Effective November 28, at least one designated infection preventionist who meets specific education, training, and time requirements must be responsible for the infection prevention and control program in every Medicare- and/or Medicaid-certified skilled nursing facility/nursing facility (SNF/NF). One of those responsibilities is to be a member of the quality assessment and assurance (QAA) committee and to regularly report to the committee about the infection prevention and control program.

The underlying requirement in §483.40 of the Code of Federal Regulations (CFR) for F740 (Behavioral Health Services) feeds into multiple facets of the care process—and multiple additional F-tags:

Each resident must receive and the facility must provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Behavioral health encompasses a resident’s whole emotional and mental well-being, which includes, but is not limited to, the prevention and treatment of mental and substance use disorders.

The Fiscal Year (FY) 2020 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule updates the fee-for-service Medicare Part A payment rates using the new Patient-Driven Payment Model (PDPM) case-mix classification system effective October 1, 2019. On the payment side, the Centers for Medicare & Medicaid Services (CMS) made multiple small corrections, ranging from adjusting the market basket update to correcting the wage-index file. 

However, the biggest changes that CMS finalized involve new MDS data submission requirements for Standardized Patient Assessment Data Elements (SPADEs) under the Skilled Nursing Facility Quality Reporting Program (SNF QRP) that will go into effect on October 1, 2020—just one year after PDPM implementation. But the changes don’t stop there. Directors of nursing services (DNSs) also need to prepare for a few PDPM policy revisions and updates to the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program. 

Here are the highlights of the FY 2020 SNF PPS Final Rule that DNSs need to know about.

Your facility needed a new director of nursing (DON), so you stepped up to the plate to give it your best shot. You went through the selection process, feel confident in your leadership skills, and are ready to lead a team to success.

But you have a small confession to make: you’re not sure where to start!

Being a new DON can be challenging, so here is some advice to get you going.

Accountable care organizations (ACOs) seek to partner with skilled nursing facilities (SNFs) that can produce the best quality outcomes while they simultaneously control costs, says Kim Barrows, RN, BSN, LNHA, president of KB Post Acute Strategic Specialists (KB-PASS) in Moores Hill, IN. “That’s the primary difference between the fee-for-service Medicare patient and the ACO patient. You have to make sure that you are helping the ACO control costs—even after the patient discharges from the SNF.”

To work successfully with ACOs, directors of nursing services (DNSs) can put the following steps into practice as they manage their buildings.

The Centers for Medicare & Medicaid Services (CMS) has published two key rules impacting the requirements for participation for Medicare- and/or Medicaid-certified long-term care facilities:

• Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements Final Rule; and

• Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule.
  
  

The Arbitration Agreements Final Rule, which goes into effect this September 16, adopted the 2017 proposed rule with some changes. CMS has repealed the prohibition against pre-dispute, binding arbitration agreements, but the new regulations “specify that a facility must not require any resident or his or her representative to sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue receiving care at, the facility and must explicitly inform the resident or his or her representative of his or her right not to sign the agreement as a condition of admission to, or as a requirement to continue receiving care at, the facility.”