Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®
The Centers for Medicare & Medicaid Services (CMS) conducted the annual SNF QRP Training Sessions this week (July 31st and August 1st) live in and from Baltimore, MD. Approximately 250 attendees were present for the in-person training while another 1000+ logged on to view & listen from a distance. Both days were packed with information, practice coding sessions and an opportunity to speak to CMS (they listened) regarding industry concerns as they relate to the MDS Item Set, the SNF QRP and Quality Measures. Both days were extremely productive and provided insight into some of the MDS changes effective October 1, 2018 as well as some valuable sneak previews into what will be addressed in the updated RAI User’s Manual.
Here are some of the key pieces of information I took away from attending the session (not in any particular order and not an all-inclusive list by any means. I came away with a full head of information.):
- CMS officials told attendees on Day 1 that the FY2019 SNF PPS Final Rule would be posted this week. A quick check of my office email within minutes of the last session of the day found that this Final Rule had just been posted! I posted a blog to our website a few minutes after finding the posting. The 424-page Final Rule is definitely a must-read as is the related Fact Sheet. One of the biggest/most-anticipated elements of the Final Rule is the announcement of the replacement of the current RUG-IV SNF PPS reimbursement system with the proposed PDPM (Patient-Driven Payment Model) system. The industry knew that PDPM would be coming but the big question was when. This Final Rule provided the answer – October 1, 2019. We’ll have 1 more year to work under the current RUG-IV system and 1 year to gear up to begin implementation of the PDPM system.
- The RAI User’s Manual, v1.16, is going to be released either the 1st or 2nd week of September. That wasn’t great news (if CMS posts the 2nd week of September, that gives us 2 short weeks to digest and disseminate the information needed to begin encoding the MDS 3.0 Item Set correctly starting October 1, 2018) but it was news nonetheless as everyone has been anxiously awaiting the posting of that manual to prepare their IDT for the changes to the MDS Item Set. I have presented 2 webinars to showcase these changes to help facilities prepare. You are welcome to access the handout for these webinars. In addition, I will be presenting an update webinar, complete with information learned during the SNF QRP Training sessions, on August 30th. You can register for 30 Days Out and Counting: What’s Changing with the MDS 3.0 Item Set on October 1, 2018 to learn more about these changes as well as SNF QRP-related information.
Breaking News: During this afternoon’s SNF/LTC Open Door Forum, a CMS official announced that the RAI Manual, v1.16, will be posted the 1st week of September. Cross your fingers for this happening the 1st week!
- K0510C and K0150D (Nutritional Approaches) and K0710A and K0170B (Percent Intake by Artificial Route) are not required for completion by CMS however some states do require their completion. This change does not affect the current MDS Item Set but does beginning October 1, 2018. When questioned, CMS stated they could not provide a listing of the states that will require these 4 fields to be encoded (a dash will be used if your state does not require the completion of Column 1 for each of these items). Providers were directed to contact their individual state for this information. I will be working to identify the states that will require completion of Column 1 for these items. In the interim, I encourage you to contact your State’s RAI Coordinator and/or provider association. From the audience reaction, this was new to all of us in the room.
- While the updated RAI User’s Manual is still under construction, it quickly became obvious that a good deal of information provided during these 2-day sessions is going to be available when the RAI Manual is made available to providers. Be sure to watch for that posting and/or follow the Briggs LTC Blog for notification when this manual is available.
- Additions to coding of Section GG, as well as items to be coded at admission and discharge of a Part A resident are designed to decrease the usage of dashes in APU elements to reduce impact on provider payment. Hint: we’ll still need to have at least 1 discharge goal identified for the admission Section GG but the other discharge goals can still be dashed without penalty. You can always choose to set more than 1 discharge goal for a given resident using your clinical judgement.
- CMS spoke to the use of TPN and oxygen being included in the Drug Regimen Review (Section N2001). Watch the RAI User’s Manual for related definitions and other information on timing of physician notification and action when there is a clinically significant, potential or actual, medication issue. Physician notification and action is required by midnight of the next calendar day after identification of such an issue. The 3 new items for DRR on the MDS 3.0 v1.16.1 are SNF QRP items so accurate coding will be essential.
You can access these training materials using these links:
- SNF QRP Training Agenda
- SNF QRP Training Materials_Day 1
- SNF QRP Training Materials_Day 2_Part 1
- SNF QRP Training Materials_Day 2_Part 2
The 3 links that are entitled Training Materials are .zip files so there are several PDFs within the file.
You should also bookmark the homepage for the SNF Quality Reporting Training Program to access the above materials (the links are found beneath Downloads) as well as future postings.
CMS will make the training sessions (they were recorded live) available soon on the CMS YouTube channel. No timeline was provided so keep an eye on this channel or follow the Briggs LTC Blog.
Author Note: Thank you CMS for providing training on the MDS changes as well as SNF QRP! We appreciate all of your efforts to be transparent and provide education.