• Final PDPM Grouper DLL V1.0009 (Supporting Info Updated) Effective Oct. 1, 2020

    By CMS - February 04, 2021

    February 4, 2021

    An update to the PDPM Grouper DLL package was posted.  This is NOT a change to the previously posted DLL file itself, just supporting information.  The documentation file was updated, as there were NTA mapping changes not previously documented.  Also, one file in the source code zip from the previous package, mdsgrouper,h, was not the latest version.  The correct version is included in this updated package.  NOTE: the DLL was compiled with the latest version of mdsgrouper.h in the previous package.  Therefore, there is no change to the DLL file itself.

    An updated errata (V3.00.7) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  The resolution to issue 17 in the previous errata was flawed, as the addition of edit -3963d prevented submission of IPA inactivations.  Therefore, edit -3963d has been suspended for now, and will be revised in a future release.

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  • FY 2021 MDS 3.0 Data Specs -- New Errata Issued (2/21)

    By CMS - February 03, 2021

    February 4, 2021

     An updated errata (V3.00.7) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  The resolution to issue 17 in the previous errata was flawed, as the addition of edit -3963d prevented submission of IPA inactivations.  Therefore, edit -3963d has been suspended for now, and will be revised in a future release.

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  • NACs, Need More Time? Four Areas to Gain Efficiencies

    By Caralyn Davis, Staff Writer - February 02, 2021

    Amid the national staffing shortage, nurse assessment coordinators (NACs) may continue to face clinical demands on their time—making a fine-tuned Resident Assessment Instrument (RAI)/MDS process more critical than ever.

    Read this article for potential time sinks NACs can review, according to Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC, to find ways to gain efficiencies in the RAI process.


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  • Section G Coding Still Matters: Keep It Accurate

    By Caralyn Davis, Staff Writer - February 02, 2021

    "Despite its limited use related to Medicare Part A, section G currently remains a vital part of the MDS—and it’s worth some attention from both the nurse assessment coordinator (NAC) and the interdisciplinary team,” says Jillian Martin, RN, BS, DNS-CT, RAC-MT, RAC-CTA.

     

    Read this article to learn more about section G's impact on Quality Measures, care planning, and Medicaid payment rates, and gain tips that NACs can implement to boost section G coding accuracy.

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  • How to Triage the RAI/MDS Process

    By Caralyn Davis, Staff Writer - January 26, 2021

    Early 2021 could be challenging for the nation’s nursing homes. Recent trends in infection rates combined with the slow rollout of the COVID-19 vaccine have the potential to make the coming months “the deadliest of the pandemic for long-term care residents and staff,” says the Kaiser Family Foundation in the Jan. 14 issue brief, Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020.

     

    “Providers have a number of months yet to get through,” agrees Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA. “Getting vaccines in nursing homes is absolutely great, but COVID-19 will still be in the local communities. Nursing homes, especially facilities with high turnover, will have new residents coming in from their communities, increasing the risk of an outbreak.”

     

    To prepare, nurse assessment coordinators (NACs) should triage the Resident Assessment Instrument (RAI)/MDS process much the same way that healthcare providers triage personal protective equipment (PPE) supplies, suggests Maher. “There are three core modes: conventional, contingency, and crisis,” she notes. “Conventional mode is business as usual; COVID-19 is not in your facility. Contingency mode means that you have challenges, but you are still managing the RAI process. Crisis mode means that you face catastrophic challenges that could stop the RAI process in its tracks.”

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  • Top 5 Facts NACs Need to Know About the CY 2021 Medicare Physician Fee Schedule Final Rule

    By AAPACN - January 26, 2021

    On Dec. 2, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule. However, on Dec. 21, 2020, Congress passed the Consolidated Appropriations Act, 2021 and it was signed into law by the President on Dec. 27, 2020, which modified the previously released final rule. To help dissect this lengthy final rule, AAPACN asked Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, AVP of Clinical Innovation for Paragon Rehabilitation, a contract therapy provider, to share her insights on the most important facts nurse assessment coordinators (NACs) need to know.

     

    Decrease in payments for CPT codes

    “In the December 2 release of the final rule, there were changes to Current Procedural Terminology (CPT) codes. Because therapy for Medicare Part B services is paid for by CPT codes, that was the biggest change for skilled nursing facilities (SNFs) in the final rule. The rule caused a big decrease in payment for the way we bill Part B. Originally, it was going to be a cut of about 9%. While there were some CPT codes that received an increase, like PT evaluation codes, most of them received a decrease,” says Barlow, explaining the impact of the early December version of the final rule.

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  • AHRQ: Treatments for Acute Pain: A Systematic Review (1/21)

    By AHRQ - January 24, 2021

    Main Points

    • Opioids are probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stone pain and might be similarly effective to NSAIDs for low back pain.
    • Opioids might be and NSAIDs are probably more effective than acetaminophen for surgical dental pain, but opioids are probably less effective than acetaminophen for kidney stone pain.
    • An opioid might be more effective than gabapentin for acute neuropathic pain.
    • Opioids are probably associated with increased risk of short-term adverse events versus nonopioid pharmacologic therapy for acute pain, including any adverse event, study withdrawal due to adverse events, nausea, dizziness, and somnolence, but serious adverse events are uncommon in randomized trials.
    • Being prescribed an opioid for acute low back pain or postoperative pain might be associated with increased likelihood of use of opioids at long-term followup versus not being prescribed.
    • Heat therapy is probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, massage might be effective for postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy.
    • Research is very limited on the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge.

    Structured Abstract

    Objectives. To evaluate the effectiveness and comparative effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic therapy in patients with specific types of acute pain, including effects on pain, function, quality of life, adverse events, and long-term use of opioids.

    Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to August 2020, reference lists, and a Federal Register notice.

    Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) of outpatient therapies for eight acute pain conditions: low back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain following discharge, dental pain (surgical or nonsurgical), pain due to kidney stones, and pain due to sickle cell disease. Meta-analyses were conducted on pharmacologic therapy for dental pain and kidney stone pain, and likelihood of repeat or rescue medication use and adverse events. The magnitude of effects was classified as small, moderate, or large using previously defined criteria, and strength of evidence was assessed.

    Results. One hundred eighty-three RCTs on the comparative effectiveness of therapies for acute pain were included. Opioid therapy was probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stones, and might be similarly effective as NSAIDs for low back pain. Opioids and NSAIDs were more effective than acetaminophen for surgical dental pain, but opioids were less effective than acetaminophen for kidney stone pain. For postoperative pain, opioids were associated with increased likelihood of repeat or rescue analgesic use, but effects on pain intensity were inconsistent. Being prescribed an opioid for acute low back pain or postoperative pain was associated with increased likelihood of use of opioids at long-term followup versus not being prescribed, based on observational studies. Heat therapy was probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, acupressure might be effective for acute musculoskeletal pain, an opioid might be effective for acute neuropathic pain, massage might be effective for some types of postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy. Most studies had methodological limitations. Effect sizes were primarily small to moderate for pain, the most commonly evaluated outcome. Opioids were associated with increased risk of short-term adverse events versus NSAIDs or acetaminophen, including any adverse event, nausea, dizziness, and somnolence. Serious adverse events were uncommon for all interventions, but studies were not designed to assess risk of overdose, opioid use disorder, or long-term harms. Evidence on how benefits or harms varied in subgroups was lacking.

    Conclusions. Opioid therapy was associated with decreased or similar effectiveness as an NSAID for some acute pain conditions, but with increased risk of short-term adverse events. Evidence on nonpharmacological therapies was limited, but heat therapy, spinal manipulation, massage, acupuncture, acupressure, a cervical collar, and exercise were effective for specific acute pain conditions. Research is needed to determine the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge; effects of therapies for acute pain on non-pain outcomes; effects of therapies on long-term outcomes, including long-term opioid use; and how benefits and harms of therapies vary in subgroups.

    Citation

    Chou R, Wagner J, Ahmed AY, Blazina I, Brodt E, Buckley DI, Cheney TP, Choo E, Dana T, Gordon D, Khandelwal S, Kantner S, McDonagh MS, Sedgley C, Skelly AC. Treatments for Acute Pain: A Systematic Review. Comparative Effectiveness Review No. 240. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 20(21)-EHC006. Rockville, MD: Agency for Healthcare Research and Quality; December 2020. 

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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (1/21)

    By CMS - January 18, 2021

    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. 

    On December 1, 2020 the Nursing Home Compare website was retired. It has been replaced by the new Care Compare website. Care Compare can be accessed at: (https://www.medicare.gov/care-compare/). The Provider Data Catalog (PDC) located at https://data.cms.gov/provider-data/ allows users to search and download the publicly reported data. While this Technical Users’ Guide has been revised to refer to Care Compare, there may be previously published materials or documents that refer to Nursing Home Compare and all prior references to Nursing Home Compare will now apply to Care Compare.

     

    January 2021 Revisions

     

    Health Inspection Rating Changes:

    Beginning with the January 2021 refresh, CMS resumed calculating the health inspection rating domain and began to use results from surveys that occurred after March 3, 2020. Additionally, focused infection control surveys are included in the rating calculation, with citations from these surveys counting towards the total weighted health inspection score (similar to how complaint survey citations are counted).

    These changes resulted in updates to the Special Focus Facility (SFF) program, including updates to SFF candidates, and facilities’ status for receiving an icon for noncompliance related to abuse. Specifically, updates to the health inspection data due to the incorporation of surveys occurring after March 3, 2020 and the updating of the complaint periods means that the abuse icon will be removed for facilities that no longer meet the abuse icon criteria based on more recent survey findings. Once facilities no longer meet criteria for the abuse icon, their health inspection rating will no longer be capped at two stars. More information on the abuse icon is found in the Health Inspection section of this document.


    Staffing Rating Changes:

    Beginning with the January 2021 refresh, facilities that did not report staffing for the November 14, 2020 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available” with the January, February, and March refreshes. Starting with the April 2021 refresh of Care Compare, when staffing data submitted by the February 14, 2021 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for October – December 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star.

     

    Quality Measure Rating Changes:

    Quarterly updates of most of the quality measures (QMs) posted on Care Compare and used in the FiveStar Quality Rating System resumed with the January 2021 refresh. For the January 2021 update, CMS used data for July 2019- June 2020 for all of the measures that were updated. The two QMs that are part of the Skilled Nursing Facility Quality Reporting Program (Percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened and Rate of successful return to home and community from a SNF) will not be updated in January 2021.


    January 2020 addition: Technical specifications for claims-based measures


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  • Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020: Kaiser Family Foundation Review (1/21)

    By Kaiser Family Foundation - January 18, 2021

    For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority group. A second, related analysis synthesizes the findings of 30 studies that examined potential factors associated with COVID-19 cases and deaths in long-term care facilities.

    KFF held a web briefing yesterday to review this latest data on COVID-19 cases and deaths in long-term care facilities and examine how the effort to vaccinate residents and staff in long-term care settings is going, challenges experienced so far, and opportunities for improvement. 

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  • OIG to Look at Medicare Part D Payments in SNF Stays and Nursing Home Background Checks (1/21)

    By OIG - January 15, 2021

    Medicare Part D Payments During Covered Part A SNF Stay

    Medicare Part A prospective payments to skilled nursing facilities (SNFs) cover most services, including drugs and biologicals furnished by the SNF for use in the facility for the care and treatment of beneficiaries. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to posthospital SNF care because these drugs are already included in the consolidated payment for Part A SNF stays. We will determine whether Medicare Part D paid for drugs that should have been paid under Part A SNF stays.

     

    Announced or Revised

    Agency

    Title

    Report Number(s)

    Expected Issue Date (FY)

    January 2021

    Centers for Medicare and Medicaid Services

    Medicare Part D Payments During Covered Part A SNF Stay

    W-00-21-35866

    2022

     

    Background Checks for Nursing Home Employees

    Federal regulation 42 CFR 483.12(a)(3) provides beneficiaries who rely on long-term care services with protection from abuse, neglect, and theft by preventing prospective employees with disqualifying offenses from being employed by these care providers and facilities. The National Background Check Program was enacted by legislation in 2010 to assist States in developing and improving systems for conducting Federal and State background checks. Prior OIG work has shown that not all States complied with the National Background Check Program for Long-Term Care Providers. We will determine whether Medicaid beneficiaries in nursing homes in selected States were adequately safeguarded from caregivers with a criminal history of abuse, neglect, exploitation, mistreatment of residents, or misappropriation of resident property, according to Federal requirements. 

     

    Announced or Revised

    Agency

    Title

    Report Number(s)

    Expected Issue Date (FY)

    January 2021

    Centers for Medicare and Medicaid Services

    Background Checks for Nursing Home Employees

    W-00-21-31553

    2022

     

     

     


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  • The importance of device selection, education, and training for appropriate and effective inhalation therapy in COPD

    By Shahin Sanjar, PhD., Sunovion Pharmaceuticals Inc. - January 13, 2021

    Inhalation treatment of respiratory conditions such as asthma and COPD is the predominant mode of therapy for the simple and logical reason that applying pharmacological agents to the target organ reduces the drug dose, maintains good efficacy, as well as reduces potential systemic adverse effects. To this end, there are now multiple systems for delivering therapeutic agents either as single or fixed dose combinations of two or three agents. The focus of this article is on the delivery devices and potential challenges with multiple device options rather than the therapeutic agents. It is important to recognize that even the best therapeutic agents cannot be effective unless they are delivered to the correct target organ or site. 


    Given the wealth of treatment and delivery options, it is surprising that treatment of COPD remains less than optimal and reported rates of device use errors remain high (Sanchis J et al. 2016, Molimard et al. 2017). This topic has been broadly discussed in the latest Global Initiative for Obstructive Lung Disease (GOLD 2021) report, with an emphasis on effective training and appropriate device selection for COPD patients. In a recent study, only 23% of patients discharged from the hospital demonstrated appropriate use of dry powder inhalers (Sulaiman et al. 2017). It is important to note that despite significant improvements in device design and a greater understanding of drug delivery issues, such as aerodynamics of particle flow as well as optimal particle size for pulmonary delivery, device error rates have remained high for decades (Sanchis et al. 2016). It is now well-recognized that education and training are key components of proper inhaler use, which requires regular assessment and the implementation of the “teach back” method (Dantic 2014). The importance of continued assessment is highlighted by the observation that the training effect does not persist (Press et al. 2016).

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  • Section M: Skin Conditions - Assessment and Coding of Pressure Ulcers/Injuries: CMS Web-Based Training (1/21)

    By MX - January 13, 2021
    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of pressure ulcers/injuries. This 90-minute course is intended for providers in Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs), and is designed to be used on demand anywhere you can access a browser.
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  • Cross-Setting QRP Data Elements and Quality Measures: CMS Web-Based Training (1/21)

    By CMS - January 13, 2021

    From Data Elements to Quality Measures – Cross-Setting QRP Web-Based Training

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings. The PAC settings included are those covered under the Centers for Medicare & Medicaid Services (CMS) Quality Reporting Programs (QRPs) for Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Skilled Nursing Facilities (SNFs). Information covered will include a short review of the QRPs’ cross-setting quality measures (QM), how data elements feed into these cross-setting QMs, how QMs are calculated and appear on QM reports and how to access and use this data for quality improvement. 

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  • Contract Year 2022 Medicare Advantage and Part D Final Rule (1/21)

    By CMS - January 13, 2021

    The Centers for Medicare & Medicaid Services (CMS) issued a final rule that further advances the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs. The changes finalized today are generally effective for the 2022 plan year and will potentially lower enrollee cost sharing on some of the most expensive prescription drugs. This final rule will allow enrollees to know in advance and compare their out-of-pocket payments for different prescription drugs. The changes will result in an estimated $75.4 million in savings to the federal government over ten years.

    “The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” said CMS Administrator Seema Verma. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”

    As part of the administration’s commitment to promoting price transparency and lowering prescription drug prices, the final rule will require Part D plans to offer a real-time benefit comparison tool starting January 1, 2023, so enrollees can obtain information about lower-cost alternative therapies under their prescription drug benefit plan. Enrollees would be able to compare cost sharing to find the most cost-effective prescription drugs for their health needs. For example, if a doctor recommends a specific cholesterol-lowering drug, the enrollee could look up what the co-pay would be and see if a different, similarly effective option might save the enrollee money. With this tool, enrollees will be better able to know what they will need to pay before they are standing at the pharmacy counter. This follows a similar CMS requirement that Part D plans support a prescriber real-time drug benefit tool that went into effect January 1, 2021. Congress codified a similar requirement for prescriber real-time benefit tools in the recently enacted Consolidated Appropriations Act, 2021 (Public Law No. 116-260).

    In the Medicare Part D program, enrollees choose the prescription drug plan that best meets their needs. Many plans offering prescription drug coverage place drugs into different “tiers” on their formularies. Today, all drugs on a plan’s specialty tier – the tier that has the highest-cost drugs – have the same level of cost sharing. Under the final rule, CMS is allowing Part D plans to have a second, “preferred” specialty tier with a lower cost sharing level than their other specialty tier. This change gives Part D plans more tools to negotiate better deals with manufacturers on the highest-cost drugs and lower out-of-pocket costs for enrollees in exchange for placing these products on the “preferred” specialty tier.

    Under the Part D program, plans currently do not have to disclose to CMS the measures they use to evaluate pharmacy performance in their network agreements. CMS has heard concerns from pharmacies that the measures plans use to assess their performance are unattainable or otherwise unfair. The measures used by plans potentially impact pharmacy reimbursements. Therefore, CMS is requiring Part D plans to disclose pharmacy performance measures to CMS, which will enable CMS better understand how such measures are applied. CMS will also be able to report pharmacy performance measures publicly to increase transparency on the process and to inform the industry in its new efforts to develop a standard set of pharmacy performance measures.

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  • World Health Organization: Updated COVID-19 Interim Guidance for LTC Facilities (1/21)

    By WHO - January 12, 2021
    Infection prevention and control guidance for long-term care facilities (including NFs and SNFs) in the context of COVID-19 Interim guidance

    8 January 2021

    This document is an update of the guidance published on 21 March 2020 and contains new evidence and guidance, including the following:

    • updated results from published studies on:
      • the epidemiology and extent of SARS-CoV-2 infection among residents and staff in long-term care facilities (LTCFs);
      • the effectiveness of infection prevention and control (IPC) precautions to prevent SARS-CoV-2 transmission in LTCFs;
      • the impact of IPC precautions on mental and physical health and well-being of older people, and in particular people with dementia or other mental health or neurological disorders;
    • updated advice on IPC precautions to prevent the spread of SARS-CoV-2 and to protect health workers and caregivers of patients with suspected or confirmed COVID-19 in LTCFs;
    • advice on early detection of and testing for SARS-CoV-2 among residents and staff in LTCFs;
    • advice on policies for visitors to LTCFs and additional considerations on minimizing the mental and physical health impacts of restrictions and IPC precautions implemented in the context of COVID-19.
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