Change Package to prevent harm related to medication adverse events, other adverse events, infection, and abuse,and neglect for nursing home residents.

Summary: States will have access to an optional assessment to support RUG-III and RUG-IV from October 1, 2019 through September 30, 2020. Effective, Oct. 1, 2020, states that continue to use RUG-III or RUG-IV after October 1, 2020 will need to implement a new process to gather the needed data because many of the corresponding MDS items will no longer be present on the MDS.

Memo:

On October 1, 2020 CMS will no longer support RUG-III and RUG-IV case-mix methodologies via the Minimum Data Set (MDS). PDPM utilizes a streamlined assessment schedule compared to RUG-III and RUG-IV by eliminating all current scheduled assessments, except the 5-day, and all unscheduled assessments (i.e., Other Medicare-Required Assessments). For States that rely on these assessments for calculating their case-mix group, CMS has created an optional assessment so that Medicaid payment is not adversely impacted when PDPM is implemented on October 1, 2019. States will have some flexibility in crafting policies associated with this assessment. The optional assessment will be effective from October 1, 2019 through September 30, 2020.

Finally, in an effort to reduce provider burden, improve quality of care, and standardize data elements across provider settings, CMS will be removing several MDS data elements over the next few years. Many MDS data elements used in RUG-III and RUG-IV are no longer required for Federal purposes. With the removal of data elements, RUG-III and RUG-IV will no longer be functional. States that continue to use RUG-III or RUG-IV after October 1, 2020 will need to implement a new process to gather the needed data.

Some states, including Texas, have urged nursing homes to check their freezers for ground beef that may be recalled in this Class ! recall, meaning the beef should not be consumed.

Change is the one constant nursing homes face these days as the Centers for Medicare & Medicaid Services (CMS) pushes providers to transform from an institutional, service-driven approach to a patient-focused, clinical-need approach that highlights quality of care and quality of life. While this drive began on the survey side with the implementation of the revised Medicare/Medicaid conditions of participation, it now also is taking root on the payment side via several quality programs impacting the fee-for-service Medicare Part A program.

During the Nov. 29 Skilled Nursing Facility/Long-term Care Open Door Forum, CMS officials addressed programs on both sides of the aisle, including:

Nurses are critical to the health and well-being of residents in long-term care, overseeing all aspects of care, including residents’ physical, mental, social, and spiritual wellness. Although members of the interdisciplinary team (IDT) assist with their respective disciplines, the nurse is ultimately the one with 24/7 oversight of resident care. Nurses are the eyes and ears of the physician in the long-term care setting and serve as advocates for the residents during the drug regimen review (DRR).

Since the most recently updated CMS guidelines regarding DRR which includes medication reconciliation in the skilled nursing facility were released, facilities have struggled to understand the rules. One of the significant drivers behind these new regulations is the increased rate of medication-related adverse drug events (ADEs). One critical item, however, is still missing from the updated requirements—the resident perspective on medications. The CMS guidelines address DRR and identify the medications that must be reviewed, the scheduling of reviews, clinically significant medication issues, the facility-designated person responsible for conducting the DRR, and communication between the physician and nurse. Little to no mention is made of resident preference and choice related to medications. Do residents want to take all those medications? Is their quality of life improving?

Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports

• Notification to States –

The Centers for Medicare & Medicaid Services (CMS) will provide CMS Regional Offices (ROs) and State Survey Agencies with a list of facilities with potential staffing issues to support survey activities for evaluating sufficient staffing and improving resident health and safety.

• Updates in the PBJ Policy Manual and Frequently Asked Questions (FAQs) – We are expanding the guidance on the meal breaks policy to ensure consistency. In addition, we are adding guidance regarding reporting hours for “Universal Care Workers.”

• Additional Technical Support for Facilities – New MDS-based census reports in the Certification and Survey Provider Enhanced Reporting (CASPER) system.

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. This site includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation.

Fact Sheets

This section includes fact sheets on a variety of PDPM related topics.

• Administrative Level of Care Presumption under the PDPM
• PDPM Payments for SNF Patients with HIV/AIDS
• Concurrent and Group Therapy Limit
• PDPM Functional and Cognitive Scoring
• Interrupted Stay Policy
• MDS Changes
• NTA Comorbidity Score
• PDPM Patient Classification
• Variable Per Diem Adjustment

PDPM Frequently Asked Questions

This section contains frequently asked questions (FAQs) related to PDPM policy and implementation.

PDPM Training Presentation

This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.

PDPM Resources

This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.