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On Oct. 3, CMS published a correction notice for the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule to address a series of technical errors. “Chief among those” were corrections to the total case-mix-adjusted federal per-diem RUG-IV payment rates that were necessary due to errors in copying values, said officials with the Centers for Medicare & Medicaid Services (CMS) at the Oct. 11 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF).
Specifically, CMS has issued updated versions of both Table 6, “RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes—Urban,” and Table 7, “RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes—Rural,” to correct the Total Rate column. For example, those tables in the FY 2019 SNF PPS final rule show federal RUX payment as $832.89 for urban SNFs and $852.10 for rural SNFs. The correction notice changes the federal RUX rate to $832.61 urban and $851.84 rural.
Other FY 2019-specific corrections include the following:
TOOLS OF THE TRADE
Modern-day job searching in the senior living industry starts with development of a personal brand. You need a good online presence in the form of a website or networking profile and you need an elevator speech, business cards, and yes, a résumé. Some argue that the résumé is on its way out. In our experience, the résumé’s role has simply changed from being the primary means of landing a job to being one of several vital tools in your job-search toolbox. Successful job seekers use the résumé to pique an employer’s interest, while using online/social media profiles and interviews to convey more detailed information.
Effective Oct. 1, 2019, the Patient-Driven Payment Model (PDPM) in the skilled nursing facility prospective payment system (SNF PPS) will revamp how SNFs are paid to care for traditional fee-for-service Medicare Part A residents. “PDPM will look almost entirely different from the RUG models that SNFs have been working with for roughly 20 years,” says Scott Heichel, RN, RAC-MT, DNS-CT, QCP, CIC, director of clinical reimbursement for LeaderStat in Powell, Ohio.
When the Centers for Medicare & Medicaid Services (CMS) released the draft of the PDPM predecessor RCS-I, rumors immediately popped up that the reduction in administrative burden from the streamlined PPS assessment schedule would encourage providers to reduce their nurse assessment coordinator (NAC) staffing. However, aside from how that hot take ignored OBRA and Medicare Advantage assessments, “PDPM actually offers you the chance to make the NAC role even more important than it is under RUG-IV,” says Heichel.
The PDF file labeled “MDS3.0RAIManualv1.16R.Errata.October.1.2018,” available below, contains revisions to pages in Chapter 3, Section J, of the MDS 3.0 RAI Manual v1.16R, that amend the criteria for Major Surgery and correct the associated examples.
Changed manual pages are marked with the footer “October 2018 (R).”
The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual.
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility ValueBased Purchasing (VBP) Program.
Correction Notice SUMMARY: This document corrects technical errors in the final rule that appeared in the August 8, 2018 Federal Register (83 FR 39162) entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program.” DATES: The corrections in this document are effective October 1, 2018 .
About 15,600 nursing homes participate in Medicare and Medicaid. To help ensure that residents receive quality care, the Centers for Medicare & Medicaid Services (CMS) collect data (such as nurse staffing levels) on these nursing homes.
We testified that CMS's data showed mixed results—they showed an increase in consumer complaints along with improvements in the quality of care. We found that data issues (e.g., different states using different data collection methods) complicated CMS’s ability to assess whether the results reflected actual changes.
Since the Oct. 1, 2017, implementation of MDS item N0450 (Antipsychotic Medication Review), some providers have experienced a few hiccups in the quest for accurate reporting despite the seemingly straightforward nature of the questions. The five-part item captures the following information:
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