Nursing Home Round-Up January 2020

Regulation | January 21, 2020 | by Jodi Eyigor

A round-up of the latest nursing home news for January 2020.

With the start of a new year, here’s where things stand with CMS and nursing homes:

Rules and Interpretive Guidance

CMS announced in a memo in November 2019 that interpretive guidance for Phase 3 of the Requirements of Participation will be released in the second quarter of calendar year 2020. In the Mission & Priorities document released in December 2019, CMS stated that guidance in Chapter 5 of the State Operations Manual related to the management of facility-reported incidents and complaints will be updated in 2020. CMS has not narrowed these timelines any further, nor have any projections been made about a date for finalization of the burden reduction rule Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency that was proposed in July 2019.

National Partnership to Improve Dementia Care in Nursing Homes

In a March 2019 memo, CMS announced an initiative of enhanced enforcement for nursing homes that continued to show high rates of antipsychotic usage with little to no reduction in these rates since 2011. The goal was for these “late adopters” to reduce antipsychotic utilization rates by 15% by the end of 2019. CMS will continue this initiative in 2020. Updated goals have not yet been announced.

Additionally under the National Partnership, providers will continue to see “focused surveys” in 2020. While schizophrenia-focused surveys will be the priority, providers may also receive dementia-focused surveys. These surveys are generally completed by a CMS contractor, though the state agency may also participate or conduct the survey. Similar to standard or complaint surveys, a focused survey will be unannounced and a provider will receive a Statement of Deficiencies for which they may be required to submit a Plan of Correction. Surveys will examine the use of antipsychotic medications, appropriateness of schizophrenia diagnoses, and availability of appropriate care and services for residents diagnosed with dementia.

October 2020 Draft of Minimum Data Set (MDS)

In December 2019, CMS released draft updates to the Minimum Data Set (MDS) 3.0, scheduled to take effect in October 2020. Significant to this update was the removal of Section G Functional Status from the assessment. CMS had previously implemented Section GG Functional Abilities and Goals in 2016, though this section only applied to a resident’s SNF PPS stay up to this point. Beginning in October 2020, Section GG will be completed for all residents, regardless of whether they are admitted for skilled care or long-term care. The removal of Section G will also impact quality measures, case mix adjustment, and payment related to those factors. CMS has not yet announced a plan for how these issues will be addressed.

Hot Topics (Infection Control, Abuse, Falls)

Infection Control: Infection control continues to be the top citation in nursing home surveys nationally, with hand hygiene as the main cause for citation. Alcohol-based hand rubs are the preferred method for hand sanitizing in most situations, though CMS notes that providers have been slow to adopt this standard. Refer to this resource from Centers for Disease Control (CDC) and this short video from CMS for information on hand hygiene in healthcare settings.

Abuse: CMS introduced the Consumer Alert Icon to Nursing Home Compare in October 2019. This icon is displayed on Nursing Home Compare for any nursing home that has received an abuse citation according to specific criteria in the past 1-2 years. Icons update with each refresh of Nursing Home Compare, which occurred most recently on December 4 when approximately 80 icons were removed and 89 were added. The next update will occur on January 29. LeadingAge is currently reviewing information to identify trends in citations and the impact of the icon on nursing homes that receive it.

Falls: Falls in nursing homes are rising to a higher level of attention among the administration. The Senate Aging Committee released a report and held a hearing in October 2019 exploring falls prevention. One key recommendation of the report was to improve screening and referrals pathways, as a top indicator of fall risk is a history of previous falls. One step nursing homes can take toward falls prevention is to ensure accurate screening and coding on the MDS of falls and injuries related to falls that occur both in the nursing home and prior to nursing home admission. This includes correcting discharge assessments to accurately reflect diagnoses for residents who are transferred to the ER after a fall.

A second benefit to accurate coding is to ensure accuracy in quality measures reporting. There is often public scrutiny over the accuracy of quality measures that utilize “self-reported data”, i.e. data derived from the MDS. Improving the accuracy of this data may prevent nursing homes from losing control of our quality measures through an outside mandate to replace MDS data with Medicare claims information.

Upcoming News

Nursing Home Compare will update January 29. This refresh will update all available information, including the Consumer Alert Icon, and marks the return to the regular schedule of Nursing Home Compare updates taking place on the last Wednesday of each month.

The CMS Quality Conference will take place February 25 – 27 in Baltimore, Maryland. LeadingAge will attend this 3-day conference that will convene more than 3,000 leaders across the healthcare spectrum and will cover a range of CMS programs and issues affecting Medicare providers.

The Quality Measures thresholds recalibration will begin April 29. First announced in March 2019 with the implementation date announced this past October, CMS plans to increase quality measures thresholds every 6 months by 50% of the average rate of improvement. This change has the potential to impact providers’ star ratings in both the quality measure domain as well as the overall star rating on Nursing Home Compare.