Protocols for the prevention of Coronavirus infections in Nursing Homes have been outlined by CMS.

Infection control issues and other health and safety threats will be the exclusive focus of state survey facility inspections for some time.

CMS is directing all facilities to immediately review all of their infection control procedures to ensure compliance with CMS requirements and CDC guidelines.

CMS Plan for Coronavirus Prevention in Nursing Homes

Nursing Home Survey Changes and Coronavirus

CDC Strategies for Preventing Spread of Coronavirus in Nursing Homes

CMS recently released the initial draft version of the MDS v1.18.0 that was to become effective in October, 2020. The changes have been postponed for now due to the corona virus.

The biggest change in the draft is the elimination of Section G. Section GG is retained.

CMS has also published tables detailing the changes to each section of the MDS assessment form. The files for the initial draft and the change tables can be accessed on the CMS page:

MDS 3.0 Technical Information

Long term care facilities must develop and implement a baseline care plan for each resident within 48 hours of admission.

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.

Baseline Care Plan Regulations

CMS Updated Surveyor Guidelines for Long Term Care Faciities

PPDM, the Patient-Driven Payment Model began October 1, 2019. CMS reported the new case-mix classification system uses certain clinical factors rather than volume based services to determine Medicare reimbursement. Classification is based on the resident’s primary diagnosis, therapy components, and functional status to assign one of 16 case mix groups. The link below provides detailed information, crosswalk tables, and learning materials.

CMS Patient Driven Payment Model Information Page

The new PDPM, Patient Driven Payment Model schedule only requires 3 PPS assessments, the 5-day, interim, and discharge assessments. CMS has made worksheets available to calculate the PDPM categories that replace RUGs.

MDS items added include: the Primary Diagnosis in Section I, Surgical History categories in Section J, Interim Performance in Section GG, and additional Discharge Therapy items in section O.

The streamlined assessment policy is intended to provide more time for comprehensive baseline nursing care plans.

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