• Sept. 19 SNF/LTC Open Door Forum Agenda and Call-in Info

    By CMS - September 11, 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

    *PDPM Update

    *PBJ Update

    *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

    Read more
  • CMS Makes Direct Link Between Outcomes and Medical Review

    By Caralyn Davis, Staff Writer - September 11, 2019

    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.

    Read more
  • Are You Being Bullied in the Workplace?

    By AANAC - September 11, 2019

    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.

    Read more
  • Final PDPM Grouper DLL Released (9/19)

    By CMS - September 09, 2019

     

    The FINAL version of the PDPM Grouper DLL has been posted, along with its source code.  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.
    Read more
  • SNF QRP Measure Calculations and Reporting User's Manual Update (9/19)

    By CMS - September 05, 2019

    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.

    Read more
  • MDS 3.0 Quality Measures (QM) User's Manual V12.1 (9/19)

    By CMS - September 05, 2019

    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. This manual contains detailed specifications for the MDS 3.0 CASPER/Nursing Home Compare/Five Star quality measures.
    Read more
  • Interrupted-Stay Policy: CMS Clarifies Noncovered Days

    By Caralyn Davis, Staff Writer - September 04, 2019

    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). 

    Read more
  • FY 2020 PDPM ICD-10 Mapping Tool and MDS Item I0020B ICD-10 Code Lookup Tool (9/19)

    By CMS - September 03, 2019

    CMS has released the PDPM ICD-10 Mappings File for FY 2020 as well as the I0020B Code Lookup File. 

    Read more
  • PDPM FAQs and Fact Sheets_Revised (9/19)

    By CMS - September 03, 2019

    Fact Sheets

    This section includes fact sheets on a variety of PDPM related topics.

    • Administrative Level of Care Presumption under the PDPM
    • PDPM Payments for SNF Patients with HIV/AIDS
    • Concurrent and Group Therapy Limit
    • PDPM Functional and Cognitive Scoring
    • Interrupted Stay Policy
    • MDS Changes
    • NTA Comorbidity Score
    • PDPM Patient Classification
    • Variable Per Diem Adjustment

    PDPM Frequently Asked Questions

    This section contains frequently asked questions (FAQs) related to PDPM policy and implementation.

    Read more
  • 1Q 2019 SNF QRP Help Desk Q+A Document (9/19)

    By CMS - September 02, 2019
    A new Question and Answer (Q+A) document  is now available in the "Downloads" section of the SNF Quality Reporting Program FAQs webpage. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the first quarter (Jan - Mar) of 2019.
    Read more
  • CMS Beneficiary Notices Initiative (BNI) Mailbox Portal (9/19)

    By CMS - September 02, 2019

    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. 

    Read more
  • Final MDS 3.0 Data Specs for Oct. 1, 2019 Implementation (8/19)

    By CMS - August 21, 2019

    The FINAL version (V3.00.1) of the MDS 3.0 Data Specifications was posted.  This version is scheduled to become effective October 1, 2019.  Note that there have been additional revisions since the errata – they can be identified by looking for “post-errata” in the version notes for the items and edits.

    In addition,  V1.04.0 of the MDS 3.0 CAT Specifications  is also scheduled to become effective October 1, 2019. The specification for CAT 12 (Nutritional Status) has been updated in accordance with the changes in V3.00.0 of the MDS 3.0 Data Specifications.
    Read more
  • Skilled Documentation Paints a Picture

    By Jane Belt, MS, RN, RAC-MT, RAC-MTA, QCP - August 13, 2019

    In a previous article, we covered the basics of ethical and effective documentation practices to use in the long-term care setting. We learned that documentation can not only make the difference between saving or sacrificing you and your license, but also can make a positive impact on resident outcomes. With the basics in mind, we will explore the keys to successful skilled documentation. Why is that so important? Medicare reviewers do not ever physically see the resident; the key to their decision to pay the claim or not is in the medical record. Every entry in the medical record needs to build the case that the resident is being provided services and care that meet the definition of skilled services, that the services are so inherently complex they can only be provided by or under the supervision of professional or technical personnel. In addition, the nature of the service and the skills required for safe and effective delivery are the deciding factors.

        

    Read more
  • Under PDPM, Group/Concurrent Therapy Will Need NAC Case Management

    By Caralyn Davis, Staff Writer - August 13, 2019

    When the Patient-Driven Payment Model (PDPM) implements this October 1 in the fee-for-service Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), concurrent therapy, group therapy, and even restorative nursing will once again take on a renewed importance as tools for achieving a resident’s clinical goals, says Joel VanEaton, BSN, RN, RAC-MT, vice president of compliance and regulatory affairs for Broad River Rehab in Asheville, NC.

     

    “However, you may run into trouble if SNFs or therapists simply dictate, ‘We will do X amount of concurrent and group therapy,’” suggests VanEaton. “PDPM is intended to be a reimbursement system that elevates the resident’s voice by ensuring that resident care decisions appropriately reflect each resident’s actual care needs.”

    Read more
  • August 13 - 14 SNF QRP Training Slides Available

    By CMS - August 12, 2019
    Read more
1 of 38 Next