CMS Updates Nursing Home Care Compare Staffing and Quality Measures

• By: Maureen Carland
• On: 09/26/2023 10:13:48
• In: Quality/Regulatory

The Centers for Medicare & Medicaid Services (CMS) has issued QSO-23-21-NH, which pertains to forthcoming changes scheduled for April 2024 within the Nursing Home Care Compare Staffing and Quality Measures.
These adjustments are designed to align with previously announced changes to the Minimum Data Set (MDS) that are set to take effect on October 1, 2023. These modifications encompass shifts in the staffing level case-mix adjustment approach, transitioning from RUG-IV to PDPM. Moreover, CMS has announced its intention to eliminate the CMS-672 form (Resident Census and Conditions of Residents).
 
Additional modifications include:
Adjusting Turnover Scoring in the Absence of PBJ Data
As of  April 2024, CMS will amend the staffing rating methodology for providers that either fail to submit staffing data or provide inaccurate data. In such cases, they will receive the lowest achievable score for the relevant staff turnover metrics. The turnover measures rely on PBJ data over six consecutive quarters. Currently, nursing homes failing to submit data for staff turnover have their turnover metrics excluded from the staffing rating calculation. No alterations have been made to the consequences of missing PBJ data on the calculation of hours per resident day measures or the automatic downgrade to one-star if the most recent quarter's PBJ data is absent.
Freezing Staffing Ratings from April to June 2024 for PDPM Case-Mix Adjustment Transition
Beginning in April 2024, CMS will temporarily freeze (i.e., maintain at a constant level) staffing measures and ratings for a three-month period. This freeze is in response to the transition from RUG-IV to PDPM case-mix adjustment, prompted by the elimination of MDS Section G on October 1, 2023. The specific methodology utilizing PDPM will be disclosed in July 2024, and it will include revisions to staffing rating thresholds to uphold the same distribution of staffing points and ratings.
Freezing Four of the Fifteen Quality Measures in Five-Star
Starting in April 2024, CMS will implement a freeze on four out of the fifteen Quality Measures within the Five-Star rating system. This action is attributed to the MDS transition, which occurred on October 1, 2023, shifting from Section G to GG. The affected measures are as follows:

• Percentage of Residents Who Demonstrated Improvements in Function (short stay).
• Percent of Residents Whose Need for Assistance with Activities of Daily Living Has Increased (long stay).
• Percentage of Residents Whose Independent Mobility Declined (long stay).
• Percentage of High-Risk Residents with Pressure Ulcers (long stay).

CMS will replace the short-stay functionality measure with the new functionality measures from the Quality Reporting Program (QRP) in October 2024. The other three measures will remain frozen till January 2025. During the freeze, the measures will continue to count towards Five-Star quality ratings at the rate when the freeze takes effect.  
Updating CMS forms 671 and 672 
 
CMS has attributed the elimination of the CMS-672 form to alterations in the Minimum Data Set (MDS) framework. This decision is based on the fact that the necessary information to complete the form will no longer be accessible following the removal of Section G from the MDS. The implementation of these changes will be phased in over several weeks, in accordance with the guidelines provided in QSO 23-21-NH.
Effective September 29, 2023:

• Facilities will no longer be obligated to fill out fields F79-F145 on the CMS-672 form.
• Surveyors will no longer be required to complete certain sections of the form starting from this date.

Effective October 22, 2023:
The CMS-672 form will be entirely discontinued. As well as, data related to census, medication error rates, and ombudsman information will be transferred to the CMS-671 form.
 
Staff Contact: mcarland@mehca.org