Expect the Unexpected: This week's Top Newsmakers in Quality and Regulatory Affairs

This week's Top Newsmakers in Quality and Regulatory Affairs
Top-Line Report Updated: Five Star Survey Predictions enclosed
The 2018 fourth quarter ‘Your Top-Line' report was released on January 3, 2019 for Skilled Nursing Facility (SNF) members. This issue includes a projection on what the SNF's survey rating would be if the survey freeze was lifted today and the survey scoring rules used before the freeze were kept the same. For further information on how Trend Tracker created these projections, we have created a help document that can be accessed here to answer all your questions! Can't find Your Top-Line in your email? Not to worry! You can access current and past Top-Lines through LTC Trend Tracker by following these easy steps here.

Announcing the National Center on Advancing Person-Centered Practices and Systems

The Administration for Community Living and the Centers for Medicare and Medicaid  announced this week the launch of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS). During the past 30 years, long-term service and support needs have generally shifted to embrace person-centered principles, premised on the belief that people should have the authority to define and pursue their own vision of a good life. Yet, the degree to which these systems have fully adopted person-centered practices varies, and many continue to grapple with how to effectively implement them. The goal of NCAPPS is to promote systems change that makes person-centered principles not just an aspiration, but a reality in the lives of people who require services and supports across the lifespan. NCAPPS will assist states, tribes, and territories to transform their long-term care service and support systems to implement U.S. Department of Health and Human Services policy on person-centered thinking, planning, and practices. It will support a range of person-centered thinking, planning, and practices, regardless of funding source. Activities will include providing technical assistance to states, tribes, and territories; establishing communities of practice to promote best practices; hosting educational webinars; and creating a national clearinghouse of resources to support person-centered practice. NCAPPS is funded by the Administration for Community Living and the Centers for Medicare & Medicaid Services, and administered by the Human Services Research Institute (HSRI). Technical assistance applications are available now. States, tribes, and territories can apply for technical assistance through an application available online. The deadline for technical assistance applications is February 12, 2019. Completed applications should be submitted to For additional information please see this NCAPPS overview document. Join the NCAPPS launch webinar on January 29 at 3:00 - 4:30 pm EST to learn more about NCAPPS and to have your questions answered regarding technical assistance opportunities. Register for the webinar.

A change to our payment model just months away

For years, the Centers for Medicare & Medicaid Services (CMS) has been developing a new prospective payment system (PPS) to replace the existing Resource Utilization Group (RUGs) PPS. CMS finalized the new system last July and has set October 1, 2019 as the go live date. This new system, called the Patient-Driven Payment Model (PDPM) is a significant departure from RUGs. Under PDPM, therapy minutes have no direct relationship with payment at all. Rather, payment is driven by an array of patient characteristics. These include diagnostic information collected via ICD-10 diagnosis codes assigned by skilled nursing facility (SNF) clinicians, medical record information, functional status using Section GG of the Minimum Data Set (MDS), and a new cognitive assessment scale. Accurate coding under PDPM is critical, particularly during the Five-Day Assessment window due to the expanded importance of MDS items. In the Five-Day Assessment, patients are assigned to CMGs for each of the five service-related components. Correct assignment is particularly critical under PDPM because payments under three components—physical therapy, occupational therapy, and non-therapy ancillaries—decline over the course of the stay using a CMS-developed schedule. While a patient may be re-assigned to a different CMG following the initial Five-Day Assessment, the declining payment schedule does not return to day one of a stay. So, if the assigned CMG and related case mix index result in a rate that's too low, the declining payment schedule could become problematic later in the stay as the payments continue to decline. PDPM frees SNFs from counting therapy minutes and a largely outdated payment system. However, with change comes an array of challenges. Patient characteristics are used to assign patients to the appropriate case mix group (CMG) by PDPM direct service components (physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillaries). CMS believes PDPM provides a more holistic approach to patient care by separately adjusting each component, with a particular emphasis on the nursing component and the non-therapy ancillary component. Maine Healthcare Association, in partnership with AHCA is working to support of members with this transition by offering a one day intensive training session with accompanying tools and ongoing remote support calls to follow. Stay tuned for more information as the details for this program are finalized.