• Preliminary RAI Manual v1.17 Released (5/19)

    By CMS - May 20, 2019

    The PDF file labeled “MDS 3.0 RAI Manual v1.17 October 1, 2019” is now available.

    Please note this early release is being provided in response to stakeholder feedback. The MDS 3.0 RAI Manual v1.17 contains many updates including information related to the Patient Driven Payment Model. Please check back prior to October 1, 2019 for a final posting which may contain additional updates.

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  • CDC C. difficile Naming Convention Change (5/19)

    By National Nursing Home Quality Improvement Campaign - May 19, 2019

    The CDC has begun using Clostridioides difficile instead of Clostridium difficile to refer to the bacterium that commonly causes infectious diarrhea.

    The change followed a decision early last year by the Clinical and Laboratory Standards Institute (CLSI).

    Given that laboratories and medical publications may be transitioning to the new name, the National Nursing Home Quality Improvement Campaign is making the transition when using the full name. However, the abbreviated form C. Diff is still applicable.

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  • The Evolution of the Nurse Assessment Coordinator (NAC) Under PDPM

    By Jane Belt, MS, RN, RAC-MT, RAC-MTA, QCP and Jessie McGill, RN, RAC-MT, RAC-MTA - May 16, 2019

    The October 1, 2019, deadline for implementation of PDPM is looming. Nursing home administrators should use caution if they are thinking that fewer NAC hours will be needed just because the number of PPS assessments will decrease. The MDS is still the primary data source under PDPM, and MDS accuracy and completeness are paramount to accurate reimbursement. The preparation needed to get the NAC ready for their new role under PDPM cannot wait until October! We must start now, especially since we all know how the calendar seems to speed up when the summer months are upon us.


    Let’s take a look at some of the NAC’s current tasks and how they will change under PDPM:

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  • PDPM to SPADEs: How to Navigate the Waves of Change

    By Caralyn Davis, Staff Writer - May 16, 2019

    October 1, 2019 will mark the launch of what could be a sustained period of considerable change for the Skilled Nursing Facility Prospective Payment System (SNF PPS), the Skilled Nursing Facility Quality Reporting Program (SNF QRP), the MDS itself—and the role of the nurse assessment coordinator (NAC), suggests Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist at AANAC.

    The changes start this October 1 with the implementation of the Patient-Driven Payment Model (PDPM) for the fee-for-service Medicare Part A SNF PPS. “This is a distinctly different payment model than RUG-IV, and it will drive a complete shift in the NAC’s focus. Instead of concentrating on therapy minutes and the activities of daily living (ADLs), the NAC will have to pay attention to a whole array of clinical services that need to be captured by the 5-day MDS’s assessment reference date (ARD),” says McGill. “This will mean spending a lot of time looking for documentation, not only from the nursing staff but also from the physicians to support ICD-10-CM codes.”

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  • OIG Assessment of Nursing Home Deficiency Trends Finds Need for Improvement (5/19)

    By OIG - May 02, 2019

    Trends in Deficiencies at Nursing Homes Show That Improvements Are Needed To Ensure the Health and Safety of Residents (A-09-18-02010)

    In this data brief, we analyze nursing home deficiencies that were identified by State survey agencies (State agencies) across the Nation for calendar years 2013 through 2017 (review period). This data brief offers the Centers for Medicare & Medicaid Services (CMS) and other stakeholders (e.g., State agencies and nursing home management) insight into deficiency trends at nursing homes nation-wide. It also complements our previous report on State agencies' verification of correction of nursing home deficiencies.

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  • May 7 - 8 SNF QRP Training Materials Available

    By CMS - May 02, 2019
    May 7 - 8 SNF QRP Training Materials Available
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  • PBJ Reports Help Verify Your MDS Census Numbers

    By Caralyn Davis, Staff Writer - May 01, 2019

    Last fall, the Centers for Medicare & Medicaid Services (CMS) released two new CASPER reports for the Payroll-Based Journal (PBJ) system that went under the radar at many nursing homes. However, these reports are worth paying attention to because nurse assessment coordinators (NACs) can use them to help assess the accuracy and timeliness of MDS census data, says Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.


    “Since CMS changed the staffing census to MDS data instead of data submitted to PBJ, many facilities have seen their staffing stars decrease in the Five-Star Quality Rating System,” says Maher. “But a lot of providers haven’t connected that decrease to the change to MDS census data—they seem to think it’s a mystery.”

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  • Going From Skip Days to Interrupted Stays

    By Jessie McGill, RN, RAC-MT, RAC-MTA - May 01, 2019

    Mr. Jones admitted to Happy Acres Nursing Home on Original Medicare a couple of weeks ago, but an acute exacerbation of his COPD has resulted in an emergency room visit and an overnight stay for observation. The nurse assessment coordinator is closely watching the clock to see if Mr. Jones will return within 24 hours from discharge to meet the “midnight rule.” As another hour passes and more than 24 hours has elapsed, the NAC knows she must complete both an OBRA and a Part A PPS Discharge assessment. And for now—until October—her thinking is correct. Once the Patient-Driven Payment Model (PDPM) is implemented though, all of this will change with the “interrupted stay” policy.

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  • SNF QRP SNF Provider Preview Reports - Now Available (5/19)

    By CMS - May 01, 2019
    Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. The data contained within the Preview Reports is based on quality data submitted by SNFs between Quarter 4 – 2017 and Quarter 3 – 2018, for assessment-based quality measures, and between Quarter 1 – 2017 to Quarter 4 – 2017, for claims-based quality measures. Providers have until May 30, 2019 to review their performance data prior to the July 2019Nursing Home Compare site refresh, during which this data will be publicly displayed. Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate. 
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  • SNF QRP FY 2020 Reconsideration Request Process Estimated Timeline (5/19)

    By CMS - May 01, 2019
    The estimated CMS reconsideration process timeline for FY 2020 payment determination.
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  • CMS Policy Change for Assessment Submission Time Frame Will Impact MDS Correction Policy (5/19)

    By CMS - May 01, 2019

     The following April 30, 2019 e-mail from CMS will impact the MDS correction policy in chapter 5 of the RAI Manual .


    The current CMS policy for submission of patient assessment records allows providers to submit records for up to 36 months from the assessment target date.  Effective October 1, 2019, the CMS policy for patient assessment submission will be changed to 24 months from the assessment target date.  The policy change applies to new, modified, and inactivated records.

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  • CMS Updates State Operations Manual re: New Medicare Cards (5/19)

    By CMS - April 29, 2019

    SUBJECT: Revisions to the State Operations Manual (SOM 100-07) Chapter 2, The Certification Process, Chapter 3, Additional Program Activities, and Chapter 4, Program Administration and Fiscal Management


    I. SUMMARY OF CHANGES: The purpose of this revision is to update Chapters 2, 3 and 4 in Publication 100-07 with the New Medicare Card Project-related language.

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  • State RAI Coordinator Contact List / Appendix B Update (4/19)

    By CMS - April 25, 2019
    The April 25 update of Appendix B to the RAI Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, RAI Panel members, and Regional Office contacts. 
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  • How Can Deficiency Data Be Used to Get Ahead of Surveyors?

    By Jane Belt, MS, RN, RAC-MT, RAC-MTA, QCP - April 24, 2019

    Meeting and discussing with hundreds of nurse assessment coordinators (NACs) and fielding a wide array of questions about the Resident Assessment Instrument (RAI) process, the Minimum Data Set (MDS), Care Area Assessments (CAAs), and person-centered care plans over the years, it seemed a relatively easy assignment to discuss using deficiency data to provide useful information for the NAC. Survey data also abounds with the full text of statement of deficiencies posted monthly on the Centers for Medicare & Medicaid Services’ (CMS’s) Five-Star Quality Rating System website. With the help of a data analyst, we sifted through over 3,000 records. We looked at the numbers, determined the types of citations most often encountered by the NACs, and identified key issues and trends. To say the least, the data forced this writer to take a new approach and figure out a new angle to tackle the task, , as the cited deficiencies seemed to be much of the information that we have read before when looking at the most frequently cited F-tags. So what does the NAC need to consider in order to avoid the common pitfalls that we often see when the surveyors comb through the records?

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  • The OSA May Be Active Long-Term for Medicaid Case-Mix

    By Caralyn Davis, Staff Writer - April 24, 2019

    Revisions in the April 11 update of Patient-Driven Payment Model: Frequently Asked Questions (FAQs) suggest that the Optional State Assessment (OSA) is no longer a temporary assessment, meaning that it may remain active—and its use may actually expand—in some states for longer than the one fiscal-year (FY) transition period originally set by the Centers for Medicare & Medicaid Services (CMS). Therefore, it’s more vital than ever for nurse assessment coordinators (NACs) in Medicaid case-mix states to understand the OSA and how the October 1 transition of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) to the Patient-Driven Payment Model (PDPM) case-mix classification system from the RUG-IV system can impact their Medicaid nursing facility (NF) payments.

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