• Section GG: Assessing Usual Performance During the COVID-19 Pandemic

    By Caralyn Davis, Staff Writer - July 07, 2020

    The Centers for Medicare & Medicaid Services (CMS) makes clear in the title of MDS section GG (Usual Performance and Goals) that the assessment subitems in items GG0130 (Self-Care) and GG0170 (Mobility) are designed to capture a resident’s usual ability or usual performance. This begs the question: How can nurse assessment coordinators (NACs) and other members of the interdisciplinary team (IDT) ensure they capture usual performance in unusual times, such as in the middle of the ongoing COVID-19 pandemic?

     

    “Everyone’s nervous because nursing home residents are dealing with a new way of living, and staff are dealing with a new daily practice,” points out Melanie Tribe-Scott, BSN, RN, RAC-MTA, QCP, director of education and marketing for MDS Consultants in Medina, NY. “However, you still want to get the most complete picture of the resident possible, and you still should assess section GG the same way you always have—following the coding instructions in section GG of chapter 3 in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.”

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  • Dehydration Monitoring and Care Planning Is a Must This Summer

    By Caralyn Davis, Staff Writer - July 07, 2020

    With residents sometimes in isolation and wearing masks in various situations due to the COVID-19 pandemic, they are already more vulnerable to dehydration than normal, points out Teresa Remy, DSc, MHA, BSN, LNHA, RN, CDP, QCP, IPCO, director of consulting and clinical services for LeaderStat in Powell, OH. “Add the heat of the summer months on top of that, and providers need to be extra vigilant to prevent resident dehydration.”

     

    Implementing the following steps can help:

     

    Know the resident’s goals of care

    “First, you have to know what the resident’s goals are based on their diagnosis,” says Remy. “For example, if a resident has congestive heart failure, that needs to be taken into consideration when you are developing a care plan intervention to ensure they get adequate fluids.”

     

    It’s also important to know the resident’s wishes and preferences, says Jane Belt, MS, RN, QCP, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN. “Advance care planning is crucial to understanding the resident’s wishes. For example, advance care planning can help you understand what types of hydration therapy (artificial or not) a resident wants to receive,” she explains. “It’s their body, it’s their life, and everything you do for them has to be person-centered.”

     

    Be aware of common and uncommon symptoms of dehydration

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  • Beneficiary Notice Guidelines Tool

    By AANAC - July 07, 2020
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  • COVID-19 MLN Matters Article Update Addresses Billing Re: SNF Benefit Period Waiver (7/20)

    By CMS - July 06, 2020

    MLN Matters article Medicare FFS Response to COVID-19 Public Health Emergency Updated

    Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

    MLN Matters Number: SE20011 Revised Article

    Release Date: July 1, 2020

    Related CR Transmittal Number: N/A Related Change Request (CR)

    Number: N/A

    Effective Date: N/A

    Implementation Date: N/A

    Note: We revised the billing instructions on page 12 of this article. Changes include instructions to readmit the beneficiary on day 101 to start the Skilled Nursing Facility (SNF) benefit period waiver. All other information remains the same.

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  • SNF QRP Comorbidity HCC Groups ICD-10 Codes Updated (7/20)

    By CMS - July 06, 2020

    These charts provide an update to the Comorbidity HCC groups used for the SNF QRP as covariates for the Change in Self-Care score, Change in Mobility score, Discharge Self-Care sore, and Discharge Mobility score.

    They appear to be an update/crosswalk to the ICD-10 codes listed in table A-5 of the SNF QRP Measure Calculations and Reporting User’s Manual.

    It's worth noting that, in the user guide, there are only 24 HCC Groups, but this updated crosswalk lists 190 groups.

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  • FY 2021 ICD-10-CM Code Update (7/20)

    By CDC - July 02, 2020

    The 2021 ICD-10-CM codes are to be used from October 1, 2020 through September 30, 2021.

    Note: This replaces the FY 2020 release. These files listed below represent the FY 2021 ICD-10-CM. The FY 2021 ICD-10-CM is available in both PDF (Adobe) and XML file formats. Most files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to nchsicd10cm@cdc.gov .

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  • COVID-19 Waivers: CMS Article Answers Q's About 3-Day Hospital Stay & Benefit Period Ending/Renewal (6/20)

    By CMS - June 29, 2020

    3-day inpatient qualifying hospital stay waiver

    Benefit period ending/renewal waiver

    New MLN Matters article reviews in detail which residents each waiver applies to, including some useful examples for the benefit period waiver. Also provides extensive billing instructions.

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  • ABN (Form CMS-R-131) for Part B SNF Services - UPDATED: New Form Must Be Implemented by Aug. 31, 2020 (6/20)

    By CMS - June 27, 2020

    The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50

    Note: Skilled nursing facilities (SNFs) must use the ABN for items/services expected to be denied under Medicare Part B only.

    June 2020: The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal.  The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020.

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  • SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 (Calendar 2020) SNF QRP APU - REVISED (6/20)

    By CMS - June 26, 2020

    On January 30, 2020, CMS published the FY 2022 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Annual Payment Update (APU) Table for Reporting Assessment-Based Measures and Standardized Patient Assessment Data Elements (SPADES).

    Since that time, CMS has delayed the release of the SNF Minimum Data Set (MDS) Version 1.18.0 needed to support the Transfer of Health (TOH) Information Quality Measures and the new or revised SPADEs due to the COVID-19 Public Health Emergency.

    CMS has revised the SNF QRP APU table to reflect the updated Data Collection periods and applicable version number.  The table has also been updated with new footers to provide additional clarity on the use of the dash (-) for specific items. The revised table can be found in the Downloads section below with the title SNF QRP Table for Reporting Assessment-Based Measures for the FY 2022 SNF QRP APU.

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  • Final MDS 3.0 Item Sets and Data Specifications, Plus New Specs Erratata, for Oct. 1, 2020 (7/20)

    By CMS - June 26, 2020

    In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications.  These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1.  This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.

    The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.4 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.4) Final 04-30-2020 in the Downloads section below. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file:  MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip also posted in the Downloads section below.

    Please confirm with your State Medicaid Agency if your State will be requiring the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment.

    June 25, 2020 update:  An updated errata (V3.00.5) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  Two issues were identified.  These changes will go into production on October 1, 2020.  As a result, two edits will be revised.  These changes will facilitate calculation of PDPM HIPPS codes on OBRA assessments for states that wish to have this calculation performed. 

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  • Calendar Q2 2020 PBJ Staffing Data Due Aug. 14, 2020 and Five-Star/Nursing Home Compare Updates From CMS (6/20)

    By CMS - June 26, 2020

    Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

    Memo #QSO 20-34-NH

    Posting Date 2020-06-25

    Fiscal Year 2020

    Summary

    The Centers for Medicare & Medicaid Services (CMS) is committed to transparency about changes in publicly reported information on nursing homes during the COVID-19 public health emergency. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

    • Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.

    o Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.

    • Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant.

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  • AAPACN Advocacy Agenda Supports the LTPAC Nursing Profession During the COVID-19 Crisis

    By Tracey Moorhead - June 25, 2020

    Without a doubt, COVID-19 has been the nearly singular focus for AAPACN and our members over the last few months. We have closely communicated with members to understand the needs and challenges of long-term and post-acute care professionals during this time and developed a lengthy roster of tools, tips, and alerts for you. AAPACN has also maintained a strong advocacy and policy presence at the federal level in support of our members and the nursing profession. You might be surprised to know that many federal policy issues continued to move forward and, in many cases, garnered more attention and action during the COVID-19 pandemic.

    AAPACN actively advocates at the federal level for policy priorities important to our members.  Even before COVID-19, these priorities included building and maintaining a strong LTPAC workforce; ensuring educational opportunities for LTPAC nurses; supporting nursing research initiatives; and advocating for common-sense regulatory compliance policies. Each of these issues is impacted and underscored by the challenges of COVID-19.

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  • CMS COVID-19 Emergency Declarations and Specific SNF/NF Flexibilities UPDATED (6/20)

    By CMS - June 25, 2020

    COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (6/25/20)

    Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities) (PDF) UPDATED (6/15/20)
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  • SNF QRP Data Reporting Requirements Back in Full Force July 1, 2020

    By CMS - June 25, 2020

    Reminder

    ·         Quality Reporting Programs are expected to report their quality data to meet requirements starting Quarter 3, which begins July 1, 2020. 

    The March 27, 2020 Medicare Learning Network Newsletter (MLN) Exceptions and Extensions for Quality Reporting Program (QRP) Requirements that includes Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals (hereafter referred to as post-acute care (PAC) programs) applies only to Quarter 4 of 2019 (October 1-December 31, 2019) and Quarters 1 and 2 of 2020 (January 1-June 30, 2020).  Providers are expected to report data and meet the QRP requirements beginning with Quarter 3, 2020 that starts July 1, 2020.

     As stated in that March 27, 2020 MLN Newsletter, “In some instances, these exceptions and extensions are granted because the data collected may be greatly impacted by the response to COVID-19 and therefore should not be considered in the quality reporting program. CMS is closely monitoring the situation for potential adjustments and will update exception lists, exempted reporting periods, and submission deadlines accordingly as events occur.”

    Starting with Quarter 3 that begins July 1, 2020, CMS expects providers to report their quality data.  CMS will analyze the data for each program recognizing that the COVID-19 public health emergency (PHE) remains in effect and could impact the quality data submitted.  CMS will closely monitor the situation for public reporting of the data and provide any updates.

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  • CMS FAQs Detail Recommendations for Allowing Nursing Home Visits (6/20)

    By CMS - June 25, 2020

    CMS has issued seven Frequently Asked Questions to supplement existing guidance about the rules for nursing home visitations during the COVID-19 pandemic, starting with No. 1:

    1. What steps should nursing homes take before reopening to visitors? 

    Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19, and follow state and local direction. Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when: 

    • There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two) 

    • The nursing home is not experiencing staff shortages 

    • The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents 

    • The nursing home has adequate access to testing for COVID-19 

    • Referral hospital(s) have bed capacity on wards and intensive care units

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