CMS has identified two issues with the SNF Review and Correct Report.

“Quite a bit” of the regulatory requirements for survey won’t change with the Nov. 28, 2017, rollout of Phase 2 of the Reform of Requirements for Long-term Care Facilities (aka Mega-Rule), say officials with the Division of Nursing Homes in the Survey and Certification Group at the Centers for Medicare & Medicaid Services (CMS) during the video Appendix PP: Overview of Revised Interpretive Guidance.

“Most of the minimum quality standards that were in the regulation remain,” they explain. “There are still strong resident rights, use of the Minimum Data Set to do assessment and care planning based on the residents’ goals and preferences, and the input of the interdisciplinary team. There are still requirements for a medical director, a full-time licensed nurse, and requirements for medication review.”

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule.

SUMMARY: This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. 

DATES: These regulations are effective on October 1, 2017

2.  To assist stakeholders in their review of the RCS-I model, CMS provided a narrative discussion of the resident classification logic used under the RCS-I model discussed in the ANPRM. This file provides a step-by-step walk-through that allows stakeholders to manually determine a resident’s RCS-I classification based on the data from an MDS assessment. 

3. CMS' contractor drafted a Technical Report, which discusses the research conducted by the contractor on developing an alternative to the existing methodology used to pay for services under the SNF PPS. 

Fiscal Year 2018 and After Payments to Skilled Nursing Facilities That Do Not Submit Required Quality Data. SUMMARY OF CHANGES: This is a new Change Request (CR) to pub. 100-22, Medicare Quality Reporting Incentive Programs, Chapter 80, to reflect changes to the payment reduction reconsideration process.

This 13-page document includes 15 Q&As on topics ranging from the data collection period for claims-based QMs in the SNF QRP to the Part A PPS Discharge assessment, as well as links to additional resources.

Nov. 28, 2017, marks the implementation of some significant changes in how the Centers for Medicare & Medicaid Services (CMS) expects nursing homes to operate—and in the survey process that state surveyors will use to assess those operations. CMS survey-and-certification memo S&C: 17-36-NH gives providers critical information about how to prepare for these changes that are required under Phase 2 of the roll-out of the Reform of Requirements for Long-term Care Facilities (aka Mega-Rule) updating the Medicare/Medicaid conditions of participation. This information includes an advance copy of 696 pages of revisions to the F-tags and the Interpretive Guidance in Appendix PP, “Guidance to Surveyors of Long-term Care Facilities,” of the State Operations Manual. Providers should note that the Appendix PP revisions include new subregulatory guidance for multiple F-tags, not just the Phase 2 regulatory changes.

Here’s a summary of critical news—and what’s still to come: