CMS Announces New PBJ Focus and Oversight Initiatives

Regulation | December 04, 2018 | by Janine Finck-Boyle

On November 30th, 2018, the Centers for Medicare & Medicaid Services (CMS), Quality, Safety and Oversight Group(QSO), released QSO Memorandum, 19-02-NH, outlining updates to the Payroll Based Journal (PBJ) Policy Manual, notification to states and new Minimum Data Set (MDS) Census reports. 

The Memo announces that CMS will inform state survey agencies of facilities with potential staffing issues.  Using the new PBJ data, CMS will identify the following:

  • Facilities with low staffing on the weekends
  • Facilities with several days in a quarter without an RN onsite

CMS will provide a list of facilities with the potential issues, to support survey activities for evaluating sufficient staffing and improving resident health and safety.  States will now be required to conduct at least fifty percent of the required off-hours survey using the list provided by CMS.

In addition, CMS will identify the facilities with a high risk of noncompliance with the RN staffing requirements.  Survey teams, conducting an annual survey or complaint survey, will investigate the requirement of an RN seven days a week, eight hours a day.  If a surveyor confirms there is noncompliance, and the requirement is not met, the facility will be cited under deficiency F-tag 727.

LeadingAge will continue to monitor the impact using the PBJ data and we encourage members to report concerns or challenges with PBJ.

Over the last few months, LeadingAge has heard from members regarding the enforcement and requirement of the meal break policy and the use of universal care workers.  We have been in discussions with CMS regarding the challenges with these two areas.  Within this Memo, CMS reported updates to the PBJ Policy Manual and FAQ document expanding guidance to deducting time for meal breaks and adding language to instruct facilities to use a reasonable methodology to allocate universal care worker hours.  

The Memo also defines two reports for providers to help ensure dates are submitted timely and accurately.  The two reports are:

  • The MDS Census Summary Report
  • MDS Census Detail Report

Please contact Janine Finck-Boyle, Vice President of Regulatory Affairs, for any information or questions.