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CMS Skilled Nursing Facility Open Door Forum
Here are the notes from August 31, 2023, CMS Open Door Forum.
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The Resident Assessment Instrument Manual for MDS 3.0 version 1.18.11 V5 was released on August 22, 2023. Since then, CMS has found a few clerical errors and plan on updating them shortly, but no major changes will be done, therefore the manual stands as complete and can be educated based on the guidance it provides. Discrepancies or small errors were noted on the call in CAAs 5, 6, and 15 where there are items referenced with an ‘x’ for instance in CAA 5 GG0130X1. This is also noted in CAA 6 and 15.
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There are several other manuals/methodologies that CMS plans on having available in the coming weeks. They are;
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The Quality Measure Manual (mid-September) and posted to the NHQI page.
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The updated Payroll-Based Journal methodology for Section G: Functional Status transition to Section GG: Functional Abilities and Goals (mid-September)
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CMS 802 and 672 will be updated, but unsure as to when.
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As was the case when transitioning from MDS 2.0 to MDS 3.0, there will not be any ability to modify an MDS once it has been submitted with an ARD before October to a date on/after October 1st and vice versa. For example, if a facility submits an MDS with an ARD of 9/30/2023 for a resident and realizes that an ARD of October 1st would capture the most appropriate picture of the resident. You cannot modify the MDS to the date of October 1st. You would have to complete an inactivation of the old MDS and create a new MDS with an ARD of 10/1/2023. The same holds true for MDS’ submitted with an ARD of 10/1/2023 moving forward. You would have to inactivate the MDS with an ARD of 10/1/2023 and then create a new MDS with an ARD of 9/30/2023. The Data Sets are not exactly the same and could not transition.
We will assist you with any questions you may have regarding the process changes or updates. Please contact us at info@paanac.net
MDS 3.0 version 1.18.11 v5 FINAL Manual
The MDS 3.0 version 1.18.11 v5 Final Manual is now available. This version of the MDS 3.0 RAI Manual contains substantial revisions related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which requires that standardized assessment items be collected across post-acute care (PAC) settings. Standardized data will enable cross-setting data collection, outcome comparison, exchangeability of data, and comparison of quality within and across PAC settings. Additionally, the language of the manual has been updated throughout to be gender neutral. Guidance and examples in numerous chapters and appendices have been revised for clarification and to reflect current regulations and best practices. Due to the scope of the revisions, CMS will not issue Replacement Pages for v1.18.11; those wishing to continue using a physical copy of the manual are encouraged to print the new version.
To download the manual, follow this link
Novitas - Smart Edits COMING SOON
Novitas Solutions will be introducing Smart Edits to our electronic billing systems. This enhancement will alert providers of any claims that can be repaired prior to a denial. The messages will display on the 277CA electronic claim response report and may require the claim to be resubmitted.
Benefits of Smart Editing:
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Identify problematic claims sooner
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Receive clear notifications on how to fix claim errors
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Reduce time spent on claim resubmissions
Continue to monitor your email and the Smart Edits (JL) web page for more information on these upcoming changes.
Smart Edits - coming soon! (novitas-solutions.com)
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00275505
NOW AVAILABLE: Optional State Assessment (OSA) Item Set and OSA Manual
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The Optional State Assessment (OSA) Item Set, OSA Manual, and OSA Change History table are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The OSA is not a Federally required assessment; rather, it may be required in some States for payment purposes. Each state determines whether the OSA is required and if so, when the assessment must be completed. For questions regarding completion of the OSA, please contact your State Survey Agency.
The Pennsylvania 2022-23 State Budget was approved on July 11, 2022 with a 17.5% increase in Medicaid budget for Skilled Nursing Facilities. This is the first increase in Medicaid funding in almost a decade.
The increase is $250 million for nursing facilities, care workers, and long-term care facilities. This increase has a requirement that 70% of the funding go toward resident care spending. The focus is on increasing hourly rates for staff to increase the staffing levels to all facilities. The budget highlights can be found here
NOW AVAILABLE: Draft MDS 3.0 RAI Users Manual version 1.18.11
The draft Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Users Manual version (v)1.18.11 is now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The MDS 3.0 RAI Users Manual v1.18.11 will be effective beginning October 01, 2023.
This version of the MDS 3.0 RAI Manual contains substantial revisions related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which requires that standardized assessment items be collected across post-acute care (PAC) settings. Standardized data will enable cross-setting data collection, outcome comparison, exchangeability of data, and comparison of quality within and across PAC settings. Additionally, the language of the manual has been updated throughout to be gender neutral. Guidance and examples in numerous chapters and appendices have been revised for clarification and to reflect current regulations and best practices. Due to the scope of the revisions, CMS will not issue Replacement Pages for v1.18.11; those wishing to continue using a physical copy of the manual are encouraged to print the new version.
DRAFT RAI Manual
NOW AVAILABLE: Draft MDS 3.0 Item Sets v1.18.11
The draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.18.11 are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. CMS plans to release the final version of the MDS Item Sets in early 2023. The MDS Item Sets v1.18.11 will be effective beginning October 1, 2023
SNF and IRF QRP Quality Measure Calculations and Reporting Users Manual V4.0 and Accompanying Documents Now Available
The Skilled Nursing Facility (SNF) and Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) Quality Measure Calculations and Reporting Users Manual Version 4.0, Change Table, Risk Adjustment Appendix File, and Hierarchical Condition Categories (HCC) to International Classification of Diseases (ICD) -10 Crosswalks are now available. These documents serve as an update to the specifications used to calculate quality measures that are included in the SNF and IRF QRP effective October 1, 2022.
For more information, please visit the CMS SNF QRP Measures and Technical Information or the CMS IRF QRP Quality Reporting Measures Information website.
Public Health Emergency Declaration will expire!
The PHE, Public Health Emergency declaration will expire on May 11, 2023
iQIES for Minimum Data Set (MDS) Submission Release on April 17, 2023
CMS is excited to announce that the transition of the Minimum Data Set (MDS) assessment submission and reporting functionality to the Internet Quality Improvement and Evaluation System (iQIES) will occur on Monday, April 17, 2023. 
To properly prepare for the transition, the QIES Assessment Submission and Processing (ASAP) system for MDS submissions will be turned off on Thursday, April 13 at 8:00 p.m. ET. Providers should submit completed MDS records prior to 8:00 p.m. ET on April 13th to QIES (ASAP) or wait until 8:00 a.m. ET on April 17th to submit data in iQIES. Providers are expected to take into account all requirements when determining the date they submit completed MDS records, including but not limited to, submission timeliness, claims processing, and care planning requirements.
CMS will provide additional information through various email notifications regarding training, technical guidance, details on what to expect, and more.
Register for an iQIES Account
Please note that failure to obtain access to iQIES prior to April 17, 2023 will impact your ability to submit MDS records. As mentioned in previous communications, nursing home and swing bed providers who are required to submit data to CMS must have at least one staff person assigned and approved as the facility Provider Security Official (PSO), who works for the provider and is responsible for approving all other users for their facility. For information and instructions to register for an iQIES account, please visit: https://qtso.cms.gov/news-and-updates/action-required-register-iqies-account
iQIES Service Center
If you have questions or require assistance, please contact the iQIES Service Center at iqies@cms.hhs.gov or by phone at (800) 339-9313. Please note that call volume may be higher than normal during this time.
Biden-Harris Administration Takes Additional Steps to Strengthen Nursing Home Safety and Transparency
CMS to increase oversight of inappropriate antipsychotics use.
As part of the continuing efforts under President Bidens initiative to improve nursing home transparency, safety and quality, and accountability, today the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new actions to reduce the inappropriate use of antipsychotic medications and to bring greater transparency about nursing home citations to families.
President Biden issued a call to action to improve the quality of Americas nursing homes, and HHS is taking action so that seniors, people with disabilities, and others living in nursing homes receive the highest quality care, said HHS Secretary Xavier Becerra. No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. The steps we are taking today will help prevent these errors and give families peace of mind.
To read more on this topic go to following link
NOW AVAILABLE: Draft MDS 3.0 Item Sets version 1.19.1
The draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 and Item Matrix are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The MDS Item Sets v1.19.1 will be effective beginning October 01, 2024.
Care Compare January Refresh of SNF QRP Data – Now Available
The January 2024 refresh of the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) data is now available on Care Compare and Provider Data Catalog (PDC).
The data are based on quality assessment data submitted by SNFs to Centers for Medicare & Medicaid Services (CMS) from Quarter 2, 2022 through Quarter 1, 2023. Additionally, the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure reflects data from Quarter 1, 2023, and for the Influenza Vaccination Coverage among Healthcare Personnel (HCP) measure, Quarter 4, 2022 through Quarter 1, 2023. The data for the claims-based measures will display data from Quarter 4, 2020 through Quarter 3, 2022, and for the SNF Healthcare-Associated Infections (HAI) Requiring Hospitalization measure, Quarter 4, 2021 through Quarter 3, 2022.
Please visit Care Compare and PDC to view the updated quality data. For questions about SNF QRP Public Reporting, please email SNFQRPPRQuestions@cms.hhs.gov.
CMS SNF Open Door Forum Information 3/2/2023
Yesterday CMS had its most recent SNF Open Door Forum call for organizations all over the country. Here is a summary of what was stated during the call.
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There are only 76% of SNFs across the country that are registered for a HARP and iQIES account. Please get your accounts set up now, You will no longer be able to use QIES to submit after April 13, 2023.
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With the Public Health Emergency set to expire on May 11, 2023, this means the following.
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Any resident that was admitted utilizing the 1135 waiver regarding the three qualifying hospital stay on or before May 11, 2023 will still be allowed to remain on Medicare A as long as they are considered in a ‘skilled stay’. All other Medicare criteria must be met.
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On May 12th, all waivers are gone and the 3 Day Qualifying Stay requirement goes into effect.
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In order for the transition from QIES to iQIES to occur seamlessly, there will be downtime for MDS submissions from Thursday April 13, 2023 @ 8 PM until April 17, 2023. No MDS’ will be allowed to be submitted during this time, therefore please be aware that the submission criteria must still be met for all types of MDS’ during the downtime. There are no exceptions to this requirement.
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Once iQIES is active on April 17, 2023, CMS recommends that you do not access the QIES system to generate reports since that information will be from the previous submission and none moving forward. All previous submission information will be available in the new iQIES system for report generation.
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Any Payroll Based journal, PBJ, submissions will still need to be done through the QIES system since this process is not supported in the iQIES system yet. All PBJ reports will still be located in the QIES system as well.
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The FINAL VERSION of the MDS v. 1.18.11 will be available for download and review on or around April 1, 2023. The DRAFT version for the RAI Manual for v. 1.18.11 will be available at the same time. The FINAL version of the RAI Manual will be available on or around August 1, 2023.
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CMS will be hosting virtual education sessions on the MDS changes starting in May 2023 and virtual workshops will begin in June or July 2023.
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Two specific items were discussed during the Q & A session that all organizations across the country will need to know.
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CMS will be releasing the Optional State Assessment, OSA, version in late April to early May. This should be the version that states across the country that use RUG-III or RUG-IV to create their Case Mix Index would use until such time as they transition to another process. Stay tuned for updates on this.
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The Interrupted Stay guidelines are still in effect with this understanding, a resident who was admitted prior to May 12th that is discharged from a SNF and is out over May 12th and then re-admitted within the Interrupted Stay guidelines will be able to remain under Medicare A upon return regardless of the use of the Medicare 1135 waiver or not. If a resident is discharged over the May 12th expiration of the PHE and is out beyond the Interrupted Stay guidelines, then they must have a 3 Day qualifying stay again to use the remains of the Medicare A days IF they were admitted to the SNF under the Medicare 1135 waiver program. Any resident that had a 3 Day stay and was not under the waiver will be able to return under Medicare A following the normal Medicare A guidelines.​
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