Category: Regulatory

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MDS Changes Countdown – Day 1

COUNTDOWN DAY 1: Interdisciplinary Collaboration

When it comes to MDS assessments, teamwork makes the dream work. The MDS is a critical component of comprehensive resident care in long-term care facilities. Completing these assessments effectively requires an interdisciplinary team (IDT) approach. Interdisciplinary collaboration in MDS streamlines the assessment process and has the power to elevate the quality of care delivered to residents.

IDT meetings are the cornerstone of effective interdisciplinary collaboration, and the frequency of these meetings should be carefully considered. Regular meetings provide a platform for team members to share insights, discuss resident cases, and align on care plans.

Effective communication is at the heart of interdisciplinary collaboration. To create meaningful plans of care, it is crucial to communicate with various IDT members. This includes residents themselves, other disciplines who have recently interacted with the resident, direct staff from all shifts, and the resident’s physician. Each of these sources can provide valuable insights into the resident’s condition, preferences, and progress. By involving multiple disciplines, care plans can be tailored to align with the resident’s unique preferences and goals. This ensures that residents not only receive medically necessary care, but also maintain their dignity and quality of life.

Achieving success in MDS assessments is a collective effort. By fostering interdisciplinary collaboration, long-term care facilities can navigate the evolving landscape of MDS assessments while continuing to deliver high-quality, resident-centered care. Collaboration truly is the key to unlocking success in resident assessments and care planning. 

Reliant’s Interdisciplinary Team Meeting Clinical Resource

IN CASE YOU MISSED IT

 

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MDS Changes Countdown – Day 2

COUNTDOWN DAY 2: Quality Measure Impact

Minimum data set (MDS) assessments provide the data foundation for many quality measures. The transition from MDS 3.0 version 1.17.2 to version 1.18.11 brings significant impacts to several quality measure specifications; one of the biggest changes being the shift from Section G: Functional Status to Section GG: Functional Abilities and Goals, as well as the inability to generate a RUG-IV grouper directly impacting staffing measures.

To account for these changes, CMS released Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual V16.0 and Nursing Home Five-Star Quality Rating System: Technical Users’ Guide last week.

Quality Measure Updates:
New Measures

  • SNF Discharge Function Score measure (CMS ID: S042.01) will replace Percent of Residents Who Made Improvements in Function (Short Stay) (CMS ID: N037.03)
  • Percent of Residents With Pressure Ulcers (Long Stay) (CMS ID: N045.01) will replace Percent of High-Risk Residents With Pressure Ulcers (LS) (CMS ID: N015.03)
  • Percent of Residents With New or Worsened Bowel or Bladder Incontinence (LS) (CMS ID: N046.01) will replace Percent of Low-Risk Residents Who Lose Control of Their Bowel or Bladder (Long Stay) (CMS ID: N025.02)

Re-specified Measures to utilize Section GG items due to the removal of Section G

  • Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (Long Stay) (CMS ID: N028.03)
  • Percent of Residents Whose Ability to Walk Independently Worsened (LS) (CMS ID: N035.04)

Starting in April 2024, CMS will freeze (hold constant) impacted quality measures on Nursing Home Care Compare.

Public reporting for these measures is scheduled to resume in January 2025 or as soon as technically feasible.

Nursing Home Five-Star Quality Rating Staffing Updates

  • In July 2024, CMS will post nursing home staffing measures based on the new staffing case-mix adjustment methodology derived from PDPM as outlined in the appendix: “Updated Case-Mix Adjustment Methodology for Staffing Level Measures”
  • CMS will revise the staffing rating thresholds to maintain the same overall distribution of points for affected staffing measures.
  • Beginning in April 2024, CMS will freeze (i.e., hold constant) the staffing measures for three months while they transition to a SNF payment PDPM replacing the RUG-IV methodology.

Resources

Be on the lookout for tomorrow’s blog: Interdisciplinary Communication

IN CASE YOU MISSED IT

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MDS Changes Countdown – Day 3

COUNTDOWN DAY 3: Impact to State Case Mix

Federal regulations mandate that all nursing facilities, regardless of the Medicaid system in their state, must conduct patient specific MDS assessments, known as OBRA assessments, at specific intervals for each resident, regardless of their payer. Many states utilize these federally mandated MDS assessments to inform and calculate the case mix index (CMI). For decades, case mix states have adopted models for the MDS assessment that are similar to the Prospective Payment System (PPS) of their time, such as RUGs III or IV. However, beginning 10/1/2023, federal support for the calculation of RUG scores will end. States who continue to apply RUG methodology will have to implement the Optional State Assessment (OSA) which can no longer be combined with any other assessment. The MDS v. 1.18.11 will only support PDPM determinations. In an effort to prepare for this change, states that implement a Case Mix system, may be transitioning or have already transitioned to PDPM.

While case-mix methodologies vary from state-to-state, there are universal strategies to enhance CMI, regardless of individual state practices:

  • Timing is everything: Ensure each member of the interdisciplinary team (IDT) has the most up to date calendar of quarterly and annual Assessment Reference Dates (ARDs).
  • Verify your state plan as of 10/1/2023 for Case Mix determination and whether the OSA will be required.
  • Ensure the IDT is trained to conduct interviews timely and accurately so that all relevant information is recorded (See Section GG Assessment Quick Card).
  • Plan, implement, communicate, and assess processes for effectiveness regularly.

In the event your state is continuing to require the use of the OSA, the OSA Manual provides these instructions/coding tips:

  • Not federally mandated, but may be mandated by state
  • Contact state for clarification
  • Must be a stand-alone assessment

Effective case mix management through thorough and complete MDS assessments are critical. Now more than ever, it is essential for each member of the IDT to be educated about the changes, enabling them to contribute their expertise accordingly. Navigating case mix management through evolving payment structures is challenging, but with effective systems in place, success can be both achievable and sustainable.

Resources

Be on the lookout for tomorrow’s blog: Quality Measure Updates

IN CASE YOU MISSED IT

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MDS Changes Countdown – Day 4

COUNTDOWN DAY 4:
Care Area Triggers and Care Area Assessments

The Care Area Assessment (CAA) process is designed to assist assessors in systematically interpreting the information recorded on the MDS. This process enables clinicians to focus on key issues identified during assessments so decisions as to whether and how to intervene can be explored with the resident.

The MDS information, coupled with the CAA process, forms the foundation upon which care plans are developed. Within this framework, there are 20 problem-oriented CAAs, each incorporating MDS-based “trigger” conditions that signal the need for additional assessment and review of the triggered care area.

Previously, Section G items were used to trigger Care Areas in the MDS; however, with the retirement of Section G, CMS has updated Appendix C (CAA Resources), placing a much larger emphasis on Section GG for the CAA process. In fact, 17 of the 20 Care Areas now utilize Section GG as triggers or indicators for the Care Area.

Therefore, accurate Section GG assessment is imperative to ensure precise mapping within the Care Area Assessment process. It serves as a crucial link between the MDS and the development of each resident’s care plan. Strong interdisciplinary collaboration should extend throughout the MDS assessment process and continue during the CAA process. By understanding the components and the importance of accurate assessment, healthcare professionals can ensure thorough resident-centered care plans are developed that promote each resident’s optimal outcomes.

Be on the lookout for tomorrow’s blog: Impact to State Case Mix

IN CASE YOU MISSED IT:

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MDS Changes Countdown – Day 5

COUNTDOWN DAY 5: Section D – Mood

Beginning October 1st, the depression screening tool in the Minimum Data Set (MDS) will transition to the PHQ-2 to 9©. The PHQ-2 to 9© introduces a skip pattern logic to guide the completion of the depression screener.

The resident mood interview begins with two gateway questions that address the cardinal symptoms of depression: a persistent depressed mood and an inability to experience pleasure. By honing in on these symptoms, this tool can quickly identify those who may be at risk for depression. Based on the responses to the first two questions, the interview will either end or continue through the remaining seven questions. The embedded skip pattern is designed to reduce the length of the interview assessment for residents who fail to report the cardinal symptoms of depression. Although the interview coding may conclude with the first two questions, asking the remaining questions provides insight to the resident’s thoughts, feelings, and ideas can provide insight and impact care planning.

Beyond the initial screening, the information gathered from the PHQ-2 to 9© interview plays a crucial role in guiding supportive treatment planning and resource utilization, including:

  • Nursing component classification in the Patient Driven Payment Model (PDPM).
  • Addressing the physical, mental, emotional, social, and spiritual factors contributing to the resident’s ability to participate in meaningful activities.
  • Implementing leisure or identified interests within therapy sessions.
  • Facilitating participation in activities of interest outside of therapy.
  • Improving the resident’s health literacy to promote overall wellness.
  • Initiating referrals for additional evaluation of possible depression or other mood disorders.

Early identification of residents at risk for depression will allow for healthcare providers to intervene more effectively and efficiently. This proactive approach can lead to timely interventions and better outcomes for patients struggling with depression.

Resources

Be on the lookout for tomorrow’s blog: Care Area Triggers & Care Area Assessments

IN CASE YOU MISSED IT:

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MDS Changes Countdown – Day 6

COUNTDOWN DAY 6: Section GG – Functional Abilities

Gone are the days of the “rule of 3” and ADL self-performance versus support provided. In less than 2 weeks, Section G will be retired on all federal assessments, and Section GG will be the center of the MDS self-care and mobility universe. Elements of Section G will be transitioning to Section GG as outlined in the provided crosswalk.

Section GG is used in healthcare settings to assess functional abilities and care needs of residents. The data collected through this assessment serves as the foundation for creating individualized care plans designed to address each resident’s unique needs and goals. Accurate scoring of Section GG will become crucial in Care Area Assessments and Care Area Triggers (CATs), fundamentally shaping each resident’s individualized plan of care. Of the twenty Care Areas, seventeen use Section GG as CATs or indicators, thereby charting a new course in the determination of care needs. Additionally, Section GG will have a greater impact on 5-Star ratings, SNF quality reporting program (QRP), and SNF value-based purchasing (VBP) initiatives.

As healthcare facilities gear up for this monumental change, it is imperative that staff members proactively address additional training requirements. This includes a change in existing facility processes, a thorough review of coding language, aligning with the parameters of Section GG, and review of GG assessment periods. It is critical to foster a culture of strong interdisciplinary team (IDT) collaboration. By sharing expertise and insights from all departments within the facility, a seamless and successful transition to the era of Section GG can be assured.

Be on the lookout for Monday’s blog: Section D – Mood.

In Case You Missed It

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MDC Changes Countdown – Day 7

COUNTDOWN DAY 7: Additions, Modifications, and Clarifications

The upcoming revisions to the minimum data set (MDS) scheduled for October 1st bring significant changes. These revisions encompass 29 new and modified data elements, updates to 13 care area triggers, and modifications to 17 care area assessment worksheets. Notably, this update introduces gender neutral language and fully integrates the IMPACT Act of 2014 Standardized Patient Assessment Data Elements (SPADEs).

Below are just a few of the additions, modifications, and clarifications to review:

  • Medication List to Subsequent Provider/Resident (A2121-A2124) – New Data Elements
  • Pain Interference with Therapy Activities (J0520) – New Data Element
  • Nutritional Approaches (K0520) – Modification
  • Skin Conditions (M0300A-G) – Modification
  • High-Risk Drug Classes: Use and Indication (N0415) – Modification
  • Special Treatments, Procedures, and Programs (O0100) – Modification

The latest clarification is in relation to quality measures. CMS has released the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual V16.0 stating that one of the biggest changes involves the transition from Section G: Functional Status to Section GG: Functional Abilities and Goals.

These changes have broad implications for long-term care facilities. Proper training of staff is essential for a smooth implementation process. Staying updated is crucial for maintaining high-quality patient care and compliance with regulatory standards. Download the MDS 3.0 v1.18.11 RAI manual to guide successful implementation of all the new additions, modifications, and clarifications.

Be on the lookout for tomorrow’s blog: Section GG – Functional Abilities.

IN CASE YOU MISSED IT:

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MDS Changes Countdown – Day 8

COUNTDOWN DAY 8: Social Determinants of Health

When it comes to assessing and improving healthcare outcomes, it is not just about medical conditions and treatment. Understanding the social determinants of health (SDOH), that encompass various factors affecting people’s lives and impacting their well-being is crucial. These include socioeconomic status, education, neighborhood and physical environment, employment, and social support networks. The SDOH play a significant role in shaping an individual’s overall health as well as access to healthcare. 

To address the impact of the SDOH, the Centers for Medicare & Medicaid Services (CMS) has identified seven critical data elements for cross-setting standardization in assessment: 

  1. Race
  2. Ethnicity
  3. Preferred language
  4. Interpreter services 
  5. Health literacy
  6. Transportation
  7. Social isolation

Collecting data on these social determinants of health is about more than just checking boxes. It is an opportunity to gain insight into residents’ lives, beliefs, and values. The responses obtained during resident interviews paint a more comprehensive picture of potential barriers each resident may face upon discharge. By acknowledging and addressing these barriers, healthcare providers can better set residents up for success and in turn, reduce hospital readmissions and foster sustainable outcomes. 

Be on the lookout for tomorrow’s blog: Additions, Modifications, and Clarifications.

IN CASE YOU MISSED IT:

 

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MDS Changes Countdown – Day 9

COUNTDOWN DAY 9: Resident Interviews

In long-term care, the voice of the resident is invaluable. As the Minimum Data Set (MDS) evolves, it places increasing emphasis on resident input, particularly through interview-based questions. In the MDS 3.0 v.1.18.11, there are a total of twenty-one resident interview questionnaires (e.g., mood, preferences, pain). 

To provide the best possible care, accurate information is paramount. While medical assessments and charts are essential, self-report from the resident remains the single most reliable indicator of their well-being. Residents possess a wealth of knowledge about their own lives, preferences, and needs. Interviewing residents provides an opportunity to tap into this knowledge. By doing so, we gain insight into what they consider to be the most important facets of their lives. This knowledge forms the foundation for person-centered care and prioritizes individual preferences and choices. 

To ensure open communication in a supportive care environment, consider the following tips for a successful resident interview.

  • Introduce yourself to the resident.
  • Be sure the resident can hear what you are saying.
  • Ask whether the resident would like an interpreter.
  • Find a quiet, private area where you are not likely to be interrupted or overheard.
  • Ask the questions as they appear in the questionnaire.
  • Repeat the response options as needed.
  • Use cue cards as appropriate.
  • Move on to another question if the resident is unable to answer.
  • Break up the interview if the resident becomes tired.
  • Record the resident’s response, not what you believe they should have said.
  • If the resident becomes deeply sorrowful or agitated, sympathetically respond to their feelings.

In the ever-evolving landscape of long-term care, the resident interview has gained increasing importance. By placing residents at the center of decision-making and fostering a supportive care environment, we can truly honor their preferences and choices.

Be on the lookout for tomorrow’s blog: Social Determinants of Health. 

In case you missed yesterday’s blog, click to review: Know Your Resources.

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MDS Changes Countdown – Day 10

October 1 is 10 business days away, and with that date brings the long-awaited revisions to the minimum data set (MDS). Understanding these changes and their broad implications is crucial. Equally important is the efficient training of your staff for seamless implementation. Over the next 2 weeks, Reliant Rehabilitation will be sharing daily blog posts covering essential MDS updates, points to consider, and educational opportunities for staff including:
10. Know Your Resources
9. Resident Interviews
8. Social Determinants of Health
7. Additions, Modifications, and Clarifications
6. Section GG – Functional Abilities
5. Section D – Mood
4. Care Area Triggers & Care Area Assessments
3. Impact to State Case Mix
2. Quality Measure Impact
1. Interdisciplinary Collaboration

COUNTDOWN DAY 10: Know Your Resources
Foundational to any new learning is affirming that information is from a primary source of reference. For the MDS and RAI revisions, the primary source is CMS.
Each blog is developed by Reliant Rehabilitation’s team of RAC-Certified clinicians and contains easy to digest summaries of the MDS Updates.
Provided here is a compilation of CMS Websites, Training, and Manuals to download and bookmark as we embark on this blog series.

MDS 3.0 RAI Manual v1.18.11

MDS Item Sets v.1.18.11v5

CMS SNF 2023 Guidance Training Program

Monitor your email for updated information from Reliant including Real Time Memos, Reliant Reveal, and webinar trainings. To register for Reliant’s webinar on Effective Case Mix Management this Thursday, click HERE.

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Quarterly Confidential Feedback Reports for FY 2024 SNF VBP Program Available

The March 2023 Quarterly Confidential Feedback Reports for the FY 2024 SNF VBP Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports (CASPER) reporting system. These reports contain interim stay-level data for the SNF 30-Day All-Cause Readmission Measure (SNFRM) for 10/1/2021 – 6/30/2022 (Quarter 1 – Quarter 3 of FY 2022, the FY 2024 SNF VBP Program performance period). The interim data contained in these reports are not final and are subject to change; thus, they are not eligible for the SNF VBP Program’s Review and Correction process.

CLICK HERE to review the FAQs.

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CMS Nursing Home Stakeholder Call on 2/22/23

On February 22, 2023, CMS held a Nursing Home Stakeholder Call as part of a series of calls prior to the end of the PHE on May 11, 2023. Topics discussed included the following:

  • End of the Qualifying Stay and Benefit Waiver – The qualifying hospital (3-day) stay and benefit period (100-day refresh without the 60-day wellness) waivers will end on 5/11/23. Clarifying examples provided indicated waiver application may be applied for qualifying patient whose stay begins on or before 5/11/2023. Stakeholders were reminded that CMS is unable to extend these waivers beyond the PHE, any permanent solution would have to be implemented by congress through legislation.
  • Billing of vaccines under Part B – Billing of vaccines and monoclonal antibodies during a Part A stay under the guise of consolidated billing and excluded under the bundle and billed under Part B will be in effect until June 30, 2023.
  • Vaccination requirements and reporting – Staff vaccinations (primary series only) will continue to be required until 11/5/24 and reporting of vaccinations under NHSN must be completed until 12/21/24.
  • COVID-19 testing requirements – End when the PHE expires; however, nursing homes are still going to be expected to test per CDC standards for infection control and prevention.
  • Staffing study – Data is still being collected and analyzed on the staffing study. CMS is currently reviewing the data to determine what policies will be implemented.  CMS reiterated stakeholders will have ample time to provide feedback on any proposed changes.
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Preparing for the End of the PHE Fact Sheets

As we prepare for the end of the Public Health Emergency (PHE) on May 11, 2023, CMS and HHS have released fact sheets to aid in a smooth transition.

The PHE Fact Sheet includes information on

  • COVID-19 vaccines, testing and treatments.
  • Telehealth services.
  • Nurse Aide Training for Nursing Homes.

The LTC Fact Sheet highlights

  • The end of the 3-day prior hospitalization and 60-day wellness period waivers at the end of the PHE.
  • Payment for COVID-19 vaccines and monoclonal antibodies.

The COVID-19 PHE Transition Roadmap outlines flexibilities and processes that will and will not be affected by the end of the PHE.

CMS has agreed to provide additional resources as the end of the PHE nears. Reliant Rehabilitation will continue to keep you updated as new information is released.

 

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HRSA Releases Updates Regarding Period 4 Reporting of COVID-19 Funds

Health Resources and Services Administration (HRSA) released two important updates: 

·         Reporting Period 4 (RP4): Providers who received one or more PRF (General or Targeted) and/or ARP Rural payments exceeding $10,000, in the aggregate, from July 1 to December 31, 2021, must now report on their use of funds. The PRF Reporting Portal opened for RP4 on January 1, 2023, and will remain open through March 31, 2023, at 11:59 p.m. ET. Additional HRSA guidance is available on the PRF Reporting Resources webpage.

·         Phase 4 and ARP Rural Payment Reconsiderations Deadline: Providers who believe their Phase 4 and/or ARP Rural payment was calculated incorrectly have an opportunity to submit a payment reconsideration within 45 days of receiving the notification for their company. For more information, visit the Payment Reconsideration webpage.

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SNF Provider Preview Reports Now Available

The Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on Care Compare and Provider Data Catalog (PDC) during the April 2023 refresh.

 

The data contained within the Preview Reports are based on quality assessment data submitted by SNFs from Quarter 3, 2021 through Quarter 2, 2022. Additionally, the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure reflects data from Quarter 2, 2022. The data for the claims-based measures will display data from Quarter 3, 2019 through Quarter 4, 2019 and Quarter 3, 2020 through Quarter 2, 2021 for this refresh, and for the SNF Healthcare-Associated Infections (HAI) measure, from Quarter 4, 2020 through Quarter 3, 2021.

 

Providers have until February 16, 2023, to review their performance data. 

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A Recipe for Success

Annual regulatory updates from CMS come as no surprise; however, when coupled with significant updates from the CDC we may feel overwhelmed.

Successful implementation of regulatory, survey, federal, and state updates is possible when we implement the following strategies.

  1. BREATHE! – You’re not alone, and change does not have to be a bad thing. As a matter of fact, the new CDC and CMS guidance is leading us into a highly anticipated phase of the pandemic… a new beginning for our patients, visitors, and employees.
  2. Subscribe to CMS and CDC websites to receive fact sheets, FAQs, invites to webinars, and the latest updates.
  3. Know your company structure and departments of expertise. Watch for their guidance and recommendations.
  4. Review policies and procedures to ensure they are compliant with the new guidance.
  5. Consider any information that may need to be communicated to residents, families, and visitors (e.g., updated visitation guidance) and the best method to deliver this information (e.g., posting signage).
  6. Communicate with staff; consider various methods of delivery (email, webinars, in-person meetings).
  7. Assess the effectiveness of your facility’s implementation of new guidance and regulations. For areas needing improvement, make a plan to ensure preparedness.
  8. Connect with Reliant to receive Real Time Memos and the monthly Reliant Reveal newsletter.

In case you missed these recent publications from Reliant, click the links below to review our summaries of recently updated and upcoming regulatory guidance:

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CMS Updates Nursing Home Requirements of Participation Guidance

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities.

Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.

Key areas of guidance include

  • Requirements for surveyors to incorporate the use of Payroll Based Journal (PBJ) staffing data for their inspections.
    • CMS indicates the believe this will help identify potential noncompliance with CMS’ nursing staff requirements, uncover instance of insufficient staffing, and yield higher quality care. In addition, they state this allows facilities to begin addressing the staffing issues while the new rule making for minimum staffing levels is underway.
  • Requirements for an onsite at least part-time Infection Preventionist (IP) who has specialized training to effectively oversee the facilities infection prevention and control program.
    • CMS believes that the role of the Infection Preventionist (IP) is critical in the facility’s efforts to mitigate the onset and spread of infections. CMS cites the IP role as critical to mitigating infectious diseases through an effective infection prevention and control program.
  • For additional guidance and details, refer to the State Operations Manual and QSO-22-19-NH.

CMS included in memorandum QSO-22-19-NH recommendations related to resident room capacity.  There are no new regulations related to resident room capacity. However, CMS wanted to highlight the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment. CMS urges providers to consider making changes to their settings to allow for a maximum of double occupancy in each room and encouraging facilities to explore ways to allow for more single occupancy rooms for nursing home residents.

Additional details can be found in the following CMS documents: QSO-22-19-NH, Press Release, Fact Sheet

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CMS Provides Updated Guidance for Use of Waivers

CMS has updated its guidance and provided specific instructions for using the Qualified Hospital Stay (QHS) and benefit period waivers, as well as how this affects claims processing and SNF patient assessments.

  • To bill for the QHS waiver, include the DR condition code. To bill for the benefit period waiver:
    • Submit a final discharge claim on day 101 with patient status 01, discharge to home.
    • Readmit the beneficiary to start the benefit period waiver.
  • For ALL admissions under the benefit period waiver (within the same spell of illness):
    • Complete a 5-day PPS Assessment. (The interrupted stay policy does not apply.)
    • Follow all SNF Patient-Driven Payment Model (PDPM) assessment rules.
    • Include the HIPPS code derived from the new 5-day assessment on the claim.
    • The variable per diem schedule begins from Day 1.
  • For ALL SNF benefit period waiver claims (within the same spell of illness), include the following:
    • Condition code DR – identifies the claims as related to the PHE
    • Condition code 57 (readmission) – this will bypass edits related to the 3-day stay being within 30 days
    • COVID 100 in the remarks – this identifies the claims as a benefit period waiver request

Note: Providers may utilize the additional 100 SNF benefit days at any time within the same spell of illness.

Claims are not required to contain the above coding for ALL benefit period waiver claims.

Example: If a benefit waiver claim was paid utilizing 70 of the additional SNF benefit days and the beneficiary either was discharged or fell below a skilled level of care for 20 days, the beneficiary may subsequently utilize the remaining 30 additional SNF benefit days as along as the resumption of SNF care occurs within 60 days (that is, within the same spell of illness).

Additional instructions can be found in the article if you previously submitted a claim for a one-time benefit period waiver that rejected for exhausted benefits.

CLICK HERE to view the MLN Matters article.

CLICK HERE for the updated list of blanket waivers available.

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CMS to retire the original Compare Tools on December 1

Use Medicare.gov’s Care Compare to find and compare health care providers.

In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, which streamlines the eight original health care compare tools. The eight original compare tools – like Nursing Home Compare, Hospital Compare, Physician Compare – will be retired on December 1st. CMS urges consumers and providers to:

  • Use Care Compare on Medicare.gov and encourage people with Medicare and their caregivers to start using it, too. Go to Medicare.gov and choose “Find care”.
  • Update any links to the eight original care tools on your public-facing websites so they’ll direct your audiences to Care Compare.

With just one click on Care Compare, easy-to-understand information about nursing homes, hospitals, doctors, and other health care providers is available.

Information about health care providers and CMS quality data will be available on Care Compare, as well as via download from CMS publicly reported data from the Provider Data Catalog on CMS.gov.

Direct links to the tools & additional resources

Care Compare on Medicare.gov – https://www.medicare.gov/care-compare/

Provider Data Catalog on CMS.gov – https://data.cms.gov/provider-data/

Care Compare resources for consumers and partners – Medicare blog, Promotional video, Conference card  

Full Press Release: https://www.cms.gov/newsroom/press-releases/cms-care-compare-empowers-patients-when-making-important-health-care-decisions

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