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Nursing Home Quality Measure Changes
The following nursing home quality measures have been removed:
· Percentage of short-stay residents who report moderate to severe pain.
· Percentage of long-stay residents who report moderate to severe pain.
This change supports the federal initiative to reduce opioid utilization by seeking to prevent a potential scenario where the performance of a facility on the pain quality measures may inappropriately contribute to their decision to seek the administration of an opioid.
MDS 3.0 QM User’s Manual Version 12.1 Now Available
The MDS 3.0 QM User’s Manual Version 12.1 has been posted. The MDS 3.0 QM User’s Manual V12.1 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V12.1 can be found in the Downloads section of this page and the MDS 3.0 QM User’s Manual V12.0 has been moved to the Quality Measures Archive page.
One file related to the MDS 3.0 QM User’s Manual has been posted:
1. MDS 3.0 QM User’s Manual V12.1 contains detailed specifications for the MDS 3.0 quality measures.
2. Quality Measure Identification Number by CMS Reporting Module Table V1.7 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. A unique CMS identification number is specified for each QM.
Updates to the Nursing Home Compare website and the Five Star Quality Rating System
Posting Date 2019-10-07
Fiscal Year 2020
• CMS is removing the quality measures related to residents’ reported experience with pain from the Nursing Home Compare website and the Five Star Rating System.
• We are also advising providers we will be updating the thresholds for quality measure ratings, according to the plan introduced in CMS Memorandum QSO-19-08-NH, in which the thresholds will be updated every six months. The first update will take place April 2020.
• We are listing the dates the Nursing Home Compare website and the Five Star Rating System will be updated over the next few months.
Consumer Alerts added to the Nursing Home Compare website and the Five Star Quality Rating System
• Abuse Indicator –CMS is updating the Nursing Home Compare website to make it easier for consumers to identify facilities with instances of non-compliance related to abuse.
• Consumer Alert for Oregon Nursing Homes – CMS will be adding a consumer alert on the Nursing Home Compare website for all Oregon facilities indicating that incidents of abuse may not be reflected on the Nursing Home Compare website. This action is in response to a recommendation by the Government Accountability Office (GAO).
CMS has revised SNF-focused chapters in the following manuals in the online manual system to account for the Patient-Driven Payment Model (PDPM):
jRAVEN (version 1.7.1) is now available for download which contains the following updates:
2) All enhancements included with jRAVEN v1.7.0:
3) MDS Item Set Version V1.17
4) MDS Data Specification Version V3.00
5) VUT Version V3.1.0
6) The initial PDPM Grouper (replaced with the new version, v1.0003)
7) Supports the Correction Policy update to not allow corrections if it causes the target date to cross over the 10/1/2019 date
8) Supports the updated submission timeframe change from 3 years to 2 years
The transition from the RUG-IV to the Patient-Driven Payment Model (PDPM), was a hard transition. SNFs followed RUG-IV PPS scheduling and rules through September 30 and then, on October 1, they began PDPM. However, there is still a transition process that must be followed, and nurse assessment coordinators (NACs) need to fully understand all the requirements. NACs also need to double check all payer types and assessment reference dates (ARDs) and ensure that, by the end of October 7, the facility has completed all steps the process requires. Lastly, NACs may want to consider completing a quick triple check or a billing review to ensure all the conditions of Medicare billing have been met before the end of the transition. While the triple check process is typically reserved for reviewing the previous month’s claims, completing an expedited check by October 7, before the end of the transition, can help reduce the risk of payment penalties. Here are three key steps to a successful transition:
In addition to updating the coding instructions for MDS item I0020B (ICD Code/Resident’s Primary Medical Condition), the Centers for Medicare & Medicaid Services (CMS) made several other changes to version 1.17.1 of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual compared to the draft version 1.17. Most were expected given the updated presentations CMS officials gave at the August 13 – 14 Skilled Nursing Facility Quality Reporting Program (SNF QRP) training event, as well as the finalized requirements in the Fiscal Year (FY) 2020 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule. These included updates to the definition of an interruption window and changes to the group therapy coding instructions. However, there were also some new updates. For example, CMS established a new 10/01/2019 Cross-Over Rule as part of its MDS modification policy.
Last week, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited version 1.17.1 of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual. One change from the draft version 1.17 manual highlights some ongoing confusion about how to code ICD-10-CM diagnosis codes in MDS items I0020B (ICD Code/Resident’s Primary Medical Condition) and I8000 (Additional Active Diagnoses) to ensure accurate case-mix classification in the Patient-Driven Payment Model (PDPM).
The ICD-10 code entered in I0020B determines a Part A resident’s default primary diagnosis clinical category for the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) payment components under PDPM. In addition, ICD-10 codes entered in I8000 determine whether the resident qualifies for certain comorbidities under the SLP component (identified in Table 14, “SLP-Related Comorbidities,” in the PDPM Calculation Worksheet for SNFs section of chapter 6 in the RAI User’s Manual) or the nontherapy ancillaries (NTA) component (identified in Table 16, “NTA Comorbidity Score Calculation”).
SNFs are in the final stage of preparation for Patient-Driven Payment Model (PDPM) implementation, but alongside the payment model’s introduction, new policies are being introduced that add layers of complexity that nurse assessment coordinators (NACs) must master this fall. For example, the new Interrupted Stay Policy adds a whole new critical thinking process to what has been a simplified PPS schedule. However, the Interrupted Stay Policy does not need to cause anxiety—it just needs to be better understood. Here are seven tips to uncomplicate the Interrupted Stay Policy:
1. Understand the two criteria of the Interrupted Stay Policy.
The Interrupted Stay Policy essentially combines multiple SNF PPS stays that are separated by less than three days into one stay when the resident meets both of the following criteria:
1. Resident returns to the same skilled nursing facility (SNF), and
2. Returns by 11:59 pm of the third calendar day
The Interruption Stay Policy also introduces the concept of the “interruption window,” which begins with the calendar day of discharge and includes the two calendar days immediately following. If the resident’s Medicare stay ends, and the resident remains in the facility with benefit days remaining, then the interruption window begins on the first non-covered day and includes the next two calendar days.
The Patient-Driven Payment Model (PDPM) is designed to reallocate Medicare Part A payments made in the Skilled Nursing Facility Prospective Payment System (SNF PPS) to currently underserved beneficiaries, i.e., residents who have more clinically complex needs and high nontherapy ancillary (NTA) costs. To navigate PDPM, nurse assessment coordinators (NACs) will need to be able to code the appropriate active diagnoses, conditions, and treatments for these complex medical residents on the MDS.
Researching and using accurate ICD-10-CM diagnosis codes is critical to achieving appropriate PDPM case-mix groups for these residents. The ICD-10 code for the resident’s primary diagnosis for the SNF stay, reported in new item I0020B (ICD Code/Primary Medical Condition), will determine their default primary clinical category for classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) payment components. ICD-10 codes entered in I8000 (Additional Active Diagnoses) also can factor into comorbidities that would further impact the SLP component, as well as the NTA component.
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