Latest Long Term Care Federal Regulatory Changes
Skilled Nursing Facility PPS Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities
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
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
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:
Patient-Driven Payment Model
CMS Patient Driven Payment Model Information Page
Value Based Purchasing Program
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
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.