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2019 Pulse |
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CMS Releases CY 2020 Medicare Physician Fee Schedule Proposed Rule
On July 29, 2019, the Centers for Medicare & Medicaid
Services (CMS) issued the Proposed CY 2020 Medicare
Physician Fee Schedule (PFS), which would take effect
January 1, 2020. |
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CMS Announces Proposed Rule that would Revise Requirements
of Participation for LTC Facilities
On July 16, 2019, the Centers for Medicare & Medicaid
Services (CMS) announced a proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care
Facilities: Regulatory Provisions to Promote Efficiency and
Transparency.” The proposed rule would remove requirements
for participation identified as unnecessary, obsolete, or
excessively burdensome on long-term care (LTC) facilities. |
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ICD-10 Coding Under PDPM
The Patient-Driven Payment Model (PDPM), taking
effect on October 1, 2019 represents change for skilled
nursing providers (SNFs) in that patient condition, rather
than therapy minutes, will drive reimbursement. |
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CMS Releases FY 2020 SNF PPS Proposed Rule
On April 19, 2019, the Centers for Medicare & Medicaid
Services (CMS) issued a proposed rule for Fiscal Year (FY)
2020 that updates the Medicare payment rates and the quality
programs for skilled nursing facilities (SNFs). Effective
October 1, 2019, CMS will begin using a new case-mix model,
the Patient Driven Payment Model (PDPM). |
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CMS Revises Guidance on Immediate Jeopardy
The Centers for Medicare & Medicaid Services (CMS)
released a memorandum on March 5, 2019, "Revisions to
Appendix Q, Guidance on Immediate Jeopardy", which
includes revisions to the guidance on citing immediate
jeopardy in Appendix Q of the State Operations Manual
(SOM). |
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CMS Updates PDPM Website
See the Newest Pulse for all Key PDPM Updates, including Revisions to the PDPM Calculation Worksheet for
SNFs, Administrative Level of Care Presumption under the
PDPM, PDPM Functional and Cognitive Scoring, and more. |
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PDPM Clinical Category Updates
The fiscal year (FY) 2019 skilled nursing facility
prospective payment system (SNF PPS) final rule
included now inaccurate information related to how
the default primary diagnosis clinical category will
be determined for the physical therapy (PT),
occupational therapy (OT), and speech-language
pathology (SLP) components of the patient-driven
payment model (PDPM) that will be implemented on
October 1, 2019. |
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2018 Pulse |
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CMS Strengthens Nursing Home Oversight to Ensure Adequate Staffing
The Centers for Medicare & Medicaid Services (CMS)
published a memo on November 30, 2018 to announce
actions that will bolster nursing home oversight and improve
transparency in order to ensure that facilities are staffed
adequately. |
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CMS Issues CY 2019 Medicare Physician Fee Schedule Final Rule
On November 1, 2018, the Centers for Medicare & Medicaid
Services (CMS) issued the Final Calendar Year (CY) 2019
Medicare Physician Fee Schedule (PFS), which would
take effect January 1, 2019. |
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CMS Publishes CY 2019 Medicare Premiums and Deductibles
On October 12, 2018, the Centers for Medicare and
Medicaid Services (CMS) published the Calendar Year
(CY) 2019 premiums, deductibles and coinsurance
amounts for Medicare Part A and Part B services. |
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CMS Proposes Reduction in Emergency Preparedness Requirements
The Centers for Medicare & Medicaid Services (CMS)
issued a proposed rule to revise the applicable
conditions of participation (CoPs) for providers and
conditions for coverage (CfCs) as a continuation of
their efforts to reduce regulatory burden in accordance
with the January 30, 2017 Executive Order “Reducing
Regulation and Controlling Regulatory Costs” |
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CMS Publishes Revised MDS 3.0 RAI Manual
The Centers for Medicare and Medicaid Services (CMS)
published the MDS 3.0 RAI Manual v1.16 and MDS
forms, effective October 1, 2018. |
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SPECIAL EDITION: CMS Issues FY 2019 SNF PPS Final Rule
On July 31, 2018, the Centers for Medicare& Medicaid Services (CMS) issued a final rule [CMS-
1696- F] outlining Fiscal Year (FY) 2019 Medicare
payment rates and quality programs for skilled
nursing facilities (SNFs). |
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CMS Releases CY 2019 Proposed Medicare Physician Fee Schedule
On July 12, 2018, the Centers for Medicare& Medicaid Services (CMS) issued the Proposed
CY2019 Medicare Physician Fee Schedule (PFS),
which would take effect January 1, 2019. |
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Nursing Home Compare Updates
CMS continues to focus on reducing hospitalizations to
improve the health and safety of nursing home residents.
Over the last several years, CMS has launched several
initiatives aimed at reducing hospitalizations, such as
the Skilled Nursing Facility Value Based Purchasing
program and the Initiative to Reduce Avoidable
Hospitalizations among Nursing Facility Residents. |
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CMS Proposed New Patient-Driven Payment Model
On April 27, 2018, the Centers for Medicare and
Medicaid Services (CMS) announced a proposal to
replace the Resource Utilization Groups (RUGs)
payment system with a new model for Medicare
payment of skilled nursing care. Although it is similar
to last year’s proposed Resident Classification System
(RCS), CMS made some refinements and renamed it
the Patient-Driven Payment Model (PDPM). |
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SPECIAL EDITION: Medicare Proposes Fiscal Year 2019 Payment & Policy Changes for
Skilled Nursing Facilities
On April 27, 2018, the Centers for Medicare& Medicaid Services (CMS) issued a proposed rule [CMS-1696-P] outlining proposed Fiscal Year (FY) 2019
Medicare payment updates and proposed quality
program changes for skilled nursing facilities (SNFs). |
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SNF PEPPER Report Includes New Target Area
The Q4FY17 release of the Skilled Nursing Facility
(SNF) Program for Evaluating Payment Patterns
Electronic Report (PEPPER) with statistics through
September 2017 is now available for download
through the PEPPER Resources Portal. |
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Five-Star Quality Rating System Survey Star Methodology Update
The Centers for Medicare & Medicaid Services (CMS)
have updated the Five-Star Quality Rating System
Technical Users’ Guide to explain changes made to the
survey star rating methodology. |
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Congress Repeals Medicare Therapy Caps
On Friday, February 9, 2018, the Bipartisan Budget
Act of 2018 (HR 1892), which includes a
permanent repeal of the longstanding cap on
Medicare Part B rehabilitation therapy services was
signed into law. |
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Therapy Cap Exceptions Process Expires
On December 31, 2017, The Medicare Part B
Therapy Cap exceptions process expired. This
process allowed all covered and medically necessary
services to qualify for exceptions to the Therapy Cap. |
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2017 Pulse |
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CMS Releases 2018 Therapy Code Updates
The Centers for Medicare and Medicaid Services (CMS)
released the 2018 therapy code changes that become effective
Jan. 1, 2018. |
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CMS Publishes CY 2018 Medicare Premiums & Deductibles
On November 17, 2017, the Centers for Medicare and
Medicaid Services (CMS) published the Medicare Parts
A & B Premiums and Deductibles for Calendar Year
(CY) 2018. |
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CMS To Make Payroll-Based Journal Data Public
On September 25, 2017, the Centers for Medicare and
Medicaid (CMS) announced in a memo that it would
begin posting public use files of providers’ Payroll
Based Journaling (PBJ) data on November 1, 2017. |
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CMS Releases Final MDS 3.0 RAI Manual Updates
On August 31, 2017, the Centers for Medicare and
Medicaid Services (CMS) released the final revisions to
the MDS 3.0 RAI Manual v1.15 effective October 1,
2017. |
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SNF Value-Based Purchasing Program
On July 31, 2017, the Centers for Medicare & Medicaid
Services (CMS) issued a final rule outlining fiscal year
(FY) 2018 Medicare payment rates and quality programs
for skilled nursing facilities (SNFs). |
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CMS Issues FY 2018 SNF PPS Final Rule
On July 31, 2017, the Centers for Medicare & Medicaid
Services (CMS) issued a final rule outlining Fiscal Year
(FY) 2018 Medicare payment rates and quality
programs for skilled nursing facilities (SNFs). |
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CMS Releases Revised State Operations Manual, Appendix PP
The Centers for Medicare and Medicaid Services (CMS)
released a new Survey & Certification memo on June 30,
2017, detailing revisions to the State Operations Manual
(SOM) Appendix PP for Phase 2, F-Tag revisions, and
related issues. The revisions will be effective on November
28, 2017. |
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Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems
The bacterium Legionella can cause a serious type of
pneumonia called Legionnaires Disease (LD) in persons
at risk. Those at risk include persons who are at least 50
years old, smokers, or those with underlying medical
conditions such as chronic lung disease or
immunosuppression. |
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SNF Elements of Emergency Preparedness
On September 16, 2016, the final rule on Emergency
Preparedness Requirements for Medicare and
Medicaid Participating Providers and Suppliers was
published. |
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Skilled Nursing Facility Quality Reporting Data Submission Deadline
The IMPACT Act of 2014 mandated the establishment
of the Skilled Nursing Facility (SNF) Quality Reporting
Program (QRP). |
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SPECIAL EDITION: FY 2018 SNF PPS Proposed Rule
On April 27, 2017, the Centers for Medicare & Medicaid
Services (CMS) issued a proposed rule outlining the
Fiscal Year (FY) 2018 Medicare payment rates and
quality programs for skilled nursing facilities (SNFs). |
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The Core Elements of Antibiotic Stewardship for Nursing Homes
On October 4, 2016, The Centers for Medicare and
Medicaid Services (CMS) published a Final Rule to
revise Medicare and Medicaid participation
requirements for nursing facilities. The Final Rule
requires that facilities establish an Antibiotic
Stewardship Program as part of the Infection Prevention
and Control Program (IPCP) by November 28, 2017. |
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2017 Onsite HIPAA Audits
The Health Insurance Portability and Accountability
Act (HIPAA) Privacy regulations require health care
providers and organizations, as well as their business
associates, develop and follow procedures that ensure
the confidentiality and security of protected health
information (PHI) when it is transferred, received,
handled, or shared. |
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OIG Issues Final Rule On Exclusion Authority
On January 11, 2017, the U.S. Department of Health
and Human Services Office of Inspector General (OIG)
published its Final Rule establishing new standards for
excluding individuals and entities from participation in
federal health care programs. |
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2016 Pulse |
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CY 2017 New Therapy Evaluation Codes
For CY 2017, the Physician Fee Schedule final rule
includes a new 3- tiered current procedural terminology
(CPT) code system to replace the current single code that
covered all therapist evaluations. |
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Office of Inspector General Publishes FY 2017 OIG Work Plan
The office of Inspector General (OIG) Work Plan for Fiscal
Year (FY) 2017 provides brief descriptions of activities that
the OIG plans to initiate or continue in FY 2017. |
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CMS Publishes Reform of Requirements for
Long-Term Care Facilities Final Rule
The Centers for Medicare & Medicaid Services (CMS)
released the final rule “Medicare and Medicaid
Programs; Reform of Requirements for Long-Term Care
Facilities” on September 28, 2016. |
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CMS Establishes Emergency Preparedness Requirements for
Healthcare Providers
The Centers for Medicare & Medicaid Services
(CMS) finalized a rule to establish consistent
emergency preparedness requirements for health
care providers participating in Medicare and
Medicaid, increase patient safety during
emergencies, and establish a more coordinated
response to natural and man-made disasters. |
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CMS Releases Final MDS 3.0 RAI Manual Update
On August 26, 2016 the Centers for Medicare and
Medicaid Services (CMS) released the final
revisions to the MDS 3.0 RAI Manual v1.14
effective October 1, 2016. |
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CMS Issues FY 2017 SNF PPS Final Rule
On July 29, 2016, the Centers for Medicare & Medicaid
Services (CMS) issued the SNF PPS final rule outlining
fiscal year (FY) 2017 Medicare payment policies and
rates for the Skilled Nursing Facility Prospective
Payment System (SNF PPS), the SNF Quality
Reporting Program (SNF QRP), and the SNF Value-Based Purchasing (SNF VBP) Program. |
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New Quality Measures Impact Five-Star Quality Ratings System
The Centers for Medicare & Medicaid Services (CMS)
announced that five of the six new quality measures for
skilled nursing facilities will be phased into the Five-Star Quality Ratings system on July 27, 2016. |
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OIG FY 2016 Mid-Year Work Plan
The U.S. Department of Health and Human
Services (HHS) Office of Inspector General (OIG)
Published the fiscal year (FY) 2016 Mid-Year
Work Plan Update, summarizing new and ongoing
reviews and activities that OIG plans to pursue with
respect to HHS programs and operations during the
current fiscal year and beyond. |
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CMS Publishes Draft MDS 3.0 RAI Manual
CMS released a draft copy of the Minimum Data Set (MDS)
3.0 RAI User’s Manual v1.14, which details the requirements
for the upcoming October 1, 2016, changes to the MDS. |
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Fiscal Year 2017 SNF PPS Proposed Rule
The Centers for Medicare & Medicaid Services (CMS)
released the Skilled Nursing Facilities proposed rule on
April 21, 2016, which outlines Medicare payment rates
and policy changes for Fiscal Year (FY) 2017. CMS
proposes a positive payment update of 2.1% for skilled
nursing facilities (SNFs). |
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New Quality Measures Coming to Nursing Home Compare, Five-Star Rating
New quality measures for skilled nursing facilities
will be introduced in April 2016 the Centers for
Medicare & Medicaid Services (CMS) officials
announced during an Open Door Forum on March
3, 2016. |
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CMS Increases Site Visits to Medicare Providers
The Affordable Care Act (ACA) provided tools to
enhance the Centers for Medicare & Medicaid
Services’ (CMS) ability to screen providers and
suppliers upon enrollment and identify those that
may be at risk for committing fraud, including the
use of risk-based screening of providers and
suppliers. |
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CMS Launches Infection Control Pilot Program
The Centers for Medicare and Medicaid Services
(CMS) has begun a three-year pilot project to
improve infection control and prevention
assessments for nursing homes, hospitals and care
transitions between the two. |
