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.

Please note the following excerpt from the March 12 MLN Connects: Dementia Care & Psychotropic Medications Tracking Tool Call.

Phase 3 Requirements for Participation from the Reform of Requirements for Long-Term Care Facilities final rule

Debra Lyons, a registered nurse and Technical Director with CMS, Division of Nursing Homes”

As you may recall, this overhaul of the nursing home regulations went into effect on October 4th of 2016. And those changes were implemented in 3 phases. Phase 1 generally involves no change to the regulatory language and was implemented on November 28th, 2016. Phase 2 involved some regulatory language change. And some changes to the interpretive guidelines. And those were implemented on November 28th, 2017.

We are quickly approaching implementation of Phase 3 which will occur on November 28th, 2019. CMS plans to take a similar approach as we did with Phase 2 by releasing an advance copy of the interpretive guidelines. This advance copy will include both Phase 3 Regulations on Interpretive Guidelines, and changes that we've made to some, some select Phase 2 guidelines.

So, let me explain the changes to Phase 2. In more than a year since implementation on Phase 2, we have answered numerous inquiries from providers and surveyors alike and made – and have made decisions to clarify or modify some of those Phase 2 interpretive guidelines based on the number of inquiries we've received. CMS will make available an advance copy of the new Phase 3 regulations and guidelines along with any Phase 2 guidance that has been revised. Additionally, as we did with Phase 2, CMS will release training related to these changes that will be available to the public as well as the surveyors.

The advance copy of the interpretive guidelines and the training will be released this summer to give nursing home providers, state survey agencies, and other nursing homes stakeholders time to view the training and implement these changes. And as we did this Phase 2, we will issue an advance copy via the QSO policy memo.

Attention: MDS, OASIS, IRF, SWB, EPOC, PBJ and others using QIES remote access.

An upgrade is required to the Juniper VPN Network Client software (Network Connect Client) currently used by the QIES community to log-in to CMSNet for required submission and reporting. 

The upgrade will be initiated automatically and will take effect the next time users launch the Juniper VPN Client and log-in following the scheduled upgrade dates referenced below.  Upon connection, the automated process will begin and the user will be prompted to start the installation of the new Pulse Secure Desktop Client on their workstation.

Note! Users must have Administrator rights on their workstation or have an IT staff member with Administrator rights assist the first time a user attempts to log-in following the upgrade dates referenced below.

The upgrade to Pulse Secure Desktop Client is scheduled as follows:
User Community                                        Date:
Swing Bed and IRF                                     4/08/2019
Hospice                                                       4/30/2019
Home Health (OASIS)                                5/30/2019
Nursing Homes (MDS, EPOC and PBJ)    6/30/2019

Background

The Centers for Medicare & Medicaid Services (CMS) serves a critical quality assurance function for our country’s healthcare system.  Quality Improvement and Evaluation System (QIES) will undergo a series of system enhancements resulting in what will be now called the Internet Quality Improvement and Evaluation Systems (iQIES).  

To comply with federal security mandates, CMS is initiating new security requirements for access control to CMS Quality Systems through Remote Identify Proofing (RIDP) via the HCQIS (Healthcare Quality Information System) Access, Roles and Profile Management system. Users will create accounts in HCQIS Access Roles and Profile Management (HARP) to gain access to the iQIES system.

What is Remote Identify Proofing? 

Remote proofing is a method for verifying the identity of a user remotely, as opposed to manual proofing or in-person proofing. Based on user-entered data, the HARP system uses Experian to generate a list of personal questions for the user to answer to verify their identity remotely. Remote proofing is the HARP-recommended method for identity verification, as it is typically much faster than other methods of identity proofing. If a user cannot successfully complete remote proofing during HARP registration, he/she will need to initiate manual proofing.

Why is Remote Identify Proofing Necessary?

The primary purpose of RIDP is to eliminate unauthorized access, reduce fraud, minimize manual processing, and prevent compromise of personally identifiable information (PII). These changes are designed to be compliant with federal and CMS guidelines and requirements such as OMB M04-04e-Authentication Guidance for Federal Agencies, HSPD-12, NIST 800-53 & 63, FISMA, FIPS 199 Standards, FIPS 200 and OMB M07-16. 

What happens to the personal information used to register?

CMS does not store your personal information received for the purposes of RIDP. It only passes it to the credit reporting agency, an external identity verification system, to help confirm your identity. Your personal information is described as data that is unique to you as an individual, such as name, address, telephone number, Social Security Number, and date of birth. 

Additional communication about iQIES program information including but not limited to onboarding, stakeholder engagement opportunities, training and general updates are in development and will be distributed in the coming weeks. For assistance with HARP onboarding, users can call the QTSO Helpdesk at (800) 339-9313 or e-mail help@qtso.com. 

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.

Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated on the development of a free on-line training course in infection prevention and control for nursing home staff in the long-term care setting.

The training provides approximately 19 hours of continuing education credits as well as a certificate of completion (i.e., free CME, CNE or CEUs).

The course introduces and describes how to use IPC program implementation resources including policy and procedure templates, audit tools, and outbreak investigation tools.

The course is made up of 23 modules and sub-modules that can be completed in any order and over multiple sessions.

The course covers:

• Core activities of effective IPC programs
• Recommended IPC practices to reduce
• Pathogen transmission
• Healthcare-associated infections
• Antibiotic resistance

The Immediate Jeopardy Update Training introduces surveyors and non-surveyors to the revised Appendix Q–Core Guidelines to Determining Immediate Jeopardy. The Core Appendix Q focuses on the key components necessary to establish immediate jeopardy (IJ) under the regulations. 

These key components are:

• Noncompliance.
• Serious harm, injury, impairment, or death that has occurred or is likely to occur. 
• Immediate need for action by the provider/supplier to address the noncompliance.

The Core Appendix Q also contains information about how surveyors should determine whether IJ exists, and it includes a template that surveyors must use to ensure that sufficient evidence exists for each key component of IJ.