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CMS Provides Program Updates

In a swift-moving but information-packed Open Door Forum on Nov. 30th, Centers for Medicare and Medicaid Services (CMS) staff provided updates on the Skilled Nursing Facility (SNF) Value Based Purchasing (VBP) and Quality Reporting (QR) programs. They also touched on toolkits available to providers developed through the Civil Monetary Penalty Reinvestment Program (CMPRP) and reminded participants of an upcoming provider call on the Patient-Driven Payment Methodology (PDPM). Highlights of the call are provided below. The agenda document which lists help desk contact information for the programs discussed is available here.

SNF VBP: Providers should now be seeing the impact of their VBP multipliers on their Medicare Part A payments. The multipliers that were distributed to all facilities through the CASPER system in August are automatically applied to each RUG rate by the Medicare Administrative Contractor (MAC), so providers do not need to make any changes in their billing practices.

Under Phase One of the SNF VBP Review and Corrections process, providers have an opportunity to review and submit corrections to their Calendar Year (CY) 2017 readmission rate until March 31, 2019. A set of Frequently Asked Questions (FAQs) available here describe how to request a correction, and information on reviewing the annual performance report is here.

CMS has recently posted a complete listing of 2017 readmission rates along with rankings and incentive payment multipliers here.

In the coming weeks, CMS intends to issue the next VBP Quarterly Report showing interim stay level data for the first two quarters of Federal Fiscal Year (FFY) 2018 (i.e., October 2017 through March 2018). FFY 2018 will be the performance year for calculating VBP payment adjustments to rates effective October 2019. CMS is working on enhancing the Quarterly Reports and is seeking suggestions for making them easier to understand.

SNF QRP: SNF QRP measures have been posted on Nursing Home Compare since October 2018, with the next data refresh scheduled for late January 2019. Providers will continue to receive preview reports no later than 30 days prior to any public posting. Homes should address QRP questions to SNFQualityQuestions@cms.hhs.gov. Questions regarding public reporting should be addressed to SNFQRPPRQuestions@cms.hhs.gov.

CMS reminded participants to sign up to receive quarterly email notices from CORMAC (a CMS contractor) with reminders of the data submission deadlines for those SNFs that are under-reporting. To sign up for these notices, members should email their CMS certification number and email address to QRPHelp@cormac-corp.com. Notification emails are only sent to SNFs if they are not meeting all required reporting thresholds ahead of the submission deadline. In the most recent review, about 400 providers were not meeting the requirements.

CMS has retired warning edit 3907 in the MDS submission validation process as of Nov. 12th. Providers are urged to review edit 3891, which better informs homes on the completeness of their function process measure data reporting. Information on the validation report edits is available in Section 5 of the MDS 3.0 User Guide (available here).

Several new toolkits that focus on improving dementia care, reducing adverse events, and improving staffing quality are now available as part of the CMPRP. A Staff Competency Assessment is now available, with employee satisfaction survey tools and a guide for improving employee satisfaction coming soon. Links to the tools are available here.

The Medicare Learning Network has scheduled a call dedicated to PDPM for Tues., Dec. 11th from 1:30 to 3 p.m. to provide an overview of the new methodology and discuss the changeover from RUG-IV to PDPM. The call is free, but registration is required and can be accessed here. A question and answer session will follow the presentation, and attendees are invited to email questions in advance to PDPM@cms.hhs.gov with “December 11 Call” in the subject line.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841