• SNF QRP FAQs (3/21)

    Monday, March 1, 2021 | CMS

    Updates

    March 1, 2021

    SNF QRP FAQs

    An update to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) document is now available. This document has been updated to reflect the finalized policies for the SNF QRP in Fiscal Year (FY) 2021 and other useful resources available to providers.

    Contents

    Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Overview

    1. What is a Quality Reporting Program?

    2. What are the current measures in the SNF QRP?

    3. What are the FY 2021 updates to the SNF QRP?

    Staying Informed About the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

    4. What is the process for adding and removing measures from the SNF QRP?

    5. Are there other resources on the SNF QRP website I can use to stay up-to-date?

    6. Where can I find SNF QRP training materials?

    Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Technical Requirements

    7. How are data collected and submitted for the SNF QRP?

    8. Which items on the SNF MDS are considered for compliance determination?

    9. What are the requirements for the SNF to be considered compliant?

    10. What are the data submission deadlines for the SNF QRP?

    11. Does the definition of “quarter” for the quarterly MDS data submission deadlines include patients admitted during that quarter, discharged during that quarter, or both?

    12. What is QIES? How can I request access to QIES?

    The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the Minimum Data Set (MDS)

    13. What is the current version of the MDS?

    14. Where can I find the MDS 3.0 Resident Assessment Instrument (RAI) Manual for the SNF QRP?

    15. Who can complete a SNF MDS?

    Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Reconsiderations, Exceptions, and Extensions

    16. Does the Centers for Medicare & Medicaid Services (CMS) tell SNFs if they are noncompliant with the QRP requirements?

    17. I received a letter of notification that my SNF is non-compliant with the SNF QRP requirements. Can I ask CMS to reconsider the decision?

    18. The county where our SNF is located was affected by a natural disaster. Are we excepted from the QRP reporting requirements?

    Other Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions

    19. Does my SNF need to report health care–acquired infection data under the SNF QRP?

    20. My facility’s demographic data are incorrect on Care Compare. How do I correct them?

    21. Where are SNF quality measure data publicly reported?

    22. Which SNF quality measures are reported on the Care Compare website?

    23. Who can I contact with a specific question about the SNF QRP?

    Read more
    Comments (0)
  • Consolidated Appropriations and Coronavirus Relief Act: Impact on SNF Part A Services (2/21)

    Wednesday, February 24, 2021 | Congress

    Sections addressing SNF VBP changes and access to services for hemophilia residents:

     

    SEC. 111. IMPROVING MEASUREMENTS UNDER THE SKILLED NURSING FACILITY VALUE-BASED PURCHASING PROGRAM UNDER THE MEDICARE PROGRAM.

     

        (a) In General.--Section 1888(h) of the Social Security Act (42

    U.S.C. 1395yy(h)) is amended--

            (1) in paragraph (1), by adding at the end the following new

        subparagraph:

                ``(C) Exclusions.--With respect to payments for services

            furnished on or after October 1, 2022, this subsection shall

            not apply to a facility for which there are not a minimum

            number (as determined by the Secretary) of--

                    ``(i) cases for the measures that apply to the facility

                for the performance period for the applicable fiscal year;

                or

                    ``(ii) measures that apply to the facility for the

                performance period for the applicable fiscal year.'';

            (2) in paragraph (2)(A)--

                (A) by striking ``The Secretary shall apply'' and inserting

            ``The Secretary--

                    ``(i) shall apply'';

                (B) by striking the period at the end and inserting ``;

            and''; and

                (C) by adding at the end the following:

                    ``(ii) may, with respect to payments for services

                furnished on or after October 1, 2023, apply additional

                measures determined appropriate by the Secretary, which may

                include measures of functional status, patient safety, care

                coordination, or patient experience.

            Subject to the succeeding sentence, in the case that the

            Secretary applies additional measures under clause (ii), the

            Secretary shall consider and apply, as appropriate, quality

            measures specified under section 1899B(c)(1). In no case may

            the Secretary apply more than 10 measures under this

            subparagraph.'';

            (3) in subparagraph (A) of each of paragraphs (3) and (4), by

        striking ``measure'' and inserting ``measures''; and

            (4) by adding at the end the following new paragraph:

            ``(12) Validation.--

                ``(A) In general.--The Secretary shall apply to the

            measures applied under this subsection and the data submitted

            under subsection (e)(6) a process to validate such measures and

            data, as appropriate, which may be similar to the process

            specified in section 1886(b)(3)(B)(viii)(XI) for validating

            inpatient hospital measures.

                ``(B) Funding.--For purposes of carrying out this

            paragraph, the Secretary shall provide for the transfer, from

            the Federal Hospital Insurance Trust Fund established under

            section 1817, of $5,000,000 to the Centers for Medicare &

            Medicaid Services Program Management Account for each of fiscal

            years 2023 through 2025, to remain available until expended.''.

        (b) Report by MedPAC.--Not later than March 15, 2022, the Medicare

    Payment Advisory Commission shall submit to Congress a report on

    establishing a prototype value-based payment program under a unified

    prospective payment system for post-acute care services under the

    Medicare program under title XVIII of the Social Security Act (42

    U.S.C. 1395 et seq.). Such report--

            (1) shall--

                (A) consider design elements such as--

                    (i) measures that are important to the Medicare program

                and to beneficiaries under such program;

                    (ii) methodologies for scoring provider performance and

                effects on payment; and

                    (iii) other elements determined appropriate by the

                Commission; and

                (B) analyze the effects of implementing such prototype

            program; and

            (2) may--

                (A) discuss the possible effects, with respect to the

            Medicare program, on program spending, post-acute care

            providers, patient outcomes, and other effects determined

            appropriate by the Commission; and

                (B) include recommendations with respect to such prototype

            program, as determined appropriate by the Commission, to

            Congress and the Secretary of Health and Human Services.

     

     SEC. 134. IMPROVING ACCESS TO SKILLED NURSING FACILITY SERVICES FOR HEMOPHILIA PATIENTS.

       

    (a) In General.--Section 1888(e)(2)(A)(iii) of the Social Security

    Act (42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended by adding at the end

    the following:

     

                        ``(VI) Blood clotting factors indicated for the

                    treatment of patients with hemophilia and other

                    bleeding disorders (identified as of July 1, 2020, by

                    HCPCS codes J7170, J7175, J7177-J7183, J7185-J7190,

                    J7192-J7195, J7198-J7203, J7205, J7207-J7211, and as

                    subsequently modified by the Secretary) and items and

                    services related to the furnishing of such factors

                    under section 1842(o)(5)(C), and any additional blood

                    clotting factors identified by the Secretary and items

                    and services related to the furnishing of such factors

                    under such section.''.

     

        (b) Effective Date.--The amendment made by subsection (a) shall

    apply to items and services furnished on or after October 1, 2021.


    Read more
    Comments (0)
  • SNF Healthcare-Associated Infections Requiring Hospitalization for the SNF QRP Technical Report (2/21)

    Sunday, February 21, 2021 | CMS
    The Improving Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the Secretary to specify resource use measures, on which post-acute care (PAC) providers, including skilled nursing facilities, are required to submit necessary data specified by the Secretary. The Centers for Medicare and Medicaid Services (CMS) has contracted with Acumen, LLC and RTI International to develop the SNF HAI measure under the Quality Measure & Assessment Instrument Development & Maintenance & QRP contract (75FCMC18D0015, Task Order 75FCMC19F0003).

    This report presents the SNF HAI technical measure specifications. Section 2 provides an overview of the measure and is a high-level summary of the key features of the measure that are described in detail in the remaining sections of the document. Section 3 describes the methodology used to construct the SNF HAI measure including its data sources, study population, measure outcome, regression model, and steps for calculating the final measure score. Section 4 discusses SNF HAI measure testing including the measure’s reportability, variability, reliability, and validity testing results. Appendix A displays the ICD-10 codes used to identify HAI conditions included in the measure. Appendix B presents the results of the risk adjustment model. Lastly, Appendix C details a flow chart for calculating the measure. 
    Read more
    Comments (0)
  • CMS Section N: Medications – Drug Regimen Review Web-Based Training (2/21)

    Sunday, February 14, 2021 | CMS

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of the Drug Regimen Review standardized patient assessment data elements (SPADEs) found in the Medications Section of the guidance manuals.

    This 45-minute course is intended for providers in Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs), and is designed to be used on demand anywhere you can access a browser.

    Read more
    Comments (0)
  • Cross-Setting QRP Data Elements and Quality Measures: CMS Web-Based Training (1/21)

    Wednesday, January 13, 2021 | CMS

    From Data Elements to Quality Measures – Cross-Setting QRP Web-Based Training

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings. The PAC settings included are those covered under the Centers for Medicare & Medicaid Services (CMS) Quality Reporting Programs (QRPs) for Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Skilled Nursing Facilities (SNFs). Information covered will include a short review of the QRPs’ cross-setting quality measures (QM), how data elements feed into these cross-setting QMs, how QMs are calculated and appear on QM reports and how to access and use this data for quality improvement. 

    Read more
    Comments (0)
  • CMS Proposes Healthcare-Associated Infection and Staff COVID-19 Vaccination Measures for SNF QRP UPDATED

    Friday, January 8, 2021 | CMS

    CMS has issued its 2020 measures under consideration (MUC) list. It includes two proposed SNF QRP QMs. The list includes more detailed info about proposed numerators, denominators, and rationales for each measure:

     MUC20- 0002: Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (outcome measure)

    This measure will estimate the risk-adjusted rate of healthcare-associated infections (HAIs) that are acquired during skilled nursing facility (SNF) care and result in hospitalizations. The measure is risk adjusted to “level the playing field” and to allow comparison of measure performance based on residents with similar characteristics between SNFs. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs that are acquired during SNF care and result in hospitalization, when compared to their peers

     

    More information:

    Draft Measure Specifications: Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations For The Skilled Nursing Facility Quality Reporting Program


    MUC20- 0044: SARS-CoV-2 Vaccination Coverage among Healthcare Personnel (process measure)

    This measure tracks SARS-CoV-2 vaccination coverage among healthcare personnel (HCP) in IPPS hospitals, inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), inpatient psychiatric facilities, ESRD facilities, ambulatory surgical centers, hospital outpatient departments, skilled nursing facilities, and PPS-exempt cancer hospitals.

    CMS press release:

    New Measures Under Consideration Mark a Milestone for CMS’s Reimagined Quality Strategy to Increase Digital Innovation and Reduce Burden

    Measures advance better quality care

    The Centers for Medicare & Medicaid Services (CMS) today unveiled its 2020 list of quality and efficiency measures under consideration. Quality measures are tools the agency uses to collect data from providers on the effectiveness, safety, efficiency, and timeliness of care beneficiaries receive. Every year, CMS evaluates all measures in its programs, proposing to remove those that have become less relevant and proposing new measures that may be more meaningful based on review by external health care experts. This year, almost all of the measures proposed would be collected digitally, meaning information comes from claims and other electronic sources, and would not require doctors to retrieve data manually. As a signal for CMS’s broader direction as the agency puts patients over paperwork in the push for quality and innovation, the 2020 list of measures under consideration represents “a first” on several important fronts, particularly where digital innovation and reducing administrative burden are concerned.

    Releasing the list is the first step in the “pre-rulemaking process,” when measures under consideration go to the National Quality Forum’s Measure Applications Partnership (MAP). Funded by CMS, the MAP is an independent, voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of quality and efficiency measures and convened per statute to provide input on their selection. In a broader “CMS first,” a majority of measures under consideration in 2020 also rely on digital reporting of existing information, which can help providers spend more time with patients and less time collecting data. Coupled with a limited number of non-digital measures emphasizing patient-reported health outcomes, another priority for CMS, this digital innovation continues the reimagined quality strategy announced by CMS Administrator Seema Verma in 2017 as part of the Meaningful Measures initiative.

    “We launched Meaningful Measures because too many providers were wasting precious time and resources reporting on quality metrics, many of which were barely relevant to their specialty,” said CMS Administrator Verma. “Over the last four years, this initiative has delivered better, less onerous metrics that are actually useful to those who use them. The measures we are announcing today represent more of the same. They prioritize health outcomes, reduce burden, and give providers more time to do the work they entered medicine to do: treat patients.”

    Quality measures form the backbone of CMS’s ongoing effort to promote health for millions of Americans. The previously adopted measure for controlling high blood pressure, for example, helps CMS evaluate the quality of care by collecting data on the percentage of beneficiaries 18-85 years old whose high blood pressure has been adequately controlled during the measurement period, meaning their blood pressure readings were less than 140/90 mmHg. Additionally, reporting on these measures holds clinicians accountable for ensuring the best possible outcomes for beneficiaries.

    However, many quality measures have required intensive manual data collection and individual chart reviews, robbing doctors and other health professionals of valuable time spent caring for Americans. Over the last several years, CMS has been working to reduce provider burden by shifting toward measures that can be collected digitally using existing data. That strategy has the next iteration of the Meaningful Measures framework – or Meaningful Measures 2.0, the comprehensive initiative launched in 2017 to identify high-priority areas for quality measurement and improvement – at its heart.

    Though including a measure on the consideration list does not guarantee its adoption, the list represents a key first step and one built on collaboration between CMS and providers. Annually, the agency invites health care specialty societies and other stakeholder groups to submit candidate measures, due this year by June 30, narrowed down to identify promising candidates that warrant expert review as “measures under consideration.” The 2020 list – which includes a number of new measures, as well as several updates to modernize or replace existing measures – features:

    ·  Five outcome measures (measures that focus on the results of health care provided through Medicare), such as the rate of health care-associated infections requiring hospitalization for residents of skilled nursing facilities;

    ·  Five process measures (measures that emphasize efforts to promote standardized best practices), such as conducting kidney health evaluations or implementing interventions for patients with pre-diabetes (the medical term for blood glucose levels that are high but not yet high enough for a type-2 diabetes diagnosis). Importantly, the 2020 list includes three process measures for the coronavirus disease 2019 (COVID-19) vaccine. The measures under consideration list proposes looking at:

    ·  Vaccination coverage among health care personnel,

    ·  Vaccination by clinicians, and

    ·  Vaccination coverage for patients in End-Stage Renal Disease (ESRD) facilities;

    ·  Five cost/resource use measures (measures that evaluate how frequently health care items or services may be used, as well as how much they might cost) – including, for example, episode-based costs associated with addressing diabetes or asthma/chronic obstructive pulmonary disease;

    ·  Three composite measures (which summarize overall quality of care across multiple measures through the use of one value or piece of information); and

    ·  Two patient reported outcomes measures (measures where the information comes directly from the patient).

    All but three measures under consideration rely on digital rather than traditional “pen-and-paper” data collection. Of the non-digital measures, two are measures aimed at assessing COVID-19 vaccinations among health care personnel and patients in ESRD facilities, and the other reflects key patient-reported health outcomes, which help prioritize patient voices and empower patients to take an active role in their health.

    CMS expects to receive the MAP’s input on the 2020 measures under consideration by February 1, 2021. Experts at CMS and the Department of Health and Human Services will work collaboratively based on this assessment to select final measures available for further public comment through a notice of proposed rulemaking in the Federal Register.

    Read more
    Comments (0)
  • Feds to Distribute New Half Billion Incentive Payments to Nursing Homes in 2nd of 5 Cycles (12/20)

    Monday, December 7, 2020 | HHS

    On 12/7/20, the federal government, through the Health Resources and Services Administration (HRSA) operating under the U.S. Department of Health and Human Services (HHS), announced it will distribute $523 million in second round performance payments to over 9,000 nursing homes. These nursing homes are being rewarded for successfully reducing COVID-19 related infections and deaths between September and October.

    In August, HHS announced plans to distribute $5 billion in additional Provider Relief Fund (PRF) payments to nursing homes from which $2 billion would be dedicated to establishing an incentive-based program that rewards nursing homes that create and maintain safe environments for their residents. In October, HHS announced the first round of awardees receiving $331 million in payments for keeping new COVID-19 infection and mortality rates among residents lower than the communities they serve – as analyzed against CDC data between August and September. This announcement is the second of five evaluation cycles rewarding nursing homes for their performance reducing nursing home infection and mortality rates. Nursing homes will begin receiving payments December 9.

    Nursing Home Infection and Mortality Outcomes

    HHS found that between September and October, of the 13,251 eligible nursing homes, 9,248, or 69 percent, met the incentive program's infection control criteria. While less than the first cycle, the collective efforts of these nursing homes resulted in over 3,900 fewer infections relative to the rates seen in the communities where they exist. Against the mortality criteria, 9,128, or 68 percent of eligible nursing homes, achieved outcomes that met or exceeded the expected COVID-19 mortality rate for their facility.

    This announcement rewards nursing homes for a period in time. HHS recognizes COVID-19 is a fluid challenge and it continues to take a devastating toll on nursing homes stretched thin and disproportionately impacted due in part to factors such as their congregate setting and the existing vulnerabilities of older residents with comorbidities. This new round of incentive payments will bolster the $15 billion already distributed to nursing homes in both Targeted and General Distribution PRF funding. Recipients may use this funding to acquire additional personal protective equipment or other efforts to help slow the spread of COVID-19.

    Continued Support for Nursing Homes

    Two COVID-19 vaccine candidates have been submitted to the FDA for Emergency Use Authorization approval. In recognition of this administration's focus on protecting older Americans and as driven by data, the CDC, accepted the recommendation of the Advisory Committee on Immunization Practices (ACIP), that states prioritize nursing home residents for tier one COVID-19 vaccine distribution, once available. Placing nursing home residents and health care personnel at the top of the list for the COVID-19 vaccine will be a game-changer in what has been a difficult fight against the pandemic. Paired with continued funding directly tied to COVID-19 infection and mortality rate reductions, HHS is exhausting all measures to ensure nursing homes nationwide are safe. Residents and their families can be assured help is on the way.

    Finally, HHS is reminding all certified nursing homes that free interactive training and mentoring is available through the Agency for Healthcare Research and Quality to advance COVID-19 preparedness, safety, and infection control. To date, only half of all U.S. nursing homes have enrolled but registration remains open. The Centers for Medicare and Medicaid Services also has a free training program for nursing homes. These are vital resources nursing homes should employ to combat this pandemic.

    Read more
    Comments (0)
  • SNF QRP/ SNF VBP exceptions related to CA/OR Wildfires and Hurricane Laura (11/20)

    Tuesday, November 17, 2020 | CMS
    The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to hospitals, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, renal dialysis facilities, long-term care hospitals, and ambulatory surgical centers, and Merit-Based Incentive Payment System (MIPS) eligible clinicians, located in areas affected by the California and Oregon Wildfires, as well as by by Hurricane Laura due to the devastating impact of the storm. These healthcare providers and suppliers will be granted exceptions if they are located in one of the California or Oregon counties listed below, all of which have been designated as emergency disaster areas by the Federal Emergency Management Agency (FEMA).

    The scope and duration of the exception under each Medicare quality reporting program is described below; however, all of the exceptions are being granted to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities.

    Read more
    Comments (0)
  • HHS Stark Law and Anti-Kickback Reforms to Support Coordinated, Value-Based Care Could Bring Opportunities for SNFs (11/20)

    Monday, November 16, 2020 | HHS
    The Department of Health and Human Services (HHS) published two final rules that aim to reduce regulatory barriers to care coordination and accelerate the transformation of the healthcare system into one that pays for value and promotes the delivery of coordinated care.

    The rules provide greater flexibility for healthcare providers to participate in value-based arrangements and to provide coordinated care for patients. The final rules also ease unnecessary compliance burden for healthcare providers and other stakeholders across the industry, while maintaining strong safeguards to protect patients and programs from fraud and abuse.

    The HHS Office of Inspector General (OIG) issued the final rule “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements,” and the Centers for Medicare and Medicaid Services (CMS) issued the final rule “Modernizing and Clarifying the Physician Self-Referral Regulations.” These rules are part of HHS’s Regulatory Sprint to Coordinated Care, which has examined federal regulations that potentially impede healthcare providers’ efforts that otherwise would advance the transition to value-based care and improve the coordination of patient care across care settings in Federal healthcare programs and the commercial sector. In addition to advancing value-based care, the CMS final rule clarifies and modifies existing policies to ease unnecessary regulatory burden on physicians and other healthcare providers while reinforcing the physician self-referral law’s (often called the “Stark Law”) goal of protecting patients from unnecessary services and being steered to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest.

    The new and amended regulations related to the federal Anti-Kickback statute and the civil monetary penalties law issued by OIG address stakeholder concerns that these laws unnecessarily limit the ways in which healthcare providers can coordinate care with and for federal healthcare program beneficiaries. OIG’s final rule modifies and clarifies the agency’s proposed rule in response to comments, as explained in the preamble to the final rule. 

    For example, OIG’s final rule clarifies how medical device manufacturers and durable medical equipment companies may participate in protected care coordination arrangements that involve digital health technology, and the final rule lowers the level of “downside” financial risk parties must assume to qualify under the new safe harbor for value-based arrangements that involve substantial downside financial risk. In recognition of the urgent problem of cyber threats to the healthcare industry, the rule also broadens the new safe harbor for cybersecurity technology and services to protect cybersecurity-related hardware. 

    OIG’s final rule, and the CMS final rule to the extent the Stark Law is applicable, would facilitate a range of arrangements to improve the coordination and management of patient care and the engagement of patients in their treatment if all applicable regulatory conditions are met, including the following examples:

    • To improve patient transitions from one care delivery point to the next, a hospital may wish to provide physician offices with care coordinators that furnish individually tailored case management services for patients requiring post-acute care.
    • A hospital may wish to provide support and to reward institutional post-acute providers for achieving outcome measures that effectively and efficiently coordinate care across care settings and reduce hospital readmissions.  Such measures would be aligned with a patient’s successful recovery and return to living in the community. 
    • A primary care physician or other provider may wish to furnish a smart tablet that is capable of two-way, real-time interactive communication between the patient and his or her physician.  The patient’s access to a smart tablet could facilitate communication through telehealth and the provision of in-home services.
    • A health system furnishes cybersecurity technology to physician practices to reduce harm from cyber threats to all their systems.
    Read more
    Comments (0)
  • At A Glance QM, QRP, and VBP Tool

    Tuesday, November 10, 2020 | AADNS
    With so many Quality Measures originating from three different payment initiative programs, it's a lot to keep track of. AADNS's At A Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been updated with updates from the MDS 3.0 QM User’s Manual Version 14.0, the latest version from CMS released Oct. 19, 2020.
    Read more
    Comments (1)