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CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated twice in April 2019.
The Five Star Preview Reports will be available on April 17, 2019. To access these reports, select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting system, select the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where st is the 2-character postal code of the state in which your facility is located and facid is the state-assigned Facility ID of your facility.
Nursing Home Compare will update with April's Five Star data on April 24, 2019.
Important Note: The 5 Star Help line (800-839-9290) will be available April 22, through May 3, 2019. Please direct your inquiries to BetterCare@cms.hhs.gov if the Help Line is not available.
This section includes fact sheets on a variety of PDPM related topics.
PDPM Frequently Asked Questions
This section contains frequently asked questions (FAQs) related to PDPM policy and implementation. The PDPM FAQs were updated on 4-4 and then again on 4-11.
To date, the accuracy of section GG (functional abilities and goals) hasn’t mattered from a payment perspective. Section GG doesn’t affect payment under the RUG-IV case-mix classification system, and the Skilled Nursing Facility Quality Reporting Program (SNF QRP) only penalizes providers financially for failing to meet the data submission threshold for required MDS data elements, including section GG items. In other words, completeness—not accuracy—is what allows providers to avoid the SNF QRP’s 2% payment cut every fiscal year.
As a result, many SNFs have relied exclusively on therapy to complete section GG, says Robin Hillier, CPA, STNA, LNHA, RAC-MT, president of RLH Consulting in Westerville, OH. “However, CMS always intended section GG to be a collaboration that includes both nursing’s perspective and therapy’s perspective. PDPM will require providers to make good on CMS’s intent because section GG will affect three of the five case-mix-adjusted PDPM payment components: nursing, physical therapy (PT), and occupational therapy (OT).”
A significant percentage of nursing homes don’t take advantage of their CASPER (Certification And Survey Provider Enhanced Reports) reports, says Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.
“Almost every week when I walk into a new facility and ask for some of their CASPER reports, no one can provide them,” she explains. “For example, I may ask, ‘What does your Skilled Nursing Facility Quality Reporting Program (SNF QRP) Review and Correct Report show?’ Or ‘Can you get me a copy of your MDS 3.0 Facility-Level Quality Measure (QM) Report?’ And it’s surprising how common it is for providers not to have even heard of the reports I ask for—or if they know what the reports are, they either don’t know how to obtain them or just never do.”
Both new and seasoned directors of nursing services (DNSs) should pay attention to CASPER reports, says Maher. “The DNS job is so difficult. Using these tools that the Centers for Medicare & Medicaid Services (CMS) provides can make it a little easier to know where to focus your resources.”
PDPM Training Presentation
This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.
This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.
Topics covered include:
The enhanced Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) review and correct reports are now available, on demand in the Certification and Survey Provider Enhanced Reporting (CASPER) application. In addition to enhanced sorting functionality, this report now includes patient level data and automated CSV file creation functionality that contains patient level results. Providers can access these reports by selecting the CASPER Reporting link on the “Welcome to the CMS QIES Systems for Providers” webpage.
NOTE: You must log into the CMS Network using your CMSNet user ID and password in order to access the “Welcome to the CMS QIES Systems for Providers” webpage.
In addition to the sorting enhancements and inclusion of resident level data, these reports:
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