Patient-Driven Payment Model

Posted by LTCS on December 31, 2018
Home Health Care Nurse and Home Health Nursing Care Plans

PPDM, the Patient-Driven Payment Model will be effective October 1, 2019. The model is intended to reduce the number of payment group combinations and to simplify paperwork requirements.

CMS reports the new case-mix classification system will use certain clinical factors rather than volume based services to determine Medicare reimbursement. Classification will be based on the primary diagnosis for the resident’s stay, therapy components, and the resident’s functional status to assign one of 16 case mix groups.

LTCS books will be updated by October to include the changes. The link below provides detailed information, crosswalk tables, and learning materials.

CMS Patient Driven Payment Model Information Page

Value Based Purchasing Program

Posted by LTCS on December 31, 2018

The VBP, Value Based Purchasing Program, became effective October, 2018. With the changes, CMS states the highest performing SNFs receive the highest payments, and the lowest ranked 40 percent of SNFs receive decreased payments.

Performance rankings are based on unplanned hospital readmissions of Medicare residents within 30 days of discharge, performance scoring, and quality feedback reports.

Overview of the Skilled Nursing Facility Value-Based Purchasing Program

MDS and CAT Changes for October, 2018

Posted by LTCS on March 1, 2018

Here are the CMS links and data specifications for the new MDS 3.0 V2.01.0 version, the MDS 3.0 RAI Manual v1.16, and new MDS forms.

There are significant changes to Section GG, I, J and M. Also, there is a new version for CAT 16, Pressure Ulcer.

The changes should be incorporated into the long term care facility’s MDS baseline nursing care plans.

MDS and CAT Data Specifications for October, 2018

MDS 3.0 RAI Manual v1.16

Baseline Care Plan Requirements Outlined by CMS

Posted by LTCS on February 28, 2018

Long term care facilities must develop and implement a baseline care plan for each resident within 48 hours of admission beginning November 28, 2017, according to recently updated surveyor guidelines published by CMS.

The guidelines state the 48 hour baseline care plan must include “the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care,” including, but not limited to: initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASARR recommendation, if applicable.

According to the regulations, facilities may develop a comprehensive care plan in place of the baseline care plan if the comprehensive care plan meets all of the requirements for the baseline care plan outlined in the surveyor guidelines.

In order to assure all of the requirements of the guidelines are met, LTCS Books recommends that the facility develops and implements a comprehensive care plan within 48 hours of admission.

MDS Comprehensive Assessment v1.15.1 for October 2017

Baseline Care Plan Regulations

CMS Updated Surveyor Guidelines for Long Term Care Faciities

CMS Clinical Templates for Home Health Documentation

Posted by LTCS on February 27, 2018

CMS has published new Clinical Templates for Home Health documentation. Providers and IT vendors can choose whether or not to use the printable clinical templates. The tool can be integrated into electronic health record (EHR) systems  to assist providers with Medicare documentation.

CMS Clinical Templates