• Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (1/21)

    Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (1/21)

    By CMS -

    CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. This manual provides in-depth descriptions of the ratings and the methods used to calculate them. 

    On December 1, 2020 the Nursing Home Compare website was retired. It has been replaced by the new Care Compare website. Care Compare can be accessed at: (https://www.medicare.gov/care-compare/). The Provider Data Catalog (PDC) located at https://data.cms.gov/provider-data/ allows users to search and download the publicly reported data. While this Technical Users’ Guide has been revised to refer to Care Compare, there may be previously published materials or documents that refer to Nursing Home Compare and all prior references to Nursing Home Compare will now apply to Care Compare.

     

    January 2021 Revisions

     

    Health Inspection Rating Changes:

    Beginning with the January 2021 refresh, CMS resumed calculating the health inspection rating domain and began to use results from surveys that occurred after March 3, 2020. Additionally, focused infection control surveys are included in the rating calculation, with citations from these surveys counting towards the total weighted health inspection score (similar to how complaint survey citations are counted).

    These changes resulted in updates to the Special Focus Facility (SFF) program, including updates to SFF candidates, and facilities’ status for receiving an icon for noncompliance related to abuse. Specifically, updates to the health inspection data due to the incorporation of surveys occurring after March 3, 2020 and the updating of the complaint periods means that the abuse icon will be removed for facilities that no longer meet the abuse icon criteria based on more recent survey findings. Once facilities no longer meet criteria for the abuse icon, their health inspection rating will no longer be capped at two stars. More information on the abuse icon is found in the Health Inspection section of this document.


    Staffing Rating Changes:

    Beginning with the January 2021 refresh, facilities that did not report staffing for the November 14, 2020 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available” with the January, February, and March refreshes. Starting with the April 2021 refresh of Care Compare, when staffing data submitted by the February 14, 2021 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for October – December 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star.

     

    Quality Measure Rating Changes:

    Quarterly updates of most of the quality measures (QMs) posted on Care Compare and used in the FiveStar Quality Rating System resumed with the January 2021 refresh. For the January 2021 update, CMS used data for July 2019- June 2020 for all of the measures that were updated. The two QMs that are part of the Skilled Nursing Facility Quality Reporting Program (Percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened and Rate of successful return to home and community from a SNF) will not be updated in January 2021.


    January 2020 addition: Technical specifications for claims-based measures


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  • Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020: Kaiser Family Foundation Review (1/21)

    Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020: Kaiser Family Foundation Review (1/21)

    By Kaiser Family Foundation -

    For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority group. A second, related analysis synthesizes the findings of 30 studies that examined potential factors associated with COVID-19 cases and deaths in long-term care facilities.

    KFF held a web briefing yesterday to review this latest data on COVID-19 cases and deaths in long-term care facilities and examine how the effort to vaccinate residents and staff in long-term care settings is going, challenges experienced so far, and opportunities for improvement. 

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  • OIG to Look at Medicare Part D Payments in SNF Stays and Nursing Home Background Checks (1/21)

    OIG to Look at Medicare Part D Payments in SNF Stays and Nursing Home Background Checks (1/21)

    By OIG -

    Medicare Part D Payments During Covered Part A SNF Stay

    Medicare Part A prospective payments to skilled nursing facilities (SNFs) cover most services, including drugs and biologicals furnished by the SNF for use in the facility for the care and treatment of beneficiaries. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to posthospital SNF care because these drugs are already included in the consolidated payment for Part A SNF stays. We will determine whether Medicare Part D paid for drugs that should have been paid under Part A SNF stays.

     

    Announced or Revised

    Agency

    Title

    Report Number(s)

    Expected Issue Date (FY)

    January 2021

    Centers for Medicare and Medicaid Services

    Medicare Part D Payments During Covered Part A SNF Stay

    W-00-21-35866

    2022

     

    Background Checks for Nursing Home Employees

    Federal regulation 42 CFR 483.12(a)(3) provides beneficiaries who rely on long-term care services with protection from abuse, neglect, and theft by preventing prospective employees with disqualifying offenses from being employed by these care providers and facilities. The National Background Check Program was enacted by legislation in 2010 to assist States in developing and improving systems for conducting Federal and State background checks. Prior OIG work has shown that not all States complied with the National Background Check Program for Long-Term Care Providers. We will determine whether Medicaid beneficiaries in nursing homes in selected States were adequately safeguarded from caregivers with a criminal history of abuse, neglect, exploitation, mistreatment of residents, or misappropriation of resident property, according to Federal requirements. 

     

    Announced or Revised

    Agency

    Title

    Report Number(s)

    Expected Issue Date (FY)

    January 2021

    Centers for Medicare and Medicaid Services

    Background Checks for Nursing Home Employees

    W-00-21-31553

    2022

     

     

     


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