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This page contains the MDS 3.0 RAI Manual v1.17.1 and MDS forms, effective October 1, 2019. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas.
Since the preliminary release of the manual on May 20, 2019, changes have been made to clarify which assessments swing bed providers must complete; the definition of the “interruption window” for interrupted Part A-covered stays; the coding of item I0200B; and changes related to group therapy policies, as well as other corrections. Please see the document titled “MDS 3.0 RAI Manual v1.17.1 Replacement Manual Pages and Change Tables_October 2019."
The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for:
Date: Thursday, September 19, 2019
Start Time: 2:00 PM – 3:00 PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Todd Smith & Jill Darling
**This Agenda is Subject to Change**
I. Opening Remarks
Chair – Todd Smith (Center for Medicare)
Moderator – Jill Darling (Office of Communications)
II. Announcements & Updates
*Policy Questions should be sent to: NHStaffing@cms.hhs.gov
*Technical Issues/Questions should be sent to: NursingHomePBJTechIssues@cms.hhs.gov
*PBJ Website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html
* CMS-6058-FC Medicare, Medicaid, and Children's Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process
*SNF QRP resource update
III. Open Q&A
Under the Patient-Driven Payment Model (PDPM), resident outcomes will be key to avoiding medical review, said officials with the Centers for Medicare & Medicaid Services (CMS) during the August 14 Skilled Nursing Facility Quality Reporting Program (SNF QRP) training session, Patient-Driven Payment Model: What Is Changing (and What Is Not). Note: Find the session slides here.
The goal of PDPM is for SNFs to provide value-driven care, said officials. “Fundamentally, it comes down to a balance. A high-value and efficient provider is one that is able to achieve high-quality outcomes at low cost.”
CMS measures SNF quality of care in three main ways:
The SNF QRP;
The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program; and
The Five-Star Quality Reporting System on Nursing Home Compare.
Providers may soon have a little more room to maneuver in their Quality Assurance and Performance Improvement (QAPI) programs thanks to the recently published Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule. However, the Centers for Medicare & Medicaid Services (CMS) doesn’t seek to change the core regulations that lay out required performance improvement activities, including performance improvement projects (PIPs). The bottom line: PIPs are here to stay, and directors of nursing services (DNSs) need to make sure their teams optimize them, says Linda Winston, RN, MSN, BS, QCP-MT, DNS-MT, RAC-CT, a nurse consultant based in Norwich, NY.
What CMS wants to change
CMS proposes to again revise the Medicare/Medicaid conditions of participation (CoPs) by removing a significant chunk of the prescriptive requirements (i.e., the subparts) in the Phase 3 QAPI regulations that the agency originally designated for implementation this November 28.
The FINAL version of the PDPM Grouper DLL has been posted, along with its source code, plus an errata. Note that the DLL interface has not changed since the beta version. Documentation and test files will be provided in a separate posting – coming soon. Please report any issues found to PDPM@cms.hhs.gov.
The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 has been posted. The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 contains detailed specifications for the assessment- and claims-based quality measures reported under the SNF QRP. The manual can be found below and the Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 2.0 has been moved to the Quality Measures Archive page.
CMS has released the PDPM ICD-10 Mappings File for FY 2020 as well as the I0020B Code Lookup File.
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