CMS Officials Foreclose Questions on Staffing Mandate During Nursing Home Stakeholder Call, with Proposal Looming

At the Open Door Forum hosted by Centers for Medicare & Medicaid Services (CMS) Thursday, officials declined to field questions related to the potential federal minimum staffing mandate for nursing homes even as the proposal has progressed to the next stage.

Industry insiders shared with Skilled Nursing News that the Biden Administration’s highly anticipated proposed rule on nursing home staffing mandates, which has been under review at the Office of Management and Budget (OMB) for months, is in a new phase – it’s moved on from OMB and could be released any time. .

“We know that many of you may have questions about the forthcoming minimum nursing home staffing standards,” Jill Darling from the CMS Office of Communications, said during the forum. “CMS is committed to improving safety and quality of care for nursing home residents and looks forward to sharing the proposal with you soon.”

The issue of staffing is at the forefront of many industry leaders’ minds, especially as a leaked CMS study studied staffing minimums lower than what the agency had previously suggested would be necessary.

Stakeholders also had many questions related to resident interviews and Minimum Data Set (MDS) coding.And, the forum did cover the issued final rule CMS-1779-F, which updates the Medicare payment policies and rates for skilled nursing facilities (SNFs) under the prospective payment system (SNF PPS) for the fiscal year 2024.

CMS officials addressed key points related to the an estimated net increase of 4%, or approximately $1.4 billion, to Medicare Part A payments, changes in code mapping related to ICD-10 codes, and regulatory changes for consolidated billing exclusions.

Updates to the Skilled Nursing Facility Value-Based Purchasing (SNF-VBP) program were also discussed, including the adoption of new quality measures, adjustments for health equity, and an increase in payback percentages to ensure fair bonuses for high-performing SNFs.

“This adjustment rewards SNFs that perform well and whose resident populations include at least 20% of residents with dual eligibility status,” officials said. “This adjustment will begin with the FY2025 performance year and the FY2027 program year.”

Skilled Nursing Facility Quality Reporting Program (SNF QRP) coordinator Heidi Magladry provided updates on the SNF QRP, a pay-for-reporting program. Changes include the addition, modification, and removal of quality measures related to COVID-19 vaccination coverage among residents and healthcare personnel, and adjustments to the MDS data reporting requirements.

“The prior version of this measure reported only on whether health care personnel had received the primary vaccination series for Covid-19, while the modified measure required to report the cumulative number of health care personnel up to date with the current CDC guidance,” officials said.

The transition to an updated MDS was also discussed, and officials highlighted the significance of the change and the need for providers to ensure proper coding and assessment.

(CMS) has made efforts to recognize the role played by social, economic, and environmental factors in health outcomes, now requiring data on social activity, and by extension social isolation in resident assessments. There is also an increased emphasis on collecting accurate racial and ethnic data in resident assessments.

On the call, many stakeholders had questions about the logistics of collecting such information.

“Are we truly expected to ask our residents their race and ethnicity with every MDS?” a stakeholder asked. “So, if the patient’s unable to respond, would we truly if we have five MDSs for whatever reason need it done in a quarter’s time frame?”

CMS responded that the race and ethnicity questions are expected to be interview items.

“It’s designed to be an interview item,” a CMS official replied. “I would expect that you would be clarifying that there’s no change to that information with the resident.”

Another industry stakeholder asked how providers code with the new data set on ethnicity and race.

“On the discharge assessment, if the resident was sent for an unplanned discharge to the hospital, we can’t just ask the resident,” they said.

CMS Health Insurance Specialist, Ellen Berry, said that if operators read the guidance in the Resident Assessment Instrument (RAI) manual there’s a hierarchy of how they should collect the data.

“Obviously, a patient’s report is the primary way we want that data collected,” she said. “If the patient’s unable to respond, you can use a proxy respondent. And then the third option is through medical record documentation. So we would expect that you would have that information available. Even if the resident wasn’t immediately available to you.”

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