• Look Now for Your SNF QRP Noncompliance Letters: Requests for Reconsideration due Aug. 7

    By CMS - July 10, 2018
    CMS is providing notifications to facilities that were determined to be out of compliance with Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) requirements for CY 2017, which will affect their FY 2019 Annual Payment Update (APU). Non-compliance notifications were mailed by the Medicare Administrative Contractors (MACs) and have been placed into facilities’ CASPER folders in QIES on July 9, 2018. 

    Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59pm PST, August 7, 2018.

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  • SNF ABN Completion Tips: 4 Tips for an Error-Free Notice

    By Caralyn Davis, Staff Writer - July 10, 2018
    The revised Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN; Form CMS-10055) is “a simplified form with simplified instructions,” notes Maureen Hedrick, director of consulting services for Richter Healthcare Consultants in Twinsburg, OH. Nevertheless, mistakes can be made, so here are four tips for ensuring an error-free SNF ABN.
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  • AANAC Responds to FY 2019 SNF PPS Proposed Rule: Is Now the Time for PDPM?

    By Jessie McGill, RN, RAC-MT - July 10, 2018
    CMS took the long-term care profession by surprise in April when the SNF PPS Proposed Rule revealed the Patient-Driven Payment Model (PDPM). With a proposed implementation date of October 1, 2019, PDPM would replace RUG-IV without a phase-in or blended transition. CMS provided a 60-day comment period for the public to express concerns, support, and other feedback on the proposed rule, and AANAC responded. Following weeks of collaboration with our sister organization, AADNS, and with the Expert Advisory Panel members from both organizations, members, and other stakeholder groups, AANAC and AADNS jointly submitted 25 pages of comments to CMS. (For purposes of brevity in this article, the issuer of those comments is referred to as AANAC, but the collaborative effort should be understood.)
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  • AANAC Membership Satisfaction Survey Results

    By Staff Writer, Shannon Johnson - July 10, 2018
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  • IMPACT Act QM Development: Transfer of Medication Profile TEP Report (7/18)

    By CMS - July 09, 2018

    TEP Summary Report Available: Development of Quality Measures for the Transfer of Health Information and Care Preferences Domain - Transfer of Medication Profile

    The technical expert panel (TEP) Meeting 4 summary report for the Development of Measures under the Transfer of Health Information and Care Preferences domain is now available. This report summarizes proceedings from a follow-up cross-setting TEP meeting, which included in-depth discussion and input on the following topics:

    ·         Revisions to the measure concept and measure specifications since the TEP last met

    ·         The draft cross-setting Transfer of Medication Profile measures for Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, and Home Health Agencies

    ·         The items used to calculate the quality measure

    ·         Importance and feasibility of Information to be included in the medication profile to meet the measure criteria

    ·         Items collecting routes of transfer of the medication profile

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  • Trauma-Informed Care Infographic (7/18)

    By CDC - July 09, 2018
    The CDC is working with SAMHSA’s National Center for Trauma-Informed Care (NCTIC) to integrate a trauma-informed approach to public health emergencies. The infographic they developed for the approach may be useful in understanding trauma-informed care.
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  • CMS QSO (Survey) Memo: Updated Legionella Risk Reduction Requirements (7/18)

    By CMS - July 08, 2018

    Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease (LD)

    ***Revised 07.06.2018 to Clarify Expectations for Providers, Accrediting Organizations, and Surveyors*** ***Revised 06.09.2017 to Clarify Provider Types Affected*** 

    • Legionella Infections: The bacterium Legionella can cause a serious type of pneumonia called LD in persons at risk. Those at risk include persons who are at least 50 years old, smokers, or those with underlying medical conditions such as chronic lung disease or immunosuppression. Outbreaks have been linked to poorly maintained water systems in buildings with large or complex water systems including hospitals and long-term care facilities. Transmission can occur via aerosols from devices such as showerheads, cooling towers, hot tubs, and decorative fountains. 

    • Facility Requirements to Prevent Legionella Infections: Facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of legionella and other opportunistic pathogens in water.

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  • FY 2019 SNF PPS Pricer Update: For Your Billers (7/18)

    By CMS - July 08, 2018
    Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2019
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  • CMS SNF VBP FAQs (7/18)

    By CMS - July 02, 2018

    Topics covered include:

    • What is the Skilled Nursing Facility Value-Based Purchasing Program?
    • What SNFs are included in the SNF VBP Program?
    • What measure is currently being used in the SNF VBP Program?
    • What is the difference between a planned readmission and an unplanned readmission?
    • When does the SNFRM 30-day readmissions period begin and end?
    • Are the measures in the SNF VBP Program the same as the measures in the SNF Quality Reporting Program (QRP) and on the Nursing Home Compare website?
    • How are performance scores calculated?
    • Will SNFs be able to calculate their achievement and improvement points?
    • How are incentive payments determined?
    • How will SNFs be notified of their performance in the Program?
    • What is Phase One of the Review and Corrections process?
    • How can I correct an error in my patient-level data?
    • What is Phase Two of the Review and Corrections process?
    • Where can I find more information or ask questions about the SNF VBP Program?
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  • July 25 Special Open Door Forum: The IMPACT Act and Standardized Patient Assessment Data Elements

    By CMS - July 02, 2018
    This Special Open Door Forum (SODF) will provide information and solicit feedback pertaining to the Standardized Patient Assessment Data Elements (SPADE) work under the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). This SODF will provide an update on the recent SPADE activities including progress on national field test data collection, early feedback from providers participating in the beta data collection,  and upcoming stakeholder engagement activities that will help stakeholders remain engaged and informed during the upcoming year.
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  • Free AHRQ Antibiotic Stewardship Training: Is It Right for Your Facility?

    By AHRQ - June 27, 2018
    The AHRQ Safety Program for Improving Antibiotic Use: A National Program for Antibiotic Stewardship: 

    The Agency for Healthcare Research and Quality (AHRQ), in conjunction with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and NORC at The University of Chicago, created the AHRQ Safety Program for Improving Antibiotic Use to develop and implement a bundle of interventions designed to improve antibiotic stewardship and antibiotic prescribing practices across acute care, long-term care, and ambulatory care facilities across the United States.


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  • Nursing Home Compare & PBJ Updates: Long-stay Resident Hospitalization Rate to Be Added to NHC / Five Star; Non-Nursing Staff for PBJ to Be Posted; Health Inspection Freeze to End (6/18)

    By CMS - June 22, 2018
    • In October 2018, the long-stay hospitalization measure will be posted on the Nursing Home Compare website as a long-stay quality measure. In the spring of 2019, this quality measure will be included in the Five Star Quality Rating System.  Additionally, in July 2018 we will update the other claims-based quality measures reported on the Nursing Home Compare website.
    • To increase transparency, CMS will begin posting the number of hours worked by other staff (i.e., non-nursing) in July 2018. Facilities are required to submit hours for all other staff as listed in Table 1 of the PBJ Policy Manual. We will also distinguish between hours submitted for direct employees and contract staff. 
    • In October 2019, CMS will resume posting the average number of citations per inspection for each state and nationally. CMS is monitoring outcomes of the new inspection process and plans to resume health inspection rating calculations (i.e., end the freeze) in the spring of 2019. CMS will communicate more details about this prior to its implementation.



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  • CMS Memo Revises Policies Re: Immediate Jeopardy and Immediate Imposition of Federal Remedies (6/18)

    By CMS - June 22, 2018

    Memo # 18-18-NH

    Posting Date 2018-06-15

    Fiscal Year 2018

    Summary

    This memo replaces the following Survey & Certification (S&C) Memos: 16-31-NH released July 22, 2016 and revised on July 29, 2016, and S&C: 18-01-NH, released in draft on October 27, 2017. The October 2017 memo solicited comments on a proposed directive requiring, for certain situations, immediate imposition of federal remedies on Medicare and Medicaid participating skilled nursing facilities. After reviewing comments, CMS is issuing a final version of the directive. Substantive revisions to the prior Immediate Imposition of Federal Remedies guidance include:

    • When the current survey identifies Immediate Jeopardy (IJ) that does not result in serious injury, harm, impairment or death, the CMS Regional Offices may determine the most appropriate remedy; 
    • We clarified that Past Noncompliance deficiencies (as described in §7510.1 of this chapter) are not included in the criteria for Immediate Imposition of Remedies; and, 
    • For Special Focus Facilities (SFFs), S/S level “F” citations under tags F812, F813 or F814 are excluded from immediate imposition of remedies. 
    • Revisions to Chapter 7 of the State Operations Manual (SOM) (Attachment): The Centers for Medicare & Medicaid Services (CMS) has revised guidance in Chapter 7 of the SOM related to the Immediate Imposition of Federal Remedies as noted in this memo and its attachment. Other sections of Chapter 7 have been revised to ensure conformity and consistency with these revisions.        
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  • Proposed SNF Patient-Driven Payment Model (PDPM) for Medicare Part A: Technical Resources UPDATED (6/18)

    By CMS - June 20, 2018

    In May 2017, CMS released an Advanced Notice of Proposed Rulemaking (ANPRM) which outlined a new case-mix model, the Resident Classification System, Version I (RCS-I), that would be used to replace the existing RUG-IV case-mix model, used to classify residents in a covered Part A stay into payment groups under the SNF PPS. Since the ANPRM, we continued our stakeholder engagement efforts to address the concerns and questions raised by commenters with RCS-I. This resulted in significant changes to the RCS-I model, which have prompted us to rename the proposed model discussed in the FY 2019 SNF PPS Notice of Proposed Rulemaking (NPRM) the SNF Patient Driven Payment Model (PDPM). 

    June 2018 Update: A few typographical and usability issues were recently identified by certain stakeholders with SNF PDPM the classification logic (SNF PDPM Classification Walkthrough, Grouper Tool, and NTA Comorbidity Mapping).  In order to address these issues, CMS has posted revised versions of the three files below. Stakeholders should use these revised SNF PDPM files to inform their comments on the proposed rule.
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  • NACs on Vacation—Free From Guilt and Stress

    By Jessie McGill, RN, RAC-MT - June 20, 2018

    Sitting with your feet in the sand, sunscreen on, ready to lean back and finally start reading that book that’s been at the top of your list for weeks—it’s official, you’re on vacation! One paragraph in and you set down the book with a sigh, distracted by thoughts of work. Did Mr. Jones really discharge today as planned? Did Mrs. Elderberry refuse therapy today? Who will adjust the assessment reference date of the Discharge assessments? Will anyone remember to open an End of Therapy assessment? You grab your cell phone, knowing that if you don’t check you’ll be stressed out the rest of the day.

    Is this your idea of a vacation? For many nurse assessment coordinators (NACs) it is, but it doesn’t have to be.

    Here are some strategies to achieving a vacation free from work-related guilt and stress.

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