May 22, 2018
Volume II, Issue 5
In this edition:
-Breaking News
-Money Matters
-Coming Down the Pike
-In Effect and Important
-ACT Senior Living
    Consulting Services

Members of the ACT Senior Living Consultant team participated in the vendor shows recently held by the Ohio Health Care Association (OHCA) and the West Virginia Health Care Association (WVHCA). We saw old friends and made some new ones. Thanks for all you do to provide care and services to the populations you serve. We were honored to spend time with you.
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Breaking News
Resident Classification System Version 1 (RCS-1) is gone before it ever started! Centers for Medicare and Medicaid Services (CMS) has posted a proposed rule for 2019 that includes a new case mix grouping called the Patient Driven Payment Model (PDPM). Changes appear to have been driven by concerns shared by stakeholders.

What is different between RCS-1 and the new PDPM? The resident's case mix group can change during their stay. The level of complexity has been reduced. CMS has stated that the revision will lessen administrative burden and streamline the process, as well as provide payment that is aligned with patient care needs. If enacted in the future, the new system would become effective 10/1/19. ACT will be monitoring the proposed rule and will provide updates in future newsletters.

Money Matters
Along with the fiscal 2019 Medicare market basket increase of 2.4% that was announced recently, CMS has reinforced their intent to focus on payment systems that reward value versus volume. The new PDPM was addressed above. There are more updates to Skilled Nursing Facility (SNF) payment systems driven by requirements in the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT) Act. As reported in our April 2018 newsletter, the Value-Based Purchasing (VBP) Program 30-day All-Cause Readmissions Measure will impact payment beginning this October.

The SNF Quality Reporting Program (QRP) continues to be a moving target as proposed changes are considered. Failure to submit the required data will result in a 2% reduction in payment. There are no new Quality Measures (QMs) being proposed at present, but public display of information practices and cost versus benefit for specific measures are on the table.

Proposed rule changes are open for public comment until June 26, 2018. Additional information can be found at the CMS Newsroom.

Coming Down the Pike
CMS released an MLN Matters Article, MM10611 on
April 30, 2018 regarding the new Medicare Cost Report E-Filing (MCReF). This report is used to determine providers' Medicare reimbursable costs. The effective date for using the MCReF is June 12, 2018. The system became available to Medicare Part A providers this month with the intent of streamlining the process.

In Effect and Important
CMS published the new Five-Star Quality Rating System Technical User's Guide update in April. This, along with the April State Level Cut Point Tables, and the April Expected and Adjusted Staff Time Values Data Set can be used to project your updates for the domains. Having a process champion in-house to make accurate calculations and provide education to other members of the team is a great way to bring focus to these important measures.

ACT Senior Living Consulting Services
The ACT Senior Living Consulting team can help you make systematic changes to meet the requirements and intent of the new Infection Prevention and Control requirements that rolled out in Phase 2 and are coming in Phase 3. We can assist by:
  1. Evaluating current systems
  2. Providing a step-wise approach to implementation of requirements through providing required policies and procedures, working with you to adapt documentation practices, and identify processes to capture meaningful data
  3. Training your staff to be the experts
  4. Helping your team make sense of the data and identifying ways to use it to improve care practices and outcomes

Contact us by email to determine how we can meet your needs at

Stay up-to-date with important news by accessing this newsletter and more in the Knowledge Center on our ACT website!