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Click here for the New Nursing Home Legislation passed May 6, 2010
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MDS 3.0 Training Materials Update:
MDS 3.0 RAI Manual V1.02 July 15, 2010 – Note: This update includes the following revisions of the RAI Manual: Appendix A and H (the item sets in Appendix H have not changed since they were last published in November 2009). The revised manual is now complete with the exception of Appendix F which is forthcoming.
This file now contains revised versions of the following sections of the RAI Manual: Title Page, Chapter 1, Chapter 2, Chapter 3 (Introduction, Sections: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, S, V, X and Z), Chapter 4, Chapter 5, Chapter 6 and Appendices (A, B, C, D, E, G, and H).
MDS 3.0 Training Conference Update: A notification email has been sent to the point of contact (POC) for each organization that submitted a registration during open registration. Please note that attendance at the conference must be confirmed by responding to the notification email no later than July 19, 2010.
Some limited seating is still available for the conference. If any other organizations are interested in attending or in sending additional participants, we are accepting requests to attend on a first come, first serve basis until all slots are filled. Please submit a request to attend to
info@mdsnationalconference.com no later than 5:00pm Pacific Daylight time on Friday, July 23, 2010.
Please check the conference web site at
http://MDSNationalConference.com for more information about registration and conference updates. This includes the most current agenda and schedule, information about presenters, and documents for the conference. Please submit any questions to info@mdsnationalconference.com.
Cheryl Barton forRobin Fritter, Director
Division of Provider Relations& Outreach
Provider Communications Group, CMS
(410) 786-7485
robin.fritter@cms.hhs.gov
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Nursing Home Five-Star Quality Rating System- July News
The provider previews are available beginning today, Friday, July 16, 2010. Providers, in order to access your Five Star Preview report, go to the Minimum Data Set (MDS) State Welcome page available on the state servers where you submit MDS data and select the Certification and Survey Provider Enhanced Reports (CASPER) Reporting link located at the bottom of the page. Once in the CASPER Reporting System, click on the ‘Folders’ button. Then click on ‘My Inbox’ on the left hand side of the screen and access the Five Star Report in your ‘st LTC facid’ folder, where st is the 2-digit postal code of the state in which your facility is located and facid is the state assigned facid of your facility.
The Five-Star helpline will be available the week of July 19-23, 2010 for questions and concerns about the July data. The Nursing Home Compare website will update with July’s Five-Star data on Thursday, July 22, 2010. Please visit
http://www.cms.gov/CertificationandComplianc/13_FSQRS.asp for the latest Five-Star Quality Rating system information.**************************************************************
Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV)
National Provider Call with Question&Answer Session
The Centers for Medicare&Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV). This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EDT, on Wednesday, August 4, 2010.
This call will review payment issues including the transition from RUG-III to RUG-IV and the additional changes needed to install a hybrid RUG-III grouper (HR-III) mandated by statute.A PowerPoint slide presentation will be posted to the SNF PPS webpage at, http://www.cms.gov/SNFPPS/02_Spotlight.asp#TopOfPageS on the CMS website for you to download prior to the call so that you can follow along with the presenters. Following the formal presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
Conference call details:
Date: August 4, 2010Conference Title: Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group – Version 4 (RUG-IV) National Provider Call
Time: 1:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.
Registration will close at 1:30 p.m. EDT on August 3, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/0804102. Fill in all required data.
3. Verify that your time zone is displayed correctly in the drop down box.4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event your server blocks the confirmation emails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
6. If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.
For those of who will be unable to attend, a transcript and MP3 audio file of the call will be available at least one week after the call at http://www.cms.gov/SNFPPS/02_Spotlight.asp#TopOfPage on the CMS website.
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CMS Announces Increase in Payment Rates for Medicare Skilled Nursing Facilities for Fiscal Year 2011
http://www.cms.gov/SNFPPS/LSNFF/list.asp#TopOfPage The comment period closes on September 14, 2010.
More information is available at www.healthcare.gov, a new web portal made available by the U.S. Department of Health and Human Services.
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The Centers for Medicare&Medicaid Services (CMS) today announced nursing home payment rates for fiscal year 2011 will increase 1.7 percent. This increase will result in an estimated $542 million increase in Medicare payments to nursing homes across the country during FY 2011.
CMS updates the payment rates annually, using a market basket index reflecting changes in the prices of goods and services used to furnish covered care in nursing homes. In addition, CMS makes a forecast error adjustment whenever the difference between the forecasted and actual change in the market basket exceeds a 0.5 percentage point threshold for the most recently available fiscal year for which there is final data. In initially establishing the forecast error adjustment, CMS noted that it would reflect both upward and downward adjustments, as appropriate.
For FY 2009 (the most recently available fiscal year for which there is final data), the estimated increase in the market basket index was 3.4 percentage points, while the actual increase was 2.8 percentage points. This resulted in the actual increase being 0.6 percentage point lower than the estimated increase. Accordingly, as the difference between the estimated and actual amount of change exceeds the 0.5 percentage point threshold, the payment rates for FY 2011 include a negative 0.6 percentage point forecast error adjustment. This adjustment, when combined with the FY 2011 market basket increase factor of 2.3 percent, yields a net update of positive 1.7 percent for FY 2011.
“CMS is committed to ensuring that beneficiaries in skilled nursing facilities continue to receive high quality care while paying those facilities appropriately for that care,” said Jonathan Blum CMS Deputy Administrator and Director of the Center for Medicare. “The payment rates for the coming year that we are announcing today reflect that goal.
In the notice, CMS discusses a self-implementing provision contained in section 10325 of the Patient Protection and Affordable Care Act. This provision modifies the FY 2011 implementation schedule for the Resource Utilization Groups, version 4 (RUG-IV) case-mix classification system that CMS announced last year. CMS plans to delay implementation of the provision until system modifications are completed.
This rule will publish in the Federal Register on July 22, 2010. A copy of the update notice is available on the CMS website at:http://www.cms.gov/SNFPPS/LSNFF/list.asp#TopOfPage The comment period closes on September 14, 2010.
More information is available at www.healthcare.gov, a new web portal made available by the U.S. Department of Health and Human Services.
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Inpatient Rehabilitation Facilities (IRFs) PPS for FY 2011 (CMS-1344-N)
The Centers for Medicare&Medicaid Services (CMS) issued a Notice today (7/16) to update the fiscal year (FY) 2011 payment rates for inpatient rehabilitation facilities (IRFs).
The IRF Notice implements routine updates to the IRF prospective payment system (PPS) for discharges occurring on and after October 1, 2010. In this Notice, the CMS use the methods described in the FY 2010 IRF PPS final rule (74 FR 39762) to update the Federal prospective payment rates for FY 2011 using updated FY 2009 IRF claims and FY 2008 IRF cost report data. No policy changes are being proposed in this Notice.
The Notice incorporates a 0.25 percentage point reduction in the market basket increase for FY 2011 required by the Affordable Care Act. The changes will result in an estimated increase in IRF payments of $135 million for FY 2011. This reflects a $140 million increase from the update to the payment rates and a $5 million decrease to the proposed update to the outlier threshold amount to reduce estimated outlier payments from 3.1 percent in FY 2010 to 3 percent in FY 2011.
This Notice will publish in the Federal Register on July 22, 2010. A copy of the update Notice is available on the CMS website at:
ttp://www.cms.gov/InpatientRehabFacPPS/LIRFF/list.asp#TopOfPage
The CMS website is a primary information resource for the IRF PPS. The website URL is http://www.cms.gov/InpatientRehabFacPPS/
More information is available at www.healthcare.gov, a new web portal made available by the U.S. Department of Health and Human Services.
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The Centers for Medicare&Medicaid Services (CMS) issued a Notice today (7/16) to update the fiscal year (FY) 2011 payment rates for inpatient rehabilitation facilities (IRFs).
The IRF Notice implements routine updates to the IRF prospective payment system (PPS) for discharges occurring on and after October 1, 2010. In this Notice, the CMS use the methods described in the FY 2010 IRF PPS final rule (74 FR 39762) to update the Federal prospective payment rates for FY 2011 using updated FY 2009 IRF claims and FY 2008 IRF cost report data. No policy changes are being proposed in this Notice.
The Notice incorporates a 0.25 percentage point reduction in the market basket increase for FY 2011 required by the Affordable Care Act. The changes will result in an estimated increase in IRF payments of $135 million for FY 2011. This reflects a $140 million increase from the update to the payment rates and a $5 million decrease to the proposed update to the outlier threshold amount to reduce estimated outlier payments from 3.1 percent in FY 2010 to 3 percent in FY 2011.
This Notice will publish in the Federal Register on July 22, 2010. A copy of the update Notice is available on the CMS website at:
ttp://www.cms.gov/InpatientRehabFacPPS/LIRFF/list.asp#TopOfPage
The CMS website is a primary information resource for the IRF PPS. The website URL is http://www.cms.gov/InpatientRehabFacPPS/
More information is available at www.healthcare.gov, a new web portal made available by the U.S. Department of Health and Human Services.
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Minimum Data Set (MDS) 3.0 Training Materials Updates – July 12, 2010
New MDS 3.0 Postings: MDS 3.0 RAI Manual V1.02 July 12, 2010 – Note: This update includes the following revisions of the RAI Manual: Title Page, Chapter 3, Section M. This file now contains revised versions of the following sections of the RAI Manual: Title Page, Chapter 1, Chapter 2, Chapter 3 (Introduction, Sections: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, S, V, X and Z), Appendices B, C, D, E, and G) Chapter 4, Chapter 5, and Chapter 6.
MDS 3.0 Training Slides V1.00 July 12, 2010 –This update includes the following: Chapter 3, Section A and M. This file now contains revised versions of the following sections of the MDS 3.0 Training Slides: Chapter 3, Sections: A, B, C (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, M, N, O, P, Q, V, X and Z.
MDS 3.0 Instructor Guides V1.00 July 12, 2010 - This update includes the following: Chapter 3, Section A.
This file now contains MDS 3.0 Instructor Guides to facilitate MDS 3.0 training. Chapter 3, Sections: A, B, C, (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, N, O, P, Q, V X, and Z.
For more information, please see the following URL:
www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp
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JUST RELEASED: MLN Matters Article #SE1024 - Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
MDS 3.0 Training Slides V1.00 July 12, 2010 –This update includes the following: Chapter 3, Section A and M. This file now contains revised versions of the following sections of the MDS 3.0 Training Slides: Chapter 3, Sections: A, B, C (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, M, N, O, P, Q, V, X and Z.
MDS 3.0 Instructor Guides V1.00 July 12, 2010 - This update includes the following: Chapter 3, Section A.
This file now contains MDS 3.0 Instructor Guides to facilitate MDS 3.0 training. Chapter 3, Sections: A, B, C, (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, N, O, P, Q, V X, and Z.
For more information, please see the following URL:
www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp
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JUST RELEASED: MLN Matters Article #SE1024 - Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
The Centers for Medicare&Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1024 as the first in a series of articles concerning RAC high-dollar improper payment vulnerabilities. These articles are intended to provide education about RAC demonstration-identified vulnerabilities in an effort to prevent these same problems from occurring in the future. This article in particular focuses on Medicare’s documentation requirements and how to avoid unnecessary denial of claims. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1024.pdf on the CMS website.
**************************************************************HHS Issues Notice of Proposed Rulemaking to Implement HITECH Act Modifications to the HIPAA Rules
The Department of Health and Human Services (HHS) issued a notice of proposed rulemaking today to modify the Privacy, Security, and Enforcement Rules issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, is designed to promote the widespread adoption and standardization of health information technology, and requires HHS to modify the HIPAA Privacy, Security, and Enforcement Rules to strengthen the privacy and security protections for health information and to improve the workability and effectiveness of the HIPAA Rules.
The proposed modifications to the HIPAA Rules issued today include provisions extending the applicability of certain of the Privacy and Security Rules’ requirements to the business associates of covered entities, establishing new limitations on the use and disclosure of protected health information for marketing and fundraising purposes, prohibiting the sale of protected health information, and expanding individuals’ rights to access their information and to obtain restrictions on certain disclosures of protected health information to health plans. In addition, the proposed rule adopts provisions designed to strengthen and expand HIPAA’s enforcement provisions
“This proposed rule strengthens the privacy and security of health information, and is an integral piece of the Administration’s efforts to broaden the use of health information technology in healthcare today,” said Georgina Verdugo, director of the HHS Office for Civil Rights (OCR). These HIPAA Rules are administered and enforced by OCR.
Once it is published in the Federal Register, the notice of proposed rulemaking may be viewed and commented on for 60 days at www.regulations.gov.
In addition to issuing the notice of proposed rulemaking, OCR also updated its breach notification webpage. Breaches of unsecured protected health information affecting 500 or more individuals that are reported to the Secretary are now posted in a new, more accessible format that allows users to search and sort the reported breaches. Additionally, this new format includes brief summaries of the breach cases that OCR has investigated and closed, as well as the names of private practice providers who have reported breaches of unsecured protected health information to the Secretary.
Visit the OCR website for more information about this proposed rule and the updated breach notification webpage: www.hhs.gov/ocr/privacy/.
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Provider and Supplier Organizations
Declare Your Independence from the Paper Enrollment Process –
Use Internet-based PECOS!
The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:
- Submit an initial Medicare enrollment application
- View or change your enrollment information
- Track your enrollment application through the web submission process
- Add or change a reassignment of benefits
- Submit changes to existing Medicare enrollment information
- Reactivate an existing enrollment record
- Withdraw from the Medicare Program
Note: Internet-based PECOS will be made available for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) later this year.
Advantages of Internet-based PECOS
· Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)· Tailored application process means you only supply information relevant to YOUR application
· Gives you more control over your enrollment information, including reassignments
· Easy to check and update your information for accuracy
· Less staff time and administrative costs to complete and submit enrollment to Medicare
Using Internet-based PECOS Is Easy!
Learn how to use the system by visiting the Getting Started Guide for Provider and Supplier Organizations. Remember, creating a record in Internet-based PECOS can take several weeks for an organization provider. It is recommended that you begin this process (if necessary) well in advance of any upcoming enrollment actions. For more information on this setup process, visit ourProvider and Supplier Organization Overview.So, don’t wait, set your organization free from paper –
Start using Internet-based PECOS today!
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REMINDER: The Centers for Medicare&Medicaid Services (CMS) has released MLN Matters Article #MM6960--Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
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Centers for Medicare and Medicaid Services (CMS) Public Website Address Change
On Friday, April 2, 2010, the Centers for Medicare&Medicaid Services (CMS) will be changing our website address from www.cms.hhs.gov to www.cms.gov. Existing bookmarks and links from other websites will continue to work following this address change.
Centers for Medicare and Medicaid Services (CMS) Public Website Address Change
On Friday, April 2, 2010, the Centers for Medicare&Medicaid Services (CMS) will be changing our website address from www.cms.hhs.gov to www.cms.gov. Existing bookmarks and links from other websites will continue to work following this address change.
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Proposed Administrator Regulation Changes
Bill SB2526 and HB4856
Nursing Home Administrators Licensing and Disciplinary Act
* The purpose of the Act is to provide consistency with mandatory
reporting among other state statutes. The Act mirrors the mandatory
reporting section of the Medical Practice Act.
* The Act amends Section 17 dealing with grounds for disciplinary action
adding:
Failure by the licensee to report any adverse final action taken against
them by another licensing jurisdiction, government agency, law
enforcement agency or any court
* Failure to report to Illinois Department of Financial and Professional
Regulation surrender of license or authorization to practice as nursing
home administrator in another state or jurisdiction
* Failure to report to Illinois Department of Financial and Professional
Regulation any adverse judgment, settlement, or award arising from a
liability claim
Failure by the licensee to report any adverse final action taken against them by another licensing jurisdiction, government agency, law enforcement agency or any court
Failure to report to Illinois Department of Financial and Professional Regulation surrender of license or authorization to practice as nursing home administrator in another state or jurisdiction
Failure to report to Illinois Department of Financial and Professional Regulation any adverse judgment, settlement, or award arising from a liability claim
* The Act amends section 17.1 entities required to report, adding:
o Health Care Institutions: Shall report a person licensed under this Act has committed any act(s) in violation of this Act, constitutes unprofessional conduct related to patient care, may be mentally or physically disabled in a matter as to endanger patients under care or is terminated for cause
o Professional Liability Insurers: Shall report a person licensed under this Act with the settlement of any claim or final judgment rendered in any cause of action in favor of the plaintiff which alleged negligence in the planning, organizing, directing and supervising the operation of a nursing home
o State’s Attorney: Shall report within 5 days all instances in which a licensed person under this Act is convicted or enters a guilty plea to any crime that is a felony
o State Agencies: Shall report a person licensed under this Act has committed any act(s) in violation of this Act, constitute unprofessional conduct relating to planning, organizing, directing and supervising the operation of a nursing home or may be mentally or physically disabled in a matter as to endanger patients under care
Reports shall be filed in writing to Illinois Department of Financial and Professional Regulation within 60 days after a determination that a report is required
All reports shall contain:
*
o Name, address and telephone number for the person making the report and the person that is the subject of the report
o Name and date of birth of any person(s) whose treatment is a subject of the report or identification of the nursing home facility where the care in the report was rendered
o Brief description of the facts that gave rise to the issuance of the report
o If court action is involved, the identity of the court in which the action is filed, docket number and date of filing of the action
o Any other pertinent information
Illinois Department of Financial and Professional Regulation will notify the person who is the subject of the report within 30 days of receipt of a report
The person who is subject of the report shall submit a written statement responding, clarifying, adding to or proposing the amending of the report previously filed no more than 30 days after which the person was notified by Illinois Department of Financial and Professional Regulation of the existence of the original report
Illinois Department of Financial and Professional Regulation’s initial review of materials contained in each disciplinary file may not be less than 61 days nor more than 180 days after the receipt of the initial report by the department
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