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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.
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.
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:
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.”
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.
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.”
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.
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.
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.
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?
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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