As required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, the Centers for Medicare & Medicaid Services (CMS) released
the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)
Nursing Home Compare
on October 24, 2018. The information included claims-based measures for Medicare Spending Per Beneficiary (MSPB); and rate of successful return to home or community from a SNF. The assessment-based measures include percent of residents/patients in a SNF that develop new or worsening pressure ulcers; percentage of residents/patients whose activities of daily living and thinking skills were assessed and related goals were included in their treatment plan; and percentage of SNF patients who experience one or more falls with major injury during their SNF stay. As with all publicly shared measures, it is important that you understand the meaning and intent behind each of the measures. With the implementation of these new measures, you may see an increased scrutiny by discharge-planners from referral sources. We recommend you also be prepared to answer questions from residents/patients and their loved ones about the new measures.
Survey actions & outcomes: The CMS continues to work on revising the explanation or “guidance to surveyors” as to what constitutes “immediate jeopardy.” The application continues to be somewhat inconsistent and elusive. The most important thing to remember… if the surveyor or the CMS believes that the facility is endangering a resident’s life through noncompliance with regulations to the point that it represents a serious threat to the facility’s operations and its residents, it can be classified as immediate jeopardy.
The 2019 Medicare deductibles, coinsurance, and premium rates have been released. The Part A premium will increase to $437.00, the deductible for hospitalization is $1,364.00, Part A SNF co-insurance is $170.50 per day for days 21-100, and the Part B premium is $135.50 per month. For more detailed information, visit the
Coming Down the Pike
Payroll-Based Staffing Data: The CMS intends to use the new payroll-based staffing data to strengthen oversight of resident health and safety. Administrator Seema Verma announced on November 30 that the CMS takes their responsibility seriously and they are taking action by sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses. Based on the payroll-based data received, they will provide the state survey agencies with a list of nursing homes that appear to have staffing concerns such as a significant drop in staffing levels on weekends. According to the CMS, the survey agencies would then be required to conduct surveys on some weekends based on the list.
ACT Senior Living Consulting Services
The Patient-Driven Payment Model (PDPM) is on its way! Slated to take effect in October of 2019, the time to prepare is now. For those facilities who serve a large number of Medicare patients, it is important to understand the new metrics. ACT will be working closely with SNF clients to ensure they have a clear understanding of how the case-mix rate components combine with non-case-mix components to form the per diem rate.
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