Latest Long Term Care Federal Regulatory Changes

Skilled Nursing Facility PPS   Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities

MDS 3.0 RAI Manual

MDS 3.0 Technical Information

State Operations Manual   Minimum health and safety standards that must be met by providers participating in the Medicare and Medicaid programs

Federal Regulations for Long Term Care   Centers for Medicare & Medicaid Services, Department of Health and Human Services, Standards and Certification, Public Health, Requirements for states and Long Term Care Facilities, Title 42, Chapter IV, 400-699

Survey Requirements and Guidelines for Skilled Nursing Facilities   Protocols and interpretive guidelines surveyors are required to use in assessing the nursing home’s performance compliance with Federal requirements.

Nursing Home Quality Initiative   Resources about Minimum Data Set (MDS), Care Compare, payment, quality measures, survey and certification information for providers

Patient Driven Payment Model, PDPM   Clinical categories used for PT, OT, SLP, NTA components, and ICD-10 code mappings

Care Compare   Quality measures for consumers, providers, states, and researchers to compare information on nursing homes

Staffing Data Submission

Quality Measures

Covid 19 Resources for Long Term Care

HIPAA Administrative Simplification Regulation Text   45 CFR Parts 160, 162, and 164, March 2006, Complete version with table of contents, HIPAA survival guide, resources, toolkits

NANDA-I   North American Nursing Diagnosis Association, Develops, classifies, and maintains standardized nursing terminology. Provides updates on new diagnoses. Accepts submissions of new nursing diagnoses.

National Council of State Boards of Nursing   Maintains the Nursys database, which coordinates national publicly available nurse licensure information.

National Guideline Clearinghouse   Objective, detailed information on clinical practice guidelines. Originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans.

MDS Changes Will Drop Section G

CMS 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

Patient-Driven Payment Model

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

Value Based Purchasing Program

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 Changes from October, 2019

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.