Fall 2023 Unified Regulatory Agenda for CMS and Other HHS Agencies

Some items of potential interest: HHS/FDA Proposed Rule Stage Medical Devices; General and Plastic Surgery Devices; Classification of Certain Solid Wound Dressings, Wound Dressings Formulated as a Gel, Cream, or Ointment, and Liquid Wound Washes 0910-AI26 HHS/OIG Proposed Rule Stage Health Care Programs: Fraud and Abuse; Revisions to the Office …

CMS: Upcoming SNF QRP Measure Removals

The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program (QRP). The following quality measures are planned for removal from the iQIES Review and Correct Reports, Facility-Level Quality Measure (QM) Reports, and Resident-Level QM Reports …

TIP: CMS Announced Updated MDS Specifications File

The Centers for Medicare & Medicaid Services (CMS) recently released the MDS Data Specifications V3.01.1 (FINAL) Errata, which updated the previous MDS Data Specifications file. CMS addressed six additional issues that will be implemented on Dec. 12, 2023, but will be retroactive to Oct. 1, 2023. Any modifications to assessments …

Sections K and O Assessment Periods

Effective Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) added columns for MDS items K0520 and O0110 to assess services provided “on admission” and “at discharge.” This change results in different assessment periods for these items depending on the assessment type(s). AAPACN’s Sections K and O Assessment …

Q&A: A new wound specialist disagrees with a wound that was previously coded as a Stage 3 pressure ulcer by the physical therapist and physician. Should I do a modification of the MDS to remove the Stage 3 pressure ulcer? 

Question: A wound certified physical therapist staged a sore as a Stage 3 pressure ulcer. This was also verified with the physician and coded on the last MDS assessment. We have a new wound specialist who states this wound should not have been a Stage 3 pressure ulcer. Should I …

Q&A: What is the best practice for capturing the three days of discharge performance for section GG for an unplanned or emergent transfer?

Question: What is the best practice for capturing the three days of discharge performance for section GG for an unplanned or emergent transfer? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would recommend interviewing the caregivers over those last three days and documenting their input. Use …

Q&A: For a long-term patient readmitted from the hospital, what are the clinical conditions that would require a Significant Change in Status Assessment on readmission? 

Question: For a long-term patient readmitted from the hospital, what are the clinical conditions that would require a Significant Change in Status Assessment on readmission? Also, can I combine this assessment with a Medicare 5-Day on readmission?   Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: You need to look …

Appendix B State RAI Coordinator Contact List Updated

The November update of Appendix B to the RAI 3.0 User’s Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, RAI Panel members, and CMS locations and contacts. To ensure accurate formatting, use a current version of Adobe Acrobat Reader to view this PDF. Web-based or mobile browser plug-ins …

Errata V3.01.4 for MDS Data Specifications V3.01.1 (FINAL), FY2024 ICD-10 Codes for Item I0020B, CAT Specifications V1.06.0 Test Files, and OSA Data Specifications V3.01.0 (FINAL)

Errata V3.01.4 for MDS Data Specifications V3.01.1 (FINAL) is now available for download.  Six issues were added to the errata. As a result, four edits were revised, and there were several mapping changes of items to edits. These revisions will be implemented in production on December 12, 2023, but they …

Schizophrenia Audit Takeaways for NACs and the IDT

In the Jan. 18, 2023, Quality, Safety, and Oversight (QSO) memo QSO-23-05-NH, the Centers for Medicare & Medicaid Services (CMS) announced plans to conduct offsite audits to assess whether nursing homes appropriately assess, document, and code diagnoses captured in MDS item I6000 (Schizophrenia (e.g., Schizoaffective and Schizophreniform Disorders)) that are …