Virginia DMAS Emergency Preparations: From VHCA & DMAS

October 1, 2015

Dear Judy,

The Department of Medical Assistance Services (DMAS) asked VHCA to pass along the following information to members.   Due to the upcoming potential for inclement weather, DMAS has instituted the following emergency procedures:   1.  All pre-admission screening requirements are currently being waived for emergency admissions to the nursing facilities due to the potential for inclement weather.  The time frame covered for this waiver Friday, October 2, 2015 to Tuesday, October 6, 2015.  Any admission to nursing facilities during this time frame will be approved by DMAS provided documentation is given to support the emergency admission.  All documentation related to the emergency admission should be directed to Melissa Fritzman via fax at (804) 612-0040.  The documentation should include the completed PIRS form and information regarding the nature of the emergency admission.   2.  All emergency transportation needed to facilitate movement of individuals from their homes to a nursing facility and/or hospital will be reimbursed by DMAS.  Our transportation coordinator, LogistiCare, has been notified of DMAS' intent to honor all emergency transportation issues related to the facilitation of movement of these individuals to nursing facilities and/or hospital during the period of Friday, October 2, 2015 to Tuesday, October 6, 2015.  All transportation claims related to the movement of individuals to nursing facilities/hospitals in an emergency basis because of the inclement weather should be sent directly to Melissa Fritzman at the following address and should include clear documentation that of the nature of the transportation related to an emergency placement.     3.  Please contact LogistiCare at 1-866-679-6330 during the period of Friday, October 2, 2015 to Tuesday, October 6, 2015 for emergency placements ONLY.  This number will only be active during the time frame outlined above specifically for emergency placements ONLY.  The approvals will cover round trip transportation.     Send claims to:    Melissa Fritzman, Supervisor  Long-Term Care Division  Department of Medical Assistance Services  600 East Broad Street, Suite 1300  Richmond, Virginia 23219 If we receive any additional information or updates related to the forecasted severe weather, we will forward it to you.   Sincerely,   Keith Hare President and CEO VHCA / VCAL

Payroll Based Journal: Action Items from CMS - PBJ Voluntary sign up now, mandatory July 2016

Important PBJ Provider Action Items Step 1: Registration opened August 4th: Registration Training: - PBJ Training Modules for an introduction to the PBJ system and step by step registration instruction are available on QTSO e-University, select the PBJ option. (https://www.qtso.com/webex/qiesclasses.php) 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. You will need to be logged into your CMSNet account to access this page (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/) Step 2: Voluntary Data Submission will start October 1st: Data Submission Training: -PBJ Training Modules for the CASPER Reporting and PBJ systems will be available on September 25, 2015, on QTSO e-University, select the PBJ option. (https://www.qtso.com/webex/qiesclasses.php) -The CASPER Reporting and PBJ systems will be available on October 1, 2015. A user will be able to submit XML files or manually enter staffing and census data for work performed on or after October 1, 2015. (https://mds.qiesnet.org/mds_home.html) Other Resources: -Staffing Data Submission - PBJ Website: (http://www.cms.gov/Medicare/Quality-Initiatives- Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html) -We will communicate information about PBJ through the Skilled Nursing Facilities/Long-Term Care Open Door Forum. More information can be found at https://www.cms.gov/Outreach-and- Education/Outreach/OpenDoorForums/ODF_SNFLTC.html. MAXIMUM NUMBER OF QIES USER IDs ALLOWED Nursing home individual providers are allowed a maximum of two (2) users with Access Type = PBJ An existing MDS user may request PBJ access be added to their existing QIES (MDS) ID if they will be responsible for submitting PBJ data or A new user may register for a QIES (PBJ) ID that allows access to only the PBJ application Exceptions to these limitations may be requested and granted, if approved. If the maximum number of individual QIES user IDs is already associated with your provider, an error message will display “The max number of users has been reached for the provider”. Providers requiring more than the prescribed maximum number of active individual QIES user IDs must complete and submit an “Individual User Account Request” form to request additional IDs. This form is available at https://www.qtso.com/accesspbj.html Please Note: PBJ Corporate and PBJ Third Party Service Bureaus do not have a limit on the number of active users with Access Type = PBJ. PBJ Corporate and PBJ Third Party Service Bureaus will register/update their QIES User ID using the current form based process. These forms are located at https://www.qtso.com/accesspbj.html A list of important action items for PBJ Providers is available for download. Important PBJ Provider Action Items [PDF 31 KB] From https://www.qtso.com/providernh.html

From HHS OIG: Another Study Saying SNFs are Overpaid for Therapy

The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated

WHY WE DID THIS STUDY 

OIG, the Medicare Payment Advisory Commission, and other entities have raised longstanding concerns regarding Medicare's skilled nursing facility (SNF) payment system. These concerns focus on SNF billing, the method of paying for therapy, and the extent to which Medicare payments exceed SNFs' costs. Medicare pays SNFs a daily rate for nursing, therapy, and other services. The daily rate for therapy is primarily based on the amount of therapy provided, regardless of the specific beneficiary characteristics or care needs. 

Previously, OIG found that SNFs increasingly billed for the highest level of therapy even though key characteristics of SNF beneficiaries remained largely unchanged from 2006 to 2008. OIG also found that SNFs billed one quarter of all 2009 claims in error-primarily by billing for higher levels of therapy than they provided or were reasonable or necessary-which resulted in $1.5 billion in inappropriate Medicare payments. This study provides further evidence that supports and quantifies these concerns.

HOW WE DID THIS STUDY

This study was based on several data sources, including Medicare Part A SNF claims, Medicare cost reports, and beneficiary assessments. We used Medicare cost reports to compare Medicare payments to SNFs' costs for therapy over a 10-year period. We used claims to determine the extent to which SNF billing and beneficiary characteristics changed from fiscal years (FYs) 2011 to 2013. Finally, we determined the extent to which changes in SNF billing affected Medicare payments. 

WHAT WE FOUND

We found that Medicare payments for therapy greatly exceeded SNFs' costs for therapy. We also found that under the current payment system, SNFs increasingly billed for the highest level of therapy even though key beneficiary characteristics remained largely the same. Increases in SNF billing-particularly for the highest level of therapy-resulted in $1.1 billion in Medicare payments in FYs 2012 and 2013.

WHAT WE RECOMMEND 

The findings of this and prior OIG reports demonstrate the need for CMS to reevaluate the Medicare SNF payment system. Payment reform could save Medicare billions of dollars and encourage SNFs to provide services that are better aligned with beneficiaries' care needs. We recommend that CMS: (1) evaluate the extent to which Medicare payment rates for therapy should be reduced, (2) change the method for paying for therapy, (3) adjust Medicare payments to eliminate any increases that are unrelated to beneficiary characteristics, and (4) strengthen oversight of SNF billing. CMS concurred with all four of our recommendations.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.

North Carolina Only: Guidance from Case Mix Reviewers

From North Carolina Newsletter published by Myers & Stauffer:

If you would like to be among the first to receive seminar notifications, newsletters, resources, etc., please send an email to nchelpdesk@mslc.com to subscribe to our notification list. When sending your

message, please type “subscribe” in the subject line. In the body of the message, please include

your full name, title, phone number and facility/company name.

Q: We are implementing electronic ADL documentation; what do we need to know in order to meet the Supportive Documentation Guidelines for ADLs?

A: The Supportive Documentation Guidelines for the late loss ADLs require that the keys for self performance and support provided must include all the MDS/ADL key options (key of “7” for self performance is optional) and be equivalent to the intent and definition of the MDS/ADL key. Keep in mind that this applies to either electronic or paper ADL documentation. As part of the review, the RN Reviewer will ask to look at the actual kiosk or computer being used by staff to enter ADL documentation to verify that the language used is equivalent to the intent and definition of the MDS/ADL key. A computer screen that simply shows a picture of an ADL activity, or uses words or phrases (such as “resident does

more than staff”) that are not equivalent to the MDS/ADL key, will result in the ADL values

associated with those keys being unsupported for the review. An electronic system that “converts” these keys to the MDS/ADL key that is printed with the ADLs for the RN reviewer, does not meet the Supportive Documentation Guidelines. Any corrections made to ADL

values must be part of the legal medical record and meet the Medical Record Correction

Policy for MDS Validation Reviews

Casper User's Guide and MDS 3.0 User's Guide have been updated

These two guides are found here.

New QM Manual Version 9,0

September 21, 2015

MDS 3.0 QM User’s Manual V9.0 contains detailed specification for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V9.0 is available under the Downloads section of this page. This new file, Effective October 1, 2015, includes two key changes.  First, there are two changes to the influenza vaccine measures: a change in time period for calculation of the measures and a change to a single calculation per year. Second, there is a change to the missing values for risk adjusted measures, such that missing values for items used to calculate coefficients result in resident being assigned to the ‘low risk’ category, rather than being dropped from the calculation.

The QM User’s Manual V9.0 can be found here.

News from Virginia Survey Director at Stakeholder meeting this week

The six (not five)  MDS/Staffing focused surveys for Phase 1 of the national roll out have been completed.  Virginia has not volunteered further for the dementia or medication management pilot programs.
I have posted results of 4 of the 6.  OLC declined to discuss results of these surveys. If the other two that happened in the last two weeks will tell me how they did, I will consolidate and publish the results.  Thanks,  Judy