Category: CMS Memo

CMS S&C Memo 16-37-ALL

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CMS S&C Memo 16-37-ALL:  Office of Civil Rights (OCR) Clearance

CMS S&C Memo:16-33-NH: Protecting Resident Privacy and Prohibiting Mental Abuse Related to Photographs and Audio/Video Recordings by Nursing Home Staff

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Protecting Resident Privacy and Prohibiting Mental Abuse Related to Photographs and Audio/Video Recordings by Nursing Home Staff

  • Each resident has the right to be free from all types of abuse, including mental abuse. Mental abuse includes, but is not limited to, abuse that is facilitated or caused by nursing home staff taking or using photographs or recordings in any manner that would demean or humiliate a resident(s).
  • This CMS memo discusses the facility and State responsibilities related to the protection of residents

The CMS memo is attached or you may visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-33.pdf

CMS S&C Memo 16-31-NH: Mandatory Immediate Imposition of Federal Remedies and Assessment Factors Used to Determine the Seriousness of Deficiencies for Nursing Homes

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CMS is implementing a national policy that requires the use of federal enforcement remedies when one or more residents suffer significant harm.

This new policy is effective for all surveys completed on or after September 1, 2016.

Please see the attached memo or you may visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-31.html?DLPage=1&DLEntries=10&DLFilter=nh&DLSort=2&DLSortDir=descending

CMS has released Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide, dated July 2016

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The Centers for Medicare & Medicaid Services (CMS) made several changes to the quality measure (QM) domain of the Five Star Nursing Home Quality Rating System.   These include the addition of five new measures and several methodological changes.

The manual is available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf

CMS S&C Memo 16-40-NH/HHA/CLIA: Notice of Interim Final Rule (IFR) Agjusting Civil Monetary Penalties (CMPs)

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The Department of Health and Human Services (HHS) has published in the Federal Register on September 6, 2016 an IFR which adjusts for inflation CMP amounts authorized under the Social Security Act.  (See Adjustment of Civil Monetary Penalties for Inflation)

The IFR establishes new section 45 CFR Part 102, which lists the new CMP amounts and ranges as adjusted by the IFR for affected regulations.  The changes made by the IFR are effective on September 6, 2016.

The IFR addresses all applicable CMPs under the authority of HHS but we are highlighting only on those CMPs assessed for Skilled Nursing facilities (SNFs), Nursing Facilities (NFs), SNFs/NFs, Home Health Agencies (HHAs), and Clinical laboratories.

Please see Attachment A for this S&C here.

For more information about this memo you may visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-40.html?DLPage=1&DLEntries=10&DLFilter=nh&DLSort=2&DLSortDir=descending.

CMS S&C Memo 16-37-ALL: Office of Civil Rights (OCR) Clearance

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The Centers for Medicare & Medicaid Services (CMS) worked collaboratively with the OCR to revise the OCR clearance process for new providers and Changes of Ownership (CHOW).

The new process requires that providers successfully submit electronically an attestation of compliance with the civil rights requirements to the OCR before the State Survey Agencies (SA) and Regional Offices (RO) may process requests for initial surveys or CHOWs.

Confirmation from OCR of successful submission of the attestation will meet the requirements for OCR clearance and eliminates the need for CMS ROs to issue provisional provider agreements.

OCR will begin receiving electronic attestations on September 1, 2016.

Please see the attached Medicare Application Instructions.

For more information about this memo you may visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-37.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending.

CMS S&C Memo:16-33-NH: Protecting Resident Privacy and Prohibiting Mental Abuse Related to Photographs and Audio/Video Recordings by Nursing Home Staff

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  • Each resident has the right to be free from all types of abuse, including mental abuse. Mental abuse includes, but is not limited to, abuse that is facilitated or caused by nursing home staff taking or using photographs or recordings in any manner that would demean or humiliate a resident(s).
  • This CMS memo discusses the facility and State responsibilities related to the protection of residents

The CMS memo is available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-33.pdf.

CMS S&C Memo 16-31-NH: Mandatory Immediate Imposition of Federal Remedies and Assessment Factors Used to Determine the Seriousness of Deficiencies for Nursing Homes

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  • CMS is implementing a national policy that requires the use of federal enforcement remedies when one or more residents suffer significant harm.
  • This new policy is effective for all surveys completed on or after September 1, 2016.

For more information you may visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-31.html?DLPage=1&DLEntries=10&DLFilter=nh&DLSort=2&DLSortDir=descending.

CMS has published the updated Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual and forms which will be effective 10/1/2016

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Section GG Part 1: www.youtube.com/watch?v=pNgQ3OSaxYg
Section GG Part 2: www.youtube.com/watch?v=M1JdQxjNOqE
Section GG Part 3: www.youtube.com/watch?v=ok3U2-mQymk
Section GG Part 4: www.youtube.com/watch?v=oRmMT_uYS8Y

CMS S & C Memo:16-29-LSC: Adoption of the 2012 edition of the National Fire Protection Association (NFPA) 101 – Life Safety Code (LSC) and 2012 edition of the NFPA 99 – Health Care Facilities Code (HCFC)

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  • The Centers for Medicare & Medicaid Services (CMS) has adopted by regulation the 2012 LSC and the 2012 HCFC.  The regulation effective date is July 5, 2016.
  • CMS will begin surveying for compliance with the 2012 LSC and HCFC on November 1, 2016.
  • CMS will offer an online transitional training course for existing LSC surveyors to provide an update on the new requirements. The course will be available on September 2, 2016 via the CMS Surveyor Training Website.
  • CMS will update the ASPEN program (i.e., the information system which tracks surveys) and CMS Fire Safety Forms (2786) prior to the November 1, 2016 survey start date.

Please see the memo at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-29.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending for more details.

SC16-29.Adoption of the 2012 LSC

CMS Memo S&C 16-21-ALL: Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals

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Surveyor Guidance:  The Centers for Medicare & Medicaid Services (CMS) are clarifying requirements for providing services to justice involved individuals in skilled nursing facilities (SNFs), nursing facilities (NFs), hospitals, psychiatric hospitals, critical access hospitals (CAHs), and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID). Specifically, this guidance seeks to assure high quality care that is consistent with essential patient rights and safety for all individuals.

Please see the attached memo and scenarios below or you may visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-21.html?DLPage=3&DLEntries=10&DLSort=3&DLSortDir=descending.

SC16-21.01 Final Memo Justice-Involved
SC16-21.02 Scenarios Justice-Involved Individuals

CMS Memo S&C 16-22-LSC: Notification of Final Rule Published: Adoption of 2012 Life Safety and Health Care Facilities Code

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Fire Safety Requirements for Certain Health Care Facilities:  On May 4, 2016, the Centers for Medicare & Medicaid Services (CMS) published a final rule titled “Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities,” which updates the fire safety requirements for health care providers and suppliers.  This regulation requires certain providers and suppliers to meet the requirements of the 2012 edition of the Life Safety Code (LSC), National Fire Protection Association (NFPA) 101 and the 2012 edition of the Health Care Facilities Code, NFPA 99.

Please see the Press Release attached stating health care providers affected by this rule must comply with all regulations within 60 days of the date of the publication of the final rule (May 4, 2016).  More information is coming from CMS and we will provide updates as we receive them.

SC16-22 – Release of Final Rule LSC
Press Release for Fire Safety Requirements

CMS Memo S&C 16-11 ALL: Exit Conferences- Sharing Specific Regulatory References or Tags

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The Centers for Medicare & Medicaid Services (CMS) has clarified guidance to surveyors regarding the procedures for conducting exit conferences, specifically related to the sharing of regulatory tags.  There are significant changes to the exit conference process in this memo.  In addition to the guidance in this memo, CMS has also given direction that the staff identifier list is not to be released even if requested.  This guidance applies to Medicare/Medicaid certified homes only.  The Section for Long-Term Care Regulation will implement these changes no later than March 31, 2016.

Please see the memo and attachments below or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-11.html?DLPage=2&DLEntries=10&DLSort=3&DLSortDir=descending.

SC16-11-ALL Memo
SC16-11-ALL.02 SOM Chapter 2
SC16-11-ALL.03 SOM Chapter 5
SC16-11-ALL.04 SOM Appendix P

CMS Memo S&C 16-13-NH: Payroll-Based Journal (PBJ) – Implementation of required electronic submission of Staffing Data for Long Term Care (LTC) Facilities

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Information about the requirement for LTC facilities to electronically submit staffing data through the PBJ:

Please see the memo here for details.

CMS National Database Extended Downtime

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All QIES systems will be down from Wednesday, March 16 after 7:00 P.M. (Central) through Monday, March 21 2016 at 10:49 (Central).  This downtime will affect all QIES connectivity and systems.  The National database will not be available.  CASPER reports will not be available.

An email blast regarding this extended downtime was sent out to the provider community on January 21, 2016.  The email recommended that providers plan their business needs around this downtime and submit their resident assessments early.  Notices have also been posted on the QIES Systems for Providers webpages regarding the extended downtime.

If you have any questions concerning this information, please contact the QTSO Help Desk at help@qtso.com or 1-888-477-7876.

CMS Memo S&C 16-04-NH: Focused Dementia Care Survey Tools

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In response to feedback from stakeholders and partners of the National Partnership to Improve Dementia Care in Nursing Homes, CMS is sharing the revised survey materials that were developed for the 2014 Focused Dementia Care Survey Pilot and 2015 expansion effort. The intent is that facilities would use these tools to assess their own practices in providing resident care.

Please see the memo and attachments below or you may visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-16-04.html?DLPage=1&DLEntries=10&DLSort=3&DLSortDir=descending.

SC16-04.01
SC16-04.02
SC16-04-03

Updated MDS Information – additional

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On October 1, 2015 a new version of the RAI Manual became effective, Version 1.13.  Most of the changes were minor but there is one important change to point out.  Prior to the update, Significant Change MDS’s were required if a resident enrolled in or discontinued hospice.  Those rules are still in effect, but now, a Significant Change MDS is also required when a resident changes hospice providers and remains a resident at the nursing home.  This new rule is in the RAI manual in Chapter 2 on page 21.  A Significant Change MDS may also be required in situations when the hospice providing services is purchased by another hospice provider.

The new manual can be found at:  www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursinghomeQualityInits/MDS30RAIManual.html.  Scroll to the bottom of the page.  The first link is the ENTIRE Manual.  The second link is just the pages that have been changed as of October 1, 2015.  You will also find a summary of the changes in the second link.

If you have any questions, you may contact Stacey Bryan, BSN, RN, State RAI Coordinator, Department of Health & Senior Services, Telephone 573-751-6308 or E-mail Stacey.bryan@health.mo.gov.

ICD-10 Resources

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CMS has released a ICD-10 Resources Guide.  The guide concentrates on quick references and key steps to take to get ready for the October 1 transition.  Some of the resources include the Quick Start Guide, Infographics, Videos, and more ways to stay up to date on other information regarding ICD-10.

Please see the ICD-10 Resources Flyer for more information located here.  You may also visit the CMS ICD web page here and the Road to 10 webpage here for the latest news and resources to help prepare.

CMS Open Door Forum

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Electronic submission of staffing data for long-term care facilities – Payroll Based Journal (PBJ).

Registration is OPEN and ALL Long-term Care facilities are encouraged to register for the voluntary data submission period.  Please use the resources listed below to register:

Registration Training:

Registration:

  • Obtain a CMSNet User ID for PBJ Individual, Corporate and Third Party users, if you don’t already have one for other QIES applications (https://www.qtso.com/cmsnet.html).
  • Obtain a PBJ QIES Provider ID for CASPER Reporting and PBJ system access (https://mds.qiesnet.org/mds_home.html).
  • PBJ Corporate and Third-Parties must use the current form based process to register for a QIES ID.  Registration forms are available under the Access Request Information / Forms section on the right side of the page (https://www.qtso.com/).

For technical questions on how to register, please email NursingHomePBJTechIssues@cms.hhs.gov.

Additionally, CMS has posted an updated PBJ Policy Manual Draft and a list of frequently asked questions (FAQ) and answers about PBJ instructions and policies.  Please visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html for more information.  For policy related questions, please email NHStaffing@cms.hhs.gov.

Proposed Reform of Requirements for Long-Term Care Facilities Call – Registration Now Open

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August 11, 2015:  2:30-4:00 pm ET (1:30 p.m.-3:00 p.m. CT)

This Medicare Learning Network (MLN) Connects National Provider Call provides an overview of the proposed rule to reform the requirements for long-term care facilities.  These requirements are the federal health and safety standards that long-term care facilities must meet in order to participate in the Medicare or Medicaid programs.  This presentation provides background for updating these requirements and briefly walks through many of the changes included in the proposal.  A question and answer session follows the presentation.

Agenda:

  • Highlights of the proposed rule
  • Overarching themes of the proposed rule
  • Methods for reviewing and commenting on the proposed rule

The registration page is located here: www.eventsvc.com/blhtechnologies/register/8c43349f-8523-4e24-b48f-4c70f0ad8480.

The call detail page is here: www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2015-08-11-Long-Term-Care.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending.

The link to the proposed regulations is here: www.gpo.gov/fdsys/pkg/FR-2015-07-16/pdf/2015-17207.pdf.

CMS Updated Medical Coverage Requirements

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The Centers for Disease Control and Prevention (CDC) has issued new recommendations for the pneumococcal vaccine in adults over the age of 65.  The CDC recommends that providers now use two pneumococcal vaccines for adults aged ≥65.  These vaccinations are 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23).  The CDC recommendations are located at www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm.

CMS has updated the Medicare coverage requirements to align with this recommendation.  These Medicare coverage requirements were implemented on February 2, 2015 as posted in the MLN Matters document: MM9051.

Please visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf to see that specific MLN Matters document.

CMS has instructed providers to continue to code item O0300 as instructed in the current RAI User’s Manual.

CMS Memo S&C 15-40-NH: Information Only – Review and Status of Nursing Home Survey: Summary of Traditional and Quality Indicator Survey (QIS) Findings and Issues

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For the past 10 years, the Centers for Medicare & Medicaid Services (CMS) and the States have used two standard survey processes that assess the quality of care and quality of life for nursing home residents.  The memo has a review of both the traditional survey and QIS processes.  CMS is continuing to make improvements to QIS to address the challenges, concerns and feedback we have received to optimize the effectiveness and efficiency of survey process.

The memo and attachment are both attached or you may visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-15-40.html?DLPage=4&DLEntries=10&DLSort=3&DLSortDir=descending.

CMS Memo S&C 15-36-ALL: New Instructions for Providers Filing an Appeal with the Departmental Appeals Board (DAB)

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Effective October 1, 2014, providers that disagree with actions imposed on their facility must file a hearing request electronically using the DAB’s E-Filing System (DAB E-File).  For assistance in submitting a request through the DAB E-File System, filers may call the Civil Remedies Division main telephone line at 202-565-9462.  For technical issues regarding the DAB E-File System, filers may contact E-File System Support at OSDABImmediateOffice@hhs.gov.

The memo and two attachments are attached (Memo, DAB e-file instructions, and Appeal Rights) or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-15-36.html?DLPage=4&DLEntries=10&DLSort=3&DLSortDir=descending.

CMS Memo S&C 15-37-NH: Proposed Rule: SNF Medicare FY 2016 Payments, Quality Reporting, Value-Based Purchasing and Staffing Requirements – Informational Only

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CMS has issued a new S&C memo regarding their new proposed rule to implement requirements regarding the submission of staffing data based on payroll and other verifiable and auditable data.  Specifically, long-term care facilities would be required to submit to CMS direct care staffing information including: the category of work for each individual that performs direct care (including, but not limited to, whether the individual is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other type of medical personnel specified by CMS); resident and census data; and information on staff turnover and tenure.  Long-term care facilities would also be required to specify whether the individual is an employee of the facility, or engaged by the facility under contract or through an agency.  Staffing data would be submitted to CMS no less frequently than quarterly.

The proposed rule “FY 2016 SNF PPS for Staffing Data Collection in Long-Term Care Facilities” was published on April 20, 2015.  The document can be found at www.gpo.gov/fdsys/pkg/FR-2015-04-20/pdf/2015-08944.pdf.

The public has until 5 p.m. on June 19, 2015 to comment on the proposed regulatory document.

Contact:  Questions regarding this memorandum should be addressed to NHStaffing@cms.hhs.gov.

Please see the complete memo attached or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-15-37.html?DLPage=4&DLEntries=10&DLSort=3&DLSortDir=descending.

Survey and Certification Memos

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15-31:  Focused Dementia Care Survey Pilot (NH – 3/27/15)

Attached to this memo is a final report that outlines the basis for the Focused Dementia Care Survey Pilot, the process utilized, conclusions gathered based upon post-pilot data analysis, as well as next steps for the future.  The CMS plans to expand upon the work of the focused survey pilot and has invited States to conduct such surveys in FY2015 on a voluntary basis.  The expansion project will involve a more intensive, targeted effort to improve surveyor effectiveness in citing poor dementia care and the overutilization of antipsychotic medications, and broaden the opportunities for quality improvement among providers.  Deficient practices noted during the surveys will result in relevant citations.  In the event that additional care concerns are identified during on-site reviews, those concerns will be investigated during the survey or will be referred to the SA as a complaint for further review.  The memo is attached here and one attachment is attached here.

15-34:  Grant Award: Reinvestment of Federal Civil Money Penalty (CMP) Funds to Benefit Nursing Home Residents (NH – 4/3/15)

The Centers for Medicare & Medicaid Services (CMS) invited proposals for a grant opportunity to utilize Federal CMP Funds for the support and further expansion of the National Partnership to Improve Dementia Care in Nursing Homes.  The Eden Alternative, Inc. was deemed to be the most eligible applicant and has been awarded a grant, in the amount of $293,129.00, for their project entitled, “Creating a Culture of Person-Directed Dementia Care.”  The memo is attached here.

15-35:  Implementation of Section 6106 of the Affordable Care Act – Collection of Staffing Data for Long Term Care Facilities (NH – 4/10/15)

In this memorandum, CMS notified States of the posting of technical specifications and related information for the electronic submission of staffing information based on payroll data.  This information is posted at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html.  The memo is here.