• 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.

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  • 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.
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  • 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.
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  • SNF QRP October Refresh 2020: Six New Measures Publicly Reported (10/20)

    Thursday, October 29, 2020 | CMS

    The October 2020 refresh of SNF QRP data is now available on Nursing Home Compare (NHC), as well as the Nursing homes including rehab services web pages within Care Compare (CCXP) and Provider Data Catalog (PDC).

    The data are based on quality assessment data submitted by SNFs to CMS from Quarter 1 2019 through Quarter 4 2019 (01/01/2019 –12/31/2019); and the annual update of the claims-based measures data from Quarter 4 2017 – Quarter 3 2019 (10/01/2017 – 9/30/2019).

    Starting in October 2020, six additional SNF QRP measures will be publicly reported on NHC, CCXP and PDC:

    ·  Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury,

    ·  Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC SNF QRP,

    ·  Application of IRF Functional Outcome Measure: Change in Self-Care (NQF #2633),

    ·  Application of IRF Functional Outcome Measure: Change in Mobility (NQF #2634),

    ·  Application of IRF Functional Outcome Measure: Discharge Self-Care Score (NQF #2635), and

    ·  Application of IRF Functional Outcome Measure: Discharge Mobility Score (NQF #2636).

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  • SNF VBP: Understanding your August 2020 Performance Score Report Webinar Recording Available (10/20)

    Wednesday, October 28, 2020 | QTSO
    This Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program event provides an overview of the SNF VBP Program for Fiscal Year (FY) 2021, including the scoring methodology, which transforms performance scores into incentive payment multipliers (IPMs), and information for accessing and interpreting the Performance Score Report (PSR). The webinar occurred on October 22, 2020 at 2:00 p.m. ET; this is the recording.
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  • SNF QRP COVID-19 PR Tip Sheet Updated (10/20)

    Thursday, October 1, 2020 | CMS
    An updated version of the SNF COVID-19 PR Tip Sheet that was posted on September 8, 2020, is now available. The purpose of this Tip Sheet is to help providers understand CMS’ public reporting strategy for the PAC QRP in the midst of the COVID-19 public health emergency (PHE).  This Tip Sheet explains the CMS strategy to account for CMS quality data which were exempted from public reporting due to COVID-19, and the impact on CMS’ Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) data on the Nursing Home Compare website refreshes.  
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (9/20)

    Tuesday, September 29, 2020 | QTSO
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • SNF QRP Measure Calculations and Reporting User's Manual Plus Version 3.0.1 Addendum (9/20)

    Thursday, September 10, 2020 | CMS


    The SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available.

    This ZIP file includes:

    1. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum provides measure-related changes specified in a change table format in lieu of a complete update to the overall manual. Use this addendum to update the v3.0 manual.
    2. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 Risk Adjustment Appendix File contains current and historical intercept values, coefficient values, and the risk-adjustment schedule for each risk-adjusted quality measure reported under the SNF QRP. 
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  • SNF QRP Webpage: How to Update Nursing Home/SNF Demographic Data (8/20)

    Friday, August 21, 2020 | CMS

    SNF Quality Reporting Program (QRP) quality data on Nursing Home Compare are updated on a quarterly basis. All data displayed on NH Compare (Skilled Nursing Facility and Nursing Home) include demographic information, such as address, telephone number, and ownership. This demographic data is generated from the information stored in the Automated Survey Processing Environment (ASPEN) system.

    Below are the steps to guide providers on how to verify and update Skilled Nursing Facility demographic data. 

    Step 1: Verify Demographic Data is Accurate

    It is important for providers to review their SNF QRP Preview Reports to verify that the demographic data is accurate. SNF QRP Preview Reports reflect the quality measure data and facility/provider demographic information that will be posted to NH Compare in the following quarter. SNF QRP Preview Reports are available in providers’ shared folder in the Centers for Medicare & Medicaid Services (CMS) designated data submission system, Certification and Survey Provider Enhanced Reporting (CASPER) during the 30-day preview windows prior to the quarterly NH Compare refreshes.

    Step 2: If Demographic Data is Inaccurate, Contact your Medicare Administrative Contractor

    If inaccurate or outdated demographic data is included on the SNF QRP Preview Report or on NH Compare, SNFs need to contact their Medicare Administrative Contractor (MAC) for assistance. When requesting updates to your demographic data, it is important to ask that the MAC send the updated 855A (provider enrollment form) to the CMS Regional Offices in order to update the ASPEN data. Changes to demographic data must be updated and uploaded to the national database via ASPEN in order for the Compare site to be updated.

    When requesting updates to demographic data, it is important to ask for updates to the data within the ASPEN system, and not the data on the Compare site.

    Please note - updates to demographic information do not happen in real-time and can take up to 6-months to appear on NH Compare. If you encounter difficulty reaching your MAC, or for assistance accessing SNF QRP provider preview reports, please contact the QTSO Help Desk at 1-800-339-9313 or iqies@cms.hhs.gov.

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  • Scaled-Back FY 2021 SNF PPS Final Rule Holds Few Surprises

    Tuesday, August 4, 2020 | Caralyn Davis, Staff Writer

    The FY 2021 SNF PPS Proposed Rule was a shadow of what the Centers for Medicare & Medicaid Services (CMS) had planned due to the ongoing coronavirus 2019 (COVID-19) public health emergency. So it's no surprise that the final rule, Medicare Program: Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNFs); Updates to the Value-Based Purchasing Program for Federal Fiscal Year (FY) 2021 (CMS-1737-F), finalizes most, if not quite all, of the proposals without modification. And while COVID-19 caused some changes to the payment rate calculations, CMS cited commenters' requests for additional relief from COVID-19 as beyond the scope of this rulemaking. 

    Here are some of the key updates that directors of nursing services (DNSs) should pay attention to:


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