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

*NEW* draft version (V3.00.0) of the MDS 3.0 Data Specifications
 
On February 5, the Centers for Medicare and Medicaid Services (CMS) posted on their MDS 3.0 Technical Information Webpage a new draft version (V3.00.0) of the MDS 3.0 Data Specifications.  This version is scheduled to become effective October 1, 2019. These specifications are used for software developers and vendors to update SNF PPS grouper, MDS, electronic health record, and billing systems to align with annual updates. There are many significant changes, to align with the transition to the new Skilled Nursing Facility Prospective Payment System (SNF PPS) from the Resource Utilization Groups, Version 4 (RUG-IV) to the Patient Driven Payment Model (PDPM).  These changes include the removal of eight RUG-IV assessment item sets, the addition of two new PDPM assessment item sets, and item additions in Sections A, GG, I, J, O and Z. See this link for the draft MDS 3.0 Item Sets v1.17 for October 1, 2019) that were issued on January 3.  The MDS draft data specifications also accommodate the utilization of the PDPM grouper (not issued yet), which also begins on October 1, 2019.
CMS Releases an Update on therapy caps and functional reporting
 
Effective for dates of service on or after January 1, 2018, providers of therapy services shall continue to report the KX modifier on claims as applicable; however, the modifier no longer represents an exception request but serves as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record after the beneficiary has exceeded the threshold of incurred expenses. Therapists must continue to track their patients' utilization toward the threshold and attach the KX modifier to all claims for therapy services that are medically necessary that exceed the annual threshold amount (in 2019, the threshold is $2,040 for PT and SLP services combined and $2,040 for OT services).
 
Looking for ideas to engage your consultant pharmacist in antibiotic stewardship activities? 

 
The New England QIN-QIO in partnership with the Massachusetts Department of Health is hosting a no-cost education webinar entitled Antimicrobial Stewardship in Long Term Care: The Time has Come - The Critical Role of the Consultant Pharmacist on Tuesday, February 12th from 11:00am to 12:00pm. This webinar will feature presentations from Shira Doron, MD, Kirthana Beaulac, PharmD and Gabriela Andujar Vazquez MD, Antimicrobial Stewardship specialists at Tufts Medical Center. Click Here to register today!
 
Staff Contact:
Danielle Watford
Director of Quality Improvement & Regulatory Affairs
dwatford@mehca.org