The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to identify and develop standardized patient assessment data elements (SPADEs) for use in the following post-acute care (PAC) patient assessment instruments: the Outcome and Assessment Information Set, used in home health agencies; the Inpatient Rehabilitation Facility Patient Assessment Instrument, used in inpatient rehabilitation facilities; the Long-Term Care Hospital Continuity Assessment Record and Evaluation Data Set, used in long-term care hospitals; and the Minimum Data Set, used in nursing homes and skilled nursing facilities. 

The October 2019 Nursing Home Compare Refresh, including quality measure results based on SNF QRP data submitted to CMS, is now available. For this refresh SNF QRP assessment-based measures performance scores will be based upon data submitted to CMS between Q1 2018 – Q4 2018 (1/01/18 – 12/31/18); claims-based measures performance scores will be based upon SNF Prospective Payment System (PPS) claims dated between Q4 2016 and Q3 2018 (10/01/16 – 9/30/18).

CMS will no longer refresh the measure Percentage of Residents/Patients with Pressure Ulcers that are New or Worsened (NQF #0678), under the SNF QRP. The October refresh, as well as all subsequent refreshes of this quality measure data will be solely related to the CMS Nursing Home 5-Star Ratings.

We are implementing the annual refresh of the SNF QRP claims-based measures during the October 2019 refresh of NH Compare. The annual refresh will include updates to the Medicare Spending per Beneficiary (MSPB) and Discharge to Community (DTC) measures. As previously announced, we have updated the methodology used to assign provider performance categories to the DTC measure. Additionally, this refresh includes the inaugural posting of provider performance scores for the Potentially Preventable Readmissions (PPR) measure, which were previously suppressed.

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.

Change tables, MDS mockups, and data specifications.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1718-F] for Fiscal Year (FY) 2020 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). This final rule is part of the agency’s continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices. The final rule [CMS-1718-F] can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities.

OVERVIEW

This fact sheet discusses three major provisions of the final rule:

·        SNF payment policy under the SNF Prospective Payment System (PPS)

·        SNF Value-Based Purchasing Program (VBP)

·        SNF Quality Reporting Program (QRP). 

This final rule includes policies that continue to move forward agency commitments to shift Medicare payments from volume to value, with the continued implementation of the SNF VBP and SNF QRP to improve program interoperability, operational quality and safety.

Videos and post-training materials (includes answers to knowledge checks and interactive sessions) from the May 2019 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training held in Kansas City, MO, on May 7 and 8, 2019, are now available.

Please note: Post-training materials include answers to knowledge checks and interactive sessions. Additionally, Section GG presentation has been updated to include links to videos shown during the training.

Effective 6/1/19, there will be enhancements to the upcoming Provider Preview Reports. The next SNF Provider Preview Report is scheduled for August 1, 2019. The updates will include:

• Pressure Ulcer Measure Transition

 -The current pressure ulcer measure, Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678), will last appear on the May 2019 SNF Provider Preview Report. Starting August 1, 2019, this measure will be removed.
 -The new pressure injury measure, Changes in Skin Integrity Post-Acute Care, will first display on the August 2020 Provider Preview Report.

• Ending suppression of the PPR claims-based measure:  
 -Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation Facility Quality Reporting Program
• Displaying measure short names in place of their long names and many aesthetic changes to field labels and headings.

• Update of the Discharge to Community Measure  
 -The refined measure results for the Discharge to Community Measure will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website and the related August 2019 Provider Preview Reports.

The DTC-PAC measure was first displayed on the Nursing Home Compare website in fall 2018 and will be refreshed in fall 2019. CMS has refined the statistical methodology for assigning providers to performance categories for public display to align with the Potentially Preventable Readmissions measures in the PAC QRPs and the Hospital-Wide Readmission measure in the Inpatient QRP. This refinement results in greater variation in provider performance categories, allowing better discernment of providers that underperform or overperform considerably compared with the national rate. The refinement will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website, and the related August 2019 Provider Preview Reports.

Background

·        The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) directed the Secretary to specify and publicly report measures reflecting successful discharge to community for use in the SNF QRP.

·        The SNF QRP DTC measure was finalized in the Fiscal Year 2017 SNF PPS Final Rule. Confidential feedback reports were distributed to SNF providers in fall 2017 and the measures were first displayed on the Nursing Home Compare website in fall 2018.

·        For the fall 2019 public display refresh of the DTC measure, and in future years, CMS has refined the method by which we assign providers to performance categories to align with the claims-based Potentially Preventable Readmissions measures in the SNF QRP and the Hospital-Wide Readmission measure in the Inpatient QRP.

·        Our revised methodology results in greater variation in performance categories, allowing better discernment of provider performance, including those that underperform or overperform considerably compared with the national rate. This refinement will be reflected in the fall 2019 Quarterly Refresh of the Nursing Home Compare website, as well as the August 2019 SNF Provider Preview Reports.