CMS Direction Regarding IDR’s
The Section for Long Term Care had a conversation with CMS in 2016 regarding the IDR/IIDR Review Release Process. CMS Regions V and VII recently provided guidance on this topic. The Missouri IDR process for certified homes has been to send the Primaris decision letter along with our own letter upon review and completion of the IDR process. We have been instructed by CMS that the third party (Primaris) decision and rationale can no longer be shared with the providers. Following is an excerpt of this guidance. The S&C referenced below is attached for your review.
S&C Memo 12-08-NH provided Interim Advance Guidance for IIDRs and provided some information that is one of the bases for our decision to take this approach: “[T]he documents and written report created by the Independent IDR entity, the State and CMS, other than the final decision of the Independent IDR process, are pre-decisional and deliberative, and therefore are protected from disclosure under the deliberative process privilege. See EPA v. Mink, 410 U.S. 73, 88 (1973); see also 5 U.S.C. § 522(b)(5) (inter-agency and intra-agency memoranda and letters generated before adoption of final agency policy or decision are protected from disclosure under Exemption 5 of the Freedom of Information Act).” (Please note the correct U.S. Code citation is actually 5 U.S.C § 552(b)(5).) Therefore, CMS asserts this privilege to not disclose documents used in our deliberative processes. Although the quoted language from the S&C Memo is not in SOM Chapter 7, the rationale remains sound.
We have communicated with the IDR Contractor about this change. Primaris will no longer prepare a letter to the provider and will simply provide their decision and rationale through memo format. Our office will continue to review the Primaris information and prepare a letter to the providers with the final decision. The Section will then forward the SLCR Decision letter to the provider. At no time can we disclose the Primaris decision and rationale. This change applies only to certified facilities. The process will not change for those facilities that are state-licensed only.
S&C: 17-17-ALL: Recommendations to Providers Regarding Cyber Security
Recommendations for Providers and Suppliers for Cyber Security: The Centers for Medicare & Medicaid Services (CMS) is reminding providers and suppliers to keep current with best practices regarding mitigation of cyber security attacks. We have outlined resources to assist facilities in their reviews of their cyber security and IT programs.
Please see the attached for more information. The S&C can also be found at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-17.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.
S&C: 17-12-NH: Long-Term Care (LTC) Regulation: Enforcement of Rule Prohibiting Use of Pre-Dispute Binding Arbitration Agreements is Suspended so Long as Court Ordered Injunction Remains in Effect
- Enforcement Suspended Until and Unless Injunction is Lifted: The Centers for Medicare & Medicaid Services (CMS) will not enforce the new rule prohibiting skilled nursing facilities, nursing facilities and dually-certified facilities from using pre-dispute binding arbitration agreements while there
Please see the S & C attached or you may view it online at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-12.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending.
S&C 17-09-ALL: Infection Control Pilot: 2017 Update
Project Overview: The Centers for Medicare & Medicaid Services (CMS) is in the second year of a three year pilot project to improve assessment of infection control and prevention regulations in Long Term Care (LTC) facilities, hospitals, and during transitions of care. All surveys during the pilot will be educational surveys (no citations will be issued) and will be conducted by a national contractor.
Second Year Activities: Using draft surveyor Infection Control Worksheets (ICWS) based on the new Long Term Care regulation as well as a revised hospital surveyor ICWS, 40 hospital surveys will be paired with surveys of LTC facilities, in order to provide an opportunity to assess infection prevention during transitions of care. In addition, CMS will pilot technical assistance opportunities for facilities in efforts to improve their infection control programs to meet these new regulations. The draft ICWSs are attached to provide transparency of CMS pilot expectations.
Please see the S&C including all documents below or view it online at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-09.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.
S&C 17-08-NH: Civil Money Penalty (CMP) Reinvestment Resource Web Page
A web page to house general information on the reinvestment of State CMP funds is now available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/LTC-CMP-Reinvestment.html. This web page serves as a location to house pertinent information for entities interested in applying for State CMP funds, States and Regional Offices (ROs), and other stakeholders.
CMS S&C Memo 17-05-ALL: Information on the Implementation Plans for the Emergency Preparedness Regulation
- Information for Implementation: The Centers for Medicare & Medicaid Services (CMS) Survey and Certification Group is providing general information regarding the implementation plans for the new Emergency Preparedness Rule. The information addresses the implementation date for providers and suppliers, the development of Interpretive Guidelines (IGs), surveyor training and resources available to assist in the implementation of this regulation.
- Affects all 17 providers and suppliers: The regulation affects all 17 providers and suppliers and must be fully implemented by November 15, 2017.
The CMS memo is here 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-17-05.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending.
CMS S&C Memo 17-03-NH: Save the Date: Training for Phase 1 Implementation of New Nursing Home Regulations
- Need for Training: The Centers for Medicare & Medicaid Services (CMS) is developing an online training for Regional Offices (RO), State Survey Agencies (SA), providers and other stakeholders on the new Nursing Home Regulations.
- Training Content and Availability: The online training will include information about Phase 1 of new Nursing Home Regulations, and will be available to all parties starting November 18, 2016.
- Mandatory Requirement: All Long Term Care (LTC) surveyors are required to complete this training in order to be able to conduct any LTC surveys after November 28, 2016.
The CMS memo is 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-17-03.html?DLPage=1&DLEntries=10&DLFilter=nh&DLSort=2&DLSortDir=descending.
- This version of the MDS 3.0 RAI Manual incorporates the new Section GG: Functional Abilities and Goals, the new Part A PPS Discharge assessment, and clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas.
CMS Provider Training Regarding the new Section GG can be found on You Tube:
If you have any questions, please feel free to contact Stacey Bryan at (573)751-6308 or Stacey.Bryan@health.mo.gov.