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For several years now, the Centers for Medicare & Medicaid Services (CMS) has been working to transform both payment and care delivery in the Medicare program. A key vehicle in the agency’s efforts is the Accountable Care Organization (ACO).
Every nursing facility must have resident care policies and procedures for respiratory care and services, including tracheostomy care and suctioning, to avoid a citation under §483.25(i) F695 Respiratory/Tracheostomy Care and Suctioning. The care policies must be developed with the medical director, the director of nursing, and when appropriate, a respiratory therapist. The respiratory care policies and procedures must be consistent with professional standards, be comprehensive and person-centered, and address each resident’s goals and preferences. The care policies must be developed prior to admitting any resident with respiratory care needs.
Effective April 24, 2019, directors of nursing services (DNSs) should expect to see some upheaval in their star ratings due to a series of changes that the Centers for Medicare & Medicaid Services (CMS) is making to the Five-Star Quality Rating System on Nursing Home Compare. These changes will impact all three Five-Star domains: the Health Inspection domain, the Staffing domain, and the Quality Measures (QM) domain.
The State Operations Manual (SOM) defines an anticipated discharge as “a discharge that is planned and not due to the resident’s death or an emergency (e.g., hospitalization for an acute condition or emergency evacuation).” For every discharge that meets this definition of anticipated, whether it be to another healthcare facility or to the resident’s home, the discharging facility is required to provide a discharge summary. With its primary purpose being to ensure that care is safely coordinated from one setting to another, the discharge summary must inform the continuing care providers of the course of treatment provided by the discharging facility. This document should be detailed and include an accurate description of the resident’s current status along with current individualized care instructions.
In order to avoid a citation for §483.21(c)(2) F661 (Discharge Summary), the discharging facility must include at least the following in the discharge summary:
In September 2018, Wendy DeCarvalho, RN, DNS-CT, QCP, and her team watched as Hurricane Florence approached their facility, which is located just two hours from the Carolina coast, nestled in a rural area in the flood zone. They banded together to keep their residents, staff, and families safe.
Here’s her advice, based on that firsthand experience, for how to handle emergencies before, during, and after they happen.
As recently as the February 14 Skilled Nursing Facility/Long-term Care Open Door Forum, officials with the Centers for Medicare & Medicaid Services (CMS) indicated that providers could have to wait several months for the release of version 12 (v12) of the MDS 3.0 Quality Measures User’s Manual. However, in a surprise move on February 21, CMS released the updated manual, as well as the Quality Measure Identification Number by CMS Reporting Module Table V1.7, on its Quality Measures (QM) page.
The most significant revisions focused on these key areas:
The short-stay and long-stay pressure ulcer QMs;
The long-stay weight loss QM;
The short-stay improvements in function QM;
The long-stay and short-stay influenza vaccination QMs.
Here are the highlights:
On Feb. 1, the QIES Technical Support Office (QTSO) announced changes to the MDS 3.0 Quality Measure Reports in the CASPER Reporting application, including calculation updates/changes to the short-stay pressure ulcer measure, the long-stay pressure ulcer measure, and the long-stay weight loss measure. As a result, providers have been expecting the Centers for Medicare & Medicaid Services (CMS) to quickly release version 12 of the MDS 3.0 Quality Measures (QM) User’s Manual. Although CMS mentioned that there would be a delay of the release of the MDS 3.0 QM User's Manual during the SNF LTC Open Door Forum on Feb. 14, the new version was posted on Feb. 21, 2019 and is now available.
In other manual news, providers also won’t get the draft version of the next update to the RAI User’s Manual for the MDS 3.0 quite as early as most hoped to help them prepare for the Oct. 1, 2019, implementation of the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS).
“We historically publish that manual more toward August,” said officials. “We do understand the need to be able to review [it for] the PDPM, so our goal is to have that published in May sometime this year.”
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