The Proposed Rule for Fiscal Year (FY) 2022 for the Skilled Nursing Facility Prospective Payment System was released early April 2021. Now that providers have had a chance to digest the proposed SNF payment updates and the PDPM parity adjustment, attention turns to the quality initiatives that have been updated.

Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. (difference of NE-NF and NA-NB).

The SNF QRP quality initiative is a pay-for-reporting program. SNFs that do not meet reporting requirements will be subject to a two-percentage (2%) reduction in their annual update. CMS is proposing to adopt two new measures and update the specifications for another measure.

  • Healthcare-Associated Infections (HAI) Requiring Hospitalization Measure – This measure uses Medicare fee-for-service (FFS) claims data to estimate the rate of HAIs that are acquired during SNF care and result in hospitalization. Examples include sepsis, urinary tract infection, and pneumonia. The SNF HAI measure will be added to the QRP beginning FY 2023.
  • COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) Measure – This measure would require SNFs to report on COVID-19 HCP vaccination to assess whether SNFs are taking steps to limit the spread of COVID-19 among their HCP, reduce the risk of transmission within their facilities and help sustain the ability of SNFs to continue serving their communities throughout the COVID-19 PHE and beyond. Vaccination data reported to the Centers for Disease Control and Prevention National Healthcare Safety Network will be used beginning October 1, 2021.
  • Update to Transfer of Health (TOH) Information to the Patient-PAC Quality Measure – CMS is proposing to update the denominator for this quality measure. Currently, the measure denominators for both the TOH Information to the Patient-PAC and the TOH Information to the Provider-PAC measures include patients discharged home under the care of an organized home health service organization or hospice. To avoid counting the patient in both TOH measures, CMS is proposing to remove this location from the definition of the denominator for the TOH Information Patient-PAC measure. CMS is expected to implement this quality measure two years after the end of the PHE.

FUTURE CHANGES

In addition to proposed quality measures, CMS is seeking two Requests for Information (RFI). A request for information is issued for Closing the Health Equity Gap and Fast Healthcare Interoperability Resources (FHIR) in support of Digital Quality Measurement in the Quality Reporting Programs.

According to the CMS, “With this RFI, we are also seeking comment on the possibility of expanding measure development, and the collection of other SPADEs that address gaps in health equity in the SNF QRP.” Providers can expect QMs in these domains in the coming years under the QRP.

Explore More Posts from MDS Consultants

Get ready for October 1

Transportation – New Item A1250

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See An additional item we will see in the upcoming MDS 3.0 v.1.18.11 in October 2023 is A1250 - Transportation. This is included in a new subset of...

New 3-day Lookbacks | Assessment Periods

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of March 24, 2023 What You Can Expect to See New 3-day lookback/assessment periods are coming to the MDS world. There are different sections of the MDS that the Nurse Assessment Coordinators...

New Pain Interview in Section J

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 22, 2023 What You Can Expect to See The most noticeable changes to Section J are evident in the pain interview, specifically questions J0510, J0520 and J0530. The RAI Manual has...

Section B – Hearing, Speech and Vision Changes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See Section B on the MDS is a component of the Standardized Patient Assessment Data Elements (SPADEs), which is utilized across post-acute care...

Race and Ethnicity – Changes in Section A

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See Section A, Identification Information for Race/Ethnicity has expanded. One of the major changes is the deletion of section A1000 Race/Ethnicity....

Read more on Toolbox Essentials

Focused Infection Control Surveys and Directed Plan of Correction

It's a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey,...

New Advanced Beneficiary Notice

Is your facility using the proper ABN form? The Centers for Medicare & Medicaid Services (CMS) recently updated the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The new ABN will be mandatory for use on 1/1/2021, but the new form can be...

Covid-19 and Skilled Status

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed. ...

Mind Your PHQs

Some skilled nursing facilities (SNFs) are concerned about accurate payment when a resident unexpectedly discharges and the Brief Interview for Mental Status (BIMS) has not yet been completed.However, they should be just as concerned about the PHQ-9. The PHQ-9...

MDS in the Emergency Preparedness Plan

The COVID-19 pandemic has highlighted the need for skilled nursing facilities to have an effective Emergency Preparedness Plan - one that includes sheltering-in-place. The Centers for Medicare and Medicaid Final Rule requires that participating providers have an...

MORE from MDS Experts

OSA or PDPM? A State-Level Decision

As of Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) has retired the A0300 Optional State Assessment (OSA) from the federally required MDS 3.0 v1.18.11 that is submitted by nursing facilities. The OSA is now a separate optional MDS assessment...

The Physician and “I”

The physician’s role in the nursing facility is essential to delivering skilled, quality care for Skilled and Long-Term Care residents. Physicians are our lead in providing clinical decision making and properly defining, clarifying, and verifying diagnoses. Only the...

Coding UTIs on the MDS 3.0

Urinary Tract Infections (UTIs) are a commonly miscoded data element on the MDS. Are you over coding UTIs? Are you not coding them at all? Should you? Shouldn’t you? The MDS has historically left data collectors asking themselves these questions. What happens if I do...

Achieving Accurate ADLs with the OSA

Section G of the MDS 3.0 was retired October 1, 2023, yet the MDS nurse may still need to use the knowledge of accurately coding ADLs with an assessment called the Optional State Assessment (OSA).  State-Optioned OSA Although the option to choose an OSA from the...

What Is an MDS Coordinator?

It’s a bit odd that when asked what you do for a living most MDS coordinators struggle to come up with an answer. Who struggles to explain what they do every day? The reality is that MDS Coordinators fully understand what this multifaceted job entails, but are at a...

Webinars & Training

Grow your knowledge with our MDS education

MDS Guides & Forms

Exclusive resources & tools we use every day

Ask an Expert Forum

Members can get 1:1 advice from our MDS experts

Let's Meet in Person

Get more info on our training & conference schedule

News for MDS Experts

Browse our blog & get news alerts on MDS changes

MDS Completion

Get your MDS' done ASAP with short-term, expert help

Remote Floater

Fill gaps on your team when & where you need

Case Mix Index

Improve your complex case mix calculations

MDS System Mgt

Best practices for MDS schedules & workflow

+ More Services

Get help on PDPM, ICD-10, quality, schizoph. audits ++