UPDATE Weekly

On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1679-F] outlining fiscal year (FY) 2018 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). In that rule, CMS finalized some key components of the SNF Value Based Purchasing (VBP) program, which impacts reimbursements starting next year.

Starting on October 1, 2018, CMS will adjust Medicare payments to providers based on how well they manage hospital readmissions based on performance in this calender year (CY) 2017 compared to CY 2015. Some SNFs will see some sort of payment reduction, which can be as high as two percent for all of their Part A Medicare payments for an entire fiscal year. There is a potential for some SNFs who achieve low rehospitalization rates to see an increase in reimbursements, but how many and by how much will not be determined until the performance period of calendar year 2017 concludes.

Newly finalized program components you need to know:

Starting October 1, 2018 (Fiscal Year 2019)

• Size of incentive pool. CMS will calculate two percent of all SNF Part A payments and use 60 percent of that figure to calculate the payment adjustment for SNFs. CMS was mandated to use between 50 and 70 percent. Despite AHCA’s recommendations to set the percentage to 70 to maximize the incentive pool available to providers, CMS opted to set the rate to 60.
• Method to link rehospitalization rates to your payment adjustment (a.k.a., exchange function). CMS elected to utilize a logistic exchange function to translate a provider’s performance in the SNF Readmission Measure (SNFRM) into a value-based incentive payment multiplier. This aligns with AHCA’s recommendation because it incentivizes providers to continuously improve their readmission rates, regardless of their current SNFRM rate, and allows for the greatest number of SNFs to receive net positive payments.
• SNF VBP scores will be rounded to five significant digits. To measure providers as precisely as possible and minimize tied rankings, CMS will round SNF VBP scores to no more than five significant digits. We modeled the effect of using extra decimal points, and found the impact will be minimal to all impacted SNFs (<$1,000 payment adjustment per year compared to not rounding).

Starting October 1, 2019 (FY 2020)

• New achievement and benchmark rates. CMS finalized the Achievement and Benchmark rates used in the determination of a SNF’s VBP score for the second year of the VBP program, which will impact payment in FY 2020. SNFs with SNFRM rehospitalization rates greater than the Achievement rate of 19.8 percent will receive no points and will lose two percent of their Medicare payments, while providers with rehospitalization rates less than the Benchmark rate of 16.3 percent, will receive 100 points and are likely to have net positive payments.
• Switching performance and baseline periods to fiscal years from calendar years. CMS is switching the measurement windows to fiscal years in the second year of the program to ensure timely notification to providers of their value-based incentive payment adjustments no later than 60 days prior to the start of a fiscal year. Switching to a fiscal year will allow CMS an extra three months for data collection, measure calculation and reporting. This means the baseline period for the second year of the program will be FY 2016 (Oct. 2015 – Sept. 2016) and the performance period will be FY 2018 (Oct. 2017 – Sept. 2018). Additionally, this means the fourth quarter of 2017 (Oct. 2017 – Dec. 2017) will count towards the performance period of both the first and second year of the program.

For more information on the SNF VBP program and to access tools and resources on ahcancalED and other sites visit AHCA’s VBP Web site here.

Please contact David Gifford or Thomas Martin with any questions.

[Return to top]

As our members are aware, starting October 1, 2018, all Skilled Nursing Facility (SNF) Medicare Part A rates will be cut by 2 percent to fund an incentive payment pool. At that time, the Centers for Medicare & Medicaid Services (CMS) will adjust payments and return some amount to providers based on how well they do in managing hospital readmissions by meeting or exceeding performance standards. This CMS effort, the SNF Value Based Purchasing (VBP) Program, links financial outcomes to quality performance.

Providers may think they don’t have to focus on the SNF VBP program yet as it does not affect payment until 2018. But CMS is currently collecting rehospitalization data that will be used to determine how much facilities earn back.

This week we are featuring Considerations for End of Life Care, part six of a 10-part resource series designed by the American Health Care Association (AHCA) to support members in reducing rehospitalizations.

Considerations for End of Life Care is a framework on advance care planning and end of life care. It contains competencies related to knowledge, skills, attitude, and behavior.

Check out this resource here to learn more!

For more information about the SNF VBP program and to access additional resources and tools, visit the AHCA SNF VBP Web site here.

[Return to top]

One item that continues to cause quite a bit of confusion among nursing facilities and Medicaid case workers in the county Department of Social Services (DSS) offices is Medicaid coverage for the first month a resident is in a nursing facility. During the month of August, the Division of Medical Assistance (DMA) Operational Support Team is conducting meetings with the county supervisors and other DSS staff across the state. One of the items included in these meetings is that DSS staff should not tell a facility that Medicaid does not cover the first month in a nursing facility, unless the Medicaid applicant/beneficiary is ineligible for Medicaid or there is no approved FL-2.

If you have provided services to residents, but have been unable to receive payment because you were told the first month was not covered, reach out to the DSS office administering the resident’s file and request that they review the first month coverage. If the DSS office still maintains that the first month is not covered, please contact Sam Clark at samc@nchcfa.org or (919) 782-3827.

[Return to top]

On Thursday, September 7, 2017, from 1:30 to 3:00 PM ET, the Centers for Medicare & Medicaid Services (CMS) will host a conference call. During this call, CMS will be discussing an optional Facility Assessment Tool it is developing. CMS will also review frequently asked questions related to Phase 2 requirements and interpretive guidance included in the revision of the State Operation Manual Appendix PP here for Phase 2 of the Reform of Requirements for Long-Term Care Facilities final rule. The presentation will include a walk-through of the Facility Assessment tool and will be followed by a question and answer session.

To register for the call, visit the MLN Event Registration Web site.

[Return to top]

Back by popular demand, Judy Wilhide Brandt will be presenting a full day seminar on the following topics in Greensboro, NC on September 26th, 2017.

• Review SNF Quality Reporting Program (QRP), Section GG Coding
• Discuss the purpose of Post-Acute QRP and the role of SNF-QRP
• Understand which MDS items are used for MDS based QRP measures and how to avoid a 2% APU reduction
• List the current QRP claims and MDS based measures with overview of how they are calculated
• Discuss the new MDS items for QRP and new QRP measures to begin collection October 2018 as finalized in the FY18 SNF Final Rule
• Discuss implications of accurate coding for Section GG, to include assessment periods, timing and value in health information exchange for transitions
• Review 5 star quality measures and accurate coding
• Discuss administrative oversight of the MDS department to ensure compliance with accurate coding and transmission for all QMs that are MDS based
• Understand how MDS coding affects risk adjustment for claims based measures
• Review Requirements and Interpretative Guidelines for baseline care planning
• Discuss authentic ways to engage the physician and CNAs in care planning as required by Phase 2 ROP

About the Presenter

Judy Wilhide Brandt is one of the nation’s leading experts on skilled nursing facility (SNF) clinical Medicare compliance, Five Star Rating System, Quality Measures and the MDS/RAI process. Judy brings over thirty-five years of combined experience to the long term care industry, with over twenty years in positions of increasing responsibility in nursing facilities as a nurse manager, executive, and consultant. She is the principle for Wilhide Consulting, Inc. and serves as an advisor, auditor, and trainer for multiple providers from stand-alone communities to multi-state chains across the country. Her services are in high demand as she can be counted on for accurate, current information in the ever-changing SNF regulatory landscape.

CLICK HERE TO REGISTER NOW!
CLICK HERE TO DOWNLOAD AND PRINT THE BROCHURE WITH THE REGISTRATION FORM!

[Return to top]

It is time once again to acknowledge front line, unlicensed personnel who have demonstrated outstanding achievements in the long term care profession. This awards program honors individuals who are the backbone in our facilities because of the support they provide to our residents. A panel of judges from the Education and Programs Committee will select a Nurse Aide winner from each of NCHCFA’s five districts. In addition, one recipient in a non-nursing discipline will receive the Riley W. Clapp Outstanding Service Award. Each of the award recipients will be honored at the Annual Awards Gala during the Annual Convention and Expo on Tuesday, January 30, 2018 in Greensboro, NC.

To complete nominations on-line or to obtain additional forms, visit the Member Center of the Association Web site at http://www.NursingHomesNC.com. Click on “News & Updates”, select “2018 NCHCFA Annual Awards Packet” and choose “Survey Monkey”. If you have any questions about the Annual Awards, call the Association office at (919) 782-3827. Click here to download and print the brochure. Click here to print the nomination forms. Nominations received in the Association office after Friday, October 20, 2017 will not be considered.

[Return to top]

While the scope of long term care settings has expanded from nursing homes and home care agencies to assisted living facilities and community-based health services, the training for nurses, managers and administrators, medical directors, and other professionals who work in these facilities is often fragmented. This book was developed to fill a widely-recognized gap in the management and leadership skills of RNs needed to improve the quality of long term care.

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product # 8398
AHCA Members (on-line price) $85.00

[Return to top]

This brochure outlines what physical restraints are, when they should be used, rules and regulations concerning restraints, and making decisions about using them. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org.

• NCHCFA Member: $30.00 per 100 brochures plus tax and shipping
• Non-Members: $60.00 per 100 brochures plus tax and shipping

[Return to top]

Understanding and dealing with negativity in the workplace

http://www.mcknights.com/guest-columns/understanding-and-dealing-with-negativity-in-the-workplace/article/682916

[Return to top]

Every year the Four Corners (the point where the borders of Arizona, Utah, Colorado, and New Mexico meet) draws about a quarter million visitors to a small plaque marking the spot. However, due to crude 19th-century surveying technology, the actual Four Corners is almost 2,000 feet to the west.

[Return to top]