-19 and therefore should not be considered in the quality reporting program. CMS is closely monitoring the situation for potential adjustments and will update exception lists, exempted reporting periods, and submission deadlines accordingly as events occur.”

    Starting with Quarter 3 that begins July 1, 2020, CMS expects providers to report their quality data.  CMS will analyze the data for each program recognizing that the COVID-19 public health emergency (PHE) remains in effect and could impact the quality data submitted.  CMS will closely monitor the situation for public reporting of the data and provide any updates.

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  • CMS FAQs Detail Recommendations for Allowing Nursing Home Visits (6/20)

    By CMS - June 25, 2020

    CMS has issued seven Frequently Asked Questions to supplement existing guidance about the rules for nursing home visitations during the COVID-19 pandemic, starting with No. 1:

    1. What steps should nursing homes take before reopening to visitors? 

    Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19, and follow state and local direction. Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when: 

    • There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two) 

    • The nursing home is not experiencing staff shortages 

    • The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents 

    • The nursing home has adequate access to testing for COVID-19 

    • Referral hospital(s) have bed capacity on wards and intensive care units

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  • CDC Long-term Care COVID-19 Resources Updated (6/20)

    By CDC - June 22, 2020

    Preparing for COVID-19 in Nursing Homes

    Updated June 25, 2020

    Summary of Changes to the Guidance:

    • Tiered recommendations to address nursing homes in different phases of COVID-19 response
    • Added a recommendation to assign an individual to manage the facility’s infection control program
    • Added guidance about new requirements for nursing homes to report to the National Healthcare Safety Network (NHSN)
    • Added a recommendation to create a plan for testing residents and healthcare personnel for SARS-CoV-2

    Related Pages

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  • CMS Medicare Program Integrity Manual Updates ADR Timeframes for Submission/Results of Insufficient/No Response (6/20)

    By CMS - June 20, 2020

    SUBJECT: Publication (Pub.) 100-08 Chapter 3 Updates to Section 3.2.3.2 (Timeframes for Submission) and Section 3.2.3.8 (No Response or Insufficient Response to Additional Documentation Requests (ADRs))

    I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to clarify our authority to request and require documentation, upon request, to determine the appropriateness of claims for payment.

    EFFECTIVE DATE: July 27, 2020 *Unless otherwise specified, the effective date is the date of service.

    IMPLEMENTATION DATE: July 27, 2020

    I. GENERAL INFORMATION

    A. Background: In certain circumstances, the MACs, Comprehensive Error Rate Testing (CERT) Contractor, Supplemental Medical Review Contractor (SMRC), Recovery Audit Contractor (RAC), Unified Program Integrity Contractors and other contractors may not be able to make a determination on a prepayment or post-payment claim they have chosen for review based upon the information on the claim, its attachments, or the billing history found in claims processing system (if applicable) or the Common Working File (CWF). In those instances, contractors may require providers or suppliers to furnish medical and related supporting documentation in order to determine the amounts due for payment. CMS and its contractors require that sufficient documentation and information be furnished to support that selected claims meet applicable coverage, coding, and billing requirements for payment

    During the medical review process, Medicare contractors may reach out to the provider or supplier and request documentation to support payment of the selected claims. Such documentation is reviewed to determine the appropriateness of a claim for payment based on its compliance with our coverage, coding, and billing requirements. Medicare contractors request documentation be provided in specified timeframes once a request for additional documentation is sent to the provider or supplier. In cases where no supporting documentation is received to conduct a medical review, the claim shall be denied. This change request clarifies our authority for to request and require documentation, upon request, to determine the appropriateness of claims for payment.

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  • COVID-19: Many States Have Multiple State-Specific Section 1135 Waivers (6/20)

    By CMS - June 19, 2020

    CMS approved additional state Medicaid waiver requests under Section 1135 of the Social Security Act (Act). The waivers were approved within days of states’ submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states. The waivers were approved within days of states' submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states.

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  • COVID-19 Medicare FAQs Updated (6/20)

    By CMS - June 19, 2020
    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.
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  • Medicare Program Integrity Manual updates re: UPIC and I-MEDIC Medical Review Processes (6/20)

    By CMS - June 18, 2020

    SUBJECT: Updates to Chapters 4, 6, and 8 of Publication (Pub.) 100-08

    I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to update various sections within Chapters 4, 6, and 8 in Pub. 100-08

    A. Background: The CMS is making revisions to Chapters 4, 6, and 8 in Pub. 100-08 based on updates to Unified Program Integrity Contractor (UPIC) and Investigations Medicare Drug Integrity Contractor (I-MEDIC) processes and procedures.

    B. Policy: The CR does not involve any legislative or regulatory policies.

    EFFECTIVE DATE: July 21, 2020 *Unless otherwise specified, the effective date is the date of service.

    IMPLEMENTATION DATE: July 21, 2020

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