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· 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.
CMS is delaying the release of the updated versions of the Minimum Data Set (MDS) needed to support the Transfer of Health (TOH) Information Quality Measures and new or revised Standardized Patient Assessment Data Elements (SPADEs) in order to provide maximum flexibilities for providers of Skilled Nursing Facilities (SNFs) to respond to the COVID-19 Pubic Health Emergency (PHE).
The release of updated versions of the MDS will be delayed until October 1st of the year that is at least 2 full fiscal years after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on September, 20, 2020, SNFs will be required to begin collecting data using the updated versions of the item sets beginning with patients discharged on October 1, 2022.
Following the PHE, CMS will announce training opportunities for providers via this webpage and announcements sent out via email distribution lists and posted on the Medicare Learning Network.
CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
In December of 2019, CMS posted a draft of the MDS 3.0 item set v1.18.0 and received feedback from our stakeholders. We would like to thank the stakeholders for sharing their concerns regarding the proposed changes to the MDS 3.0 item sets and more specifically the removal of the Section G items from OBRA assessments.
The MDS changes CMS planned for October 1, 2020 will now be delayed. CMS staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update software and IT systems.
Please direct any comments or questions regarding the above information to MDSCodinganswers@cms.hhs.gov mailbox
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.
RAND was tasked with developing and testing data elements within five areas of focus that fall under the clinical categories delineated in the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories. This eight-volume report presents background information and results of the National Beta Test, which assessed a set of data elements within the five categories under the IMPACT Act.
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.
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.
The MDS-based CASPER Quality Measures (QMs) that are posted on Nursing Home Compare, some of which drive the QM domain in the Five-Star Quality Rating System, are a frequent source of headaches for directors of nursing services (DNSs). “Everyone wants Five-Stars in the overall composite rating to attract clients, but adverse events often linger on the CASPER QMs much longer than many DNSs and administrators think they will,” says Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.
DNSs should have a basic idea of how long adverse events will impact the CASPER QMs, but that shouldn’t be the primary concern, suggests Maher. “The QMs will impact the overall Five-Star rating, but they have a lesser impact than the survey/health inspection and staffing domains. You must have Five-Stars in your QM domain to be able to add a star to your overall rating, and even Five-Stars in the QMs won’t help if your health inspection rating is one star and you’ve already added a star via the staffing domain. In addition, you have to have only one star in the QM domain to negatively affect your overall rating.” Note: For more information, see the “Overall Nursing Home Rating (Composite Measure)” section of the Nursing Home Compare Five-Star Quality Rating System Technical Users’ Guide.
So the CASPER QMs are most important as a tool that DNSs can use to identify opportunities for improvement, stresses Maher. “If you focus on providing person-centered care and improving care, you will get to five stars.”
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.
Correction Notice SUMMARY: This document corrects technical errors in the final rule that appeared in the August 8, 2018 Federal Register (83 FR 39162) entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program.” DATES: The corrections in this document are effective October 1, 2018 .
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