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IN THE NEWS

When federal news concerning Medicare happens, stay in the know.

CMS Skilled Nursing Facility Open Door Forum

Here are the notes from August 31, 2023, CMS Open Door Forum.

 

  • The Resident Assessment Instrument Manual for MDS 3.0 version 1.18.11 V5 was released on August 22, 2023. Since then, CMS has found a few clerical errors and plan on updating them shortly, but no major changes will be done, therefore the manual stands as complete and can be educated based on the guidance it provides. Discrepancies or small errors were noted on the call in CAAs 5, 6, and 15 where there are items referenced with an ‘x’ for instance in CAA 5 GG0130X1. This is also noted in CAA 6 and 15.

  • There are several other manuals/methodologies that CMS plans on having available in the coming weeks. They are;

    • The Quality Measure Manual (mid-September) and posted to the NHQI page.

    • The updated Payroll-Based Journal methodology for Section G: Functional Status transition to Section GG: Functional Abilities and Goals (mid-September)

    • CMS 802 and 672 will be updated, but unsure as to when.

  • As was the case when transitioning from MDS 2.0 to MDS 3.0, there will not be any ability to modify an MDS once it has been submitted with an ARD before October to a date on/after October 1st and vice versa. For example, if a facility submits an MDS with an ARD of 9/30/2023 for a resident and realizes that an ARD of October 1st would capture the most appropriate picture of the resident. You cannot modify the MDS to the date of October 1st. You would have to complete an inactivation of the old MDS and create a new MDS with an ARD of 10/1/2023. The same holds true for MDS’ submitted with an ARD of 10/1/2023 moving forward. You would have to inactivate the MDS with an ARD of 10/1/2023 and then create a new MDS with an ARD of 9/30/2023. The Data Sets are not exactly the same and could not transition.

 

We will assist you with any questions you may have regarding the process changes or updates. Please contact us at info@qualityoutcomesmatter.com

Optional State Assessment Available for States to use for Payment Purposes

CMS released the Optional State Assessment, OSA, for states to complete information that will allow them time to transition to the current PDPM model by October 2025. This OSA has Data Sets that are necessary for previous types of reimbursement models such as RUG-IV and RUG-III. The OSA information can be found on the CMS Minimum Data Set page at Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual | CMS

CMS Releases Proposed FY 2024  Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities

CMS released the proposed Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2024.

The proposed rule can be found here

CMS Releases DRAFT RAI Manual version 1.18.11

CMS released the DRAFT RAI Manual version 1.18.11 as well as the FINAL MDS versions earlier today. As we review the information, we will create educations on the updates. Please stay tuned for updates and if you are interested in having educations done by Stever Advisors, please contact us.

The DRAFT can be found here

CMS SNF Open Door Forum
March 2, 2023

Yesterday CMS had its most recent SNF Open Door Forum call for organizations all over the country. Here is a summary of what was stated during the call.

 

  1. There are only 76% of SNFs across the country that are registered for a HARP and iQIES account. Please get your accounts set up now, You will no longer be able to use QIES to submit after April 13, 2023.

  2. With the Public Health Emergency set to expire on May 11, 2023, this means the following.

    1. Any resident that was admitted utilizing the 1135 waiver regarding the three qualifying hospital stay on or before May 11, 2023 will still be allowed to remain on Medicare A as long as they are considered in a ‘skilled stay’. All other Medicare criteria must be met.

    2. On May 12th, all waivers are gone and the 3 Day Qualifying Stay requirement goes into effect.

  3. In order for the transition from QIES to iQIES to occur seamlessly, there will be downtime for MDS submissions from Thursday April 13, 2023 @ 8 PM until April 17, 2023. No MDS’ will be allowed to be submitted during this time, therefore please be aware that the submission criteria must still be met for all types of MDS’ during the downtime. There are no exceptions to this requirement.

  4. Once iQIES is active on April 17, 2023, CMS recommends that you do not access the QIES system to generate reports since that information will be from the previous submission and none moving forward. All previous submission information will be available in the new iQIES system for report generation.

  5. Any Payroll Based journal, PBJ, submissions will still need to be done through the QIES system since this process is not supported in the iQIES system yet. All PBJ reports will still be located in the QIES system as well.

  6. The FINAL VERSION of the MDS v. 1.18.11 will be available for download and review on or around April 1, 2023. The DRAFT version for the RAI Manual for v. 1.18.11 will be available at the same time. The FINAL version of the RAI Manual will be available on or around August 1, 2023.

  7. CMS will be hosting virtual education sessions on the MDS changes starting in May 2023 and virtual workshops will begin in June or July 2023.

  8. Two specific items were discussed during the Q & A session that all organizations across the country will need to know.

    1. CMS will be releasing the Optional State Assessment, OSA, version in late April to early May. This should be the version that states across the country that use RUG-III or RUG-IV to create their Case Mix Index would use until such time as they transition to another process. Stay tuned for updates on this.

    2. The Interrupted Stay guidelines are still in effect with this understanding, a resident who was admitted prior to May 12th that is discharged from a SNF and is out over May 12th and then re-admitted within the Interrupted Stay guidelines will be able to remain under Medicare A upon return regardless of the use of the Medicare 1135 waiver or not. If a resident is discharged over the May 12th expiration of the PHE and is out beyond the Interrupted Stay guidelines, then they must have a 3 Day qualifying stay again to use the remains of the Medicare A days IF they were admitted to the SNF under the Medicare 1135 waiver program. Any resident that had a 3 Day stay and was not under the waiver will be able to return under Medicare A following the normal Medicare A guidelines.

 

If you have any questions, please contact me at info@qualityoutcomesmatter.com 

Nursing Home Stakeholder Call held February 22, 2023

Here is an update from the Nursing Home Stakeholders call this afternoon.

 

  1. The Public Health Emergency is expiring effective May 11, 2023. CMS stated that they would provide stakeholders a 60-day notice and they stated today that they not only provided a 60-day notice but have provided a 90-day notice.

  2. John Kane reported on 1812-F Waivers:

    1. Effective with all admissions on 5/12/2023 a Medicare Part A admission will be required to have a 3-day Qualifying Hospital Stay. 

    2. Any admission on or before 5/11/2023 can be admitted and remain under the PHE Waiver of the 3-day Qualifying Hospital Stay. 

    3. CMS is aware of the requests to eliminate the requirement and advised that this is statutory and the best route for enacting this change is from our congressman and local advocacy groups but at this time the ruling stand with the end of the PHE. 

  3. The CMS reporting of COVID infections remains in effect even after the PHE expires on May 11th. This is reporting that will continue at this point until December 31st, 2024. Please ensure that you continue to provide the required reporting.

Newspaper
Journalist with microphone working on city street
Journalist with microphone working on city street

iQIES for Minimum Data Set (MDS) Submission Release on April 17, 2023

CMS will transition from the current QIES system to the new iQIES system effective April 17, 2023. To prepare for the transition, CMS is shutting down and upgrading the ASAP system on April 13, 2023. Therefore, you will not be able to submit MDS until it is back online on April 17, 2023.

If you have not created an iQIES account through HARP, please contact us. We may be able to assist you.

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