This manual presents methods used to calculate quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). This manual provides detailed information for each quality measure (QM), including quality measure definitions, inclusion and exclusion criteria and measure calculation specifications.

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility ValueBased Purchasing (VBP) Program. 

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

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?

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). 

Since November 28, 2017, there have been nearly 100 citations for QAPI failures, according to the Full Text of Statements of Deficiencies released in March 2018. Almost half of the citations are attributed to F867, QAA Activities.

So, what are other facilities being cited for, and how can you prepare?

Skilled nursing facilities should save approximately $2 billion in aggregate reduced administrative costs over the next 10 years ($12,000 and 183 hours in savings per provider annually), said officials with the Centers for Medicare & Medicaid Services (CMS) in a review of key aspects of the Fiscal Year (FY) 2019 SNF PPS Proposed Rule during the May 1 Skilled Nursing Facility/Long-term Care Open Door Forum. This estimate is based on the proposed changes to the skilled nursing facility prospective payment system (SNF PPS) assessment schedule associated with the Patient-Driven Payment Model (PDPM) if it’s implemented as proposed on Oct. 1, 2019.

“While the current [RUG-IV] system requires substantial paperwork to track the volume of service utilization over time, PDPM eliminates the need of these frequent patient assessments and allows clinicians to focus more time on treating the patient,” noted officials. Note: PDPM is based on the Resident Classification System, Version I, or RCS-I, that CMS presented last year.