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This page contains the MDS 3.0 RAI Manual v1.17.1 and MDS forms, effective October 1, 2019. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas.
Since the preliminary release of the manual on May 20, 2019, changes have been made to clarify which assessments swing bed providers must complete; the definition of the “interruption window” for interrupted Part A-covered stays; the coding of item I0200B; and changes related to group therapy policies, as well as other corrections. Please see the document titled “MDS 3.0 RAI Manual v1.17.1 Replacement Manual Pages and Change Tables_October 2019."
The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for:
Date: Thursday, September 19, 2019
Start Time: 2:00 PM – 3:00 PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Todd Smith & Jill Darling
**This Agenda is Subject to Change**
I. Opening Remarks
Chair – Todd Smith (Center for Medicare)
Moderator – Jill Darling (Office of Communications)
II. Announcements & Updates
*Policy Questions should be sent to: NHStaffing@cms.hhs.gov
*Technical Issues/Questions should be sent to: NursingHomePBJTechIssues@cms.hhs.gov
*PBJ Website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html
* CMS-6058-FC Medicare, Medicaid, and Children's Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process
*SNF QRP resource update
III. Open Q&A
Under the Patient-Driven Payment Model (PDPM), resident outcomes will be key to avoiding medical review, said officials with the Centers for Medicare & Medicaid Services (CMS) during the August 14 Skilled Nursing Facility Quality Reporting Program (SNF QRP) training session, Patient-Driven Payment Model: What Is Changing (and What Is Not). Note: Find the session slides here.
The goal of PDPM is for SNFs to provide value-driven care, said officials. “Fundamentally, it comes down to a balance. A high-value and efficient provider is one that is able to achieve high-quality outcomes at low cost.”
CMS measures SNF quality of care in three main ways:
The SNF QRP;
The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program; and
The Five-Star Quality Reporting System on Nursing Home Compare.
It can start out as little things. Something doesn’t feel quite right. The environment around you feels hushed or hostile. And then you become the target.
That was the experience for a nurse who was bullied for eight years by another staff member in her facility. She was about to walk away quietly and quit her job, like so many had before her, feeling like she could not do anything about her situation other than remove herself from it. But just in time, she found the strength she needed to keep going and to share her voice.
Although she would like to remain anonymous (we’ll refer to her as Nancy), she wanted to share her story so that, if you are experiencing workplace bullying, you can learn how to overcome it, to move forward, and to start healing.
The FINAL version of the PDPM Grouper DLL has been posted, along with its source code, plus an errata. Note that the DLL interface has not changed since the beta version. Documentation and test files will be provided in a separate posting – coming soon. Please report any issues found to PDPM@cms.hhs.gov.
The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 has been posted. The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 contains detailed specifications for the assessment- and claims-based quality measures reported under the SNF QRP. The manual can be found below and the Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 2.0 has been moved to the Quality Measures Archive page.
Under the Patient-Driven Payment Model (PDPM), the Centers for Medicare & Medicaid Services (CMS) will implement an interrupted-stay policy for the first time in the Skilled Nursing Facility Prospective Payment System (SNF PPS). The agency is already ironing out some potential bumps in the implementation process. Following the release of the draft v1.17 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, CMS has clarified the new policy to account for the difference in how the day of discharge is treated for Part A residents who physically discharge from the SNF vs. those who discharge from Part A and remain in the building (e.g., as a Medicaid resident).
CMS officials reviewed key aspects of the interrupted-stay policy, including this new clarification that impacts the count of noncovered days, during two sessions at the August 14 Skilled Nursing Facility Quality Reporting Program (SNF QRP) training event: Section A, I, J, and O Updates and Patient-Driven Payment Model: What Is Changing (and What Is Not).
CMS has released the PDPM ICD-10 Mappings File for FY 2020 as well as the I0020B Code Lookup File.
This section includes fact sheets on a variety of PDPM related topics.
PDPM Frequently Asked Questions
This section contains frequently asked questions (FAQs) related to PDPM policy and implementation.
Launch of the CMS Beneficiary Notices Initiative (BNI) Mailbox Portal for Beneficiary Notices and Related Policy Questions
This message is to announce the launch of the new CMS Beneficiary Notices Initiative (BNI) mailbox portal for beneficiary notices and related policy questions. Please note this mailbox portal replaces the BNI mailbox, BNImailbox@cms.hhs.gov. The purpose of this new BNI mailbox portal is to provide a more efficient method for responding to provider, industry, and stakeholder questions.
The new BNI mailbox portal provides links to a variety of resources and links to other CMS mailboxes and e-mail addresses. CMS encourages you to review the available resources before submitting a question to ensure that we have not already provided information on the specific topic in question. Please also refer to the list of other CMS mailboxes and e-mail addresses to ensure that you direct your question to the most appropriate area of expertise.
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