CMS updates providers on changes coming down the pipeline soon

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Staffing data for Payroll-Based Journal must be submitted by August 14, Centers for Medicare & Medicaid Services officials reminded providers last week.

The reminder is especially timely given the news of almost 1,400 skilled nursing facilities losing a rating star. In an Open Door Forum call last Thursday, CMS officials noted that only data that's been successfully submitted by the deadline is considered timely and used on the Nursing Home Compare in Five-Star Quality Rating System calculations.

Once submitted, providers must check their final validation reports, which can be accessed in the CASPER folder. It may take up to 24 hours to receive the validation report, so providers must allow time to correct errors. Receiving a final validation report only confirms that the data has been submitted successfully, not that it is accurate or complete.

To improve quality, CMS says that it may decrease the threshold for number of days with no RN reported that result in a one-star staffing rating in the future, in the hopes of further boosting quality. The agency now has a requirement to have a registered nurse onsite eight hours a day, seven days a week. Currently, those who report seven or more days a quarter with no RN hours will receive a one-star rating in the staffing domain, dropping their overall composite star rating by one star for a quarter.

As part of PBJ, CMS started posting the number of hours worked by other non-nursing staff, which includes all positions listed in the PBJ table, in July.

CMS also noted that it is enthusiastic about the new rehabilitation model of Patient-Driven Payment Model.

“We believe that PDPM represents a marked improvement over the RUG 4 model, most notably because it improves payment accuracy and appropriateness by focusing on the patient's needs, rather than the volume of services provided,” an official said.

The new PDPM was the result of “significant” provider feedback, with some 296 comments received by the agency. Officials noted that, based on feedback, the CMS simplified the way in which ICD-10 information is transmitted back to the agency.

In October, CMS also reminded providers that will start posting a quality measure related to short-stay residents who were rehospitalized. It started confidentially posting rates of hospitalizations for long-stay residents in July. By the spring, it will be included in the Five-Star system.

In February, CMS implemented a temporary freeze of the health inspection domain of the Nursing Home Compare Five-Star Quality Ratings system. During the one-year freeze, inspections conducted after November 2017 are not included in the ratings calculation.

In October 2019, it will resume posting the average number of citations per inspection for each state and nationally. CMS says it is monitoring outcomes of the new inspection process and plans to resume health inspection calculation ratings in spring 2019.