The Pfizer-BioNTech vaccine also continues to be available under EUA. 215. Under these minimum requirements, we estimated that approximately 16 percent of SNFs would be excluded from the FY 2027 Program. https://cmit.cms.gov/CMIT_public/ReportMeasure?measureId=854. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/-IMPACT-Act-Standardized-Patient-Assessment-Data-Elements. NA hours include certified nurse aides (CNAs), aides in training, and medication aides/technicians. Another commenter stated it is critical that changes to the QRP are accompanied with appropriate financial incentives so SNFs may invest in technologies that improve patient safety and compliance with data submission thresholds. (2021). Response: of this final rule, we considered 4 options to adjust for COVID-19 in a technical update to the SNFRM. 106. Start Printed Page 47618 Federal Register We received the following comment and provide our response: Comment: Commenters recommended that (1) CMS provide ample notification to providers to ensure timely reporting of the measure, (2) reporting requirements of the measure should align with what is outlined in the proposed rule, and (3) CMS should only require reporting of the measure once per influenza season. The patient must remain in his or her room. We also remain committed to the importance of value-based care and incentivizing quality care tied to payment. Centers for Disease Control and Prevention (CDC). 207. Desmet, K., & Wacziarg, R. (2022). https://doi.org/10.15585/mmwr.mm6738a2. They believe revisions to an item already used across settings would capitalize on existing workflows and be easily updated within electronic health record (EHR) systems, resulting in minimal staff burden. 18. information and does not require SNFs to enter staff personal identifiable information. https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf. https://pubmed.ncbi.nlm.nih.gov/24652942/. We will continue to critically review evidence in our measure development processes. We refer readers to the Nursing Home Staff Turnover and Weekend Staffing Levels Memo for additional information related to this measure at of the proposed rule, we proposed to recalibrate the PDPM parity adjustment discussed in the FY 2020 SNF PPS final rule (84 FR 38734). 237. www.cdc.gov/mmwr/volumes/70/wr/mm7005a1.htm. Each year, the ICD-10 Coordination and Maintenance Committee, a Federal interdepartmental committee that is chaired by representatives from the National Center for Health Statistics (NCHS) and by representatives from CMS, meets biannually and publishes updates to the ICD-10 medical code data sets in June of each year. Comment: The two had met earlier that year, according to Fox 13, when Moore approached Shakespeare, claiming that she wanted to write a book about him. The Delphi panel discussed pilot testing results from the first round of ratings during a one-hour moderated telephone conference. Providers in the urban Pacific region would experience the largest estimated increase in payments of approximately 3.6 percent. In the FY 2016 SNF PPS final rule (80 FR 46422), we also discussed our intent to adopt baseline periods that are as close as possible in duration as the performance period for a fiscal year, as well as our intent to seasonally align baseline periods with the performance period to avoid any effects on quality measurement that may result from tracking SNF performance during different times in a year. Other commenters stated how CMS will define employee in reference to the measure's denominator will be significant. To meet the minimum data submission requirements for the HCP COVID-19 Vaccine measure, SNFs submit COVID-19 vaccination data through the NHSN for at least 1 week each month. Archives of physical medicine and rehabilitation. [298] After considering the public comment, we are finalizing our proposal to adopt FY 2021 through FY 2022 (October 1, 2020 through September 30, 2022) as the baseline period for the DTC PAC SNF measure for the FY 2027 program year. Face validity was assessed through a Delphi panel, which convened in June 2011 and provided stakeholder input on the proposed measure. In addition, year-to-year fluctuations in an area's wage index can occur due to external factors beyond a provider's control, such as the COVID-19 public health emergency (PHE). Because the case and measure minimum policies will ensure that SNFs participate in the Program for a program year only if they have sufficient data for calculating accurate and reliable measure rates and SNF performance scores, we do not believe there is a continuing need to apply the low-volume adjustment (LVA) policy beginning with FY 2023. What specific challenges do SNFs anticipate for collecting the CoreQ measure? Response: or Centers for Disease Control and Prevention (CDC). https://data.cms.gov/provider-data/) to make quality data available to the public, including SNF VBP performance information. We note further that all SNFs whose performance on a quality measure exceeds the 25th percentile of performance from the baseline period can receive achievement points on a quality measure under the Program's scoring methodology. 98. Resources and training materials for annual influenza surveillance are available on the Another commenter believed an equal approach would be the least disruptive policy implementation, rather than set a precedent for potential future changes to the individual CMI components. Although the MDS data sets are assessed for accuracy, as described above, we are interested in ensuring the validity of the data reported by skilled nursing facilities because use of this data would have payment implications under the SNF VBP Program. Accessed 3/4/2022. We also refer readers to the FY 2023 SNF PPS proposed rule for our discussion of risk-adjustments for the SNF HAI measure (87 FR 22770), the DTC PAC SNF measure (87 FR 22776), and case-mix adjustment for the Total Nurse Staffing measure (87 FR 22774). Comment: Instead, these tables are available exclusively through the internet on the CMS website. 11/18/2022, 812 Due to the uncertainty regarding future price trends, forecast errors can be both positive and negative. Many commenters supported our proposal to adopt a measure of Total Nurse Staffing, citing the strong relationship between higher nurse staffing levels and improved quality of care. We believe this continued application of the 2 percent withhold is required under section 1888(h)(5)(C)(ii)(III) of the Act and that a payback percentage that is spread evenly across all qualifying SNFs is the most equitable way to reduce the impact of the withhold in light of our proposal, which we are finalizing in this final rule, to award a performance score of zero to all SNFs. Retrieved from , On October 1, 2021, M54.50, https://www.cms.gov/newsroom/press-releases/advance-information-quality-care-cms-makes-nursing-home-staffing-data-available. [30] Similarly, if the patient is classified into the SLP group SB, then the second character in the patient's HIPPS code would be a B. For any date, residents whose assessments do not meet the criteria for being identified as discharged or deceased prior to that date are assumed to reside in the facility. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as set forth below: 1. Variation in influenza vaccination rates by type of HCP demonstrates the utility of the proposed measure for targeted quality improvement efforts. As a result of the BLS name change, the productivity measure referenced in section 1886(b)(3)(B)(xi)(II) of the Act is now published by BLS as private nonfarm business total factor productivity. Our data showed that the rate of major joint replacement or spinal surgery decreased from 7.6 percent of stays in FY 2019, to 5.5 percent of stays in FY 2021, to 5.2 percent of stays in FY 2022. [206] 66. This rule updates the SNF PPS rates contained in the SNF PPS final rule for FY 2022 (86 FR 42424). Nurse is a side character who appears in William Shakespeare's tragedy Romeo and Juliet. We received one comment suggesting additional changes to similar ICD-10 code mappings and comorbidity lists that at the time were outside the scope of rulemaking. Revised Compliance Date for Certain Skilled Nursing Facility Quality Reporting Program Requirements Beginning With the FY 2024 SNF QRP, b. Morbidity and Mortality Weekly Report, We thank the commenter for support of this proposal. documents in the last year, by the Air Force Department However, the commenter did not provide additional information to support why CMS' estimate did not capture the full burden for the reporting requirements. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-17-NH.pdf. This will result in all participating SNFs receiving an identical performance score, as well as an identical incentive payment multiplier. For more information regarding inactivated vaccines we refer readers to the following web page: Validation targeting criteria utilized by the Hospital IQR Program include factors such as: (1) abnormal, conflicting or rapidly changing data patterns; (2) facilities which have joined the program within the previous 3 years, and which have not been previously validated or facilities which have not been randomly selected for validation in any of the previous 3 years; and (3) any hospital that passed validation in the previous year, but had a two-tailed confidence interval that included 75 percent (85 FR 58946). [52] website belongs to an official government organization in the United States. As described in section VI.C.2 of the proposed rule, the need for the standardized patient assessment data elements and TOH Information measures has been shown to be even more pressing with issues of health inequities, exacerbated by the COVID-19 PHE. We addressed these concerns by sharing a revised COVID-19 population definition in section V.C.2.d. The wage index applicable to FY 2023 is set forth in Tables A and B available on the CMS website at 170. In January of 2022, we began publicly reporting a staffing turnover measure on the Compare tool currently hosted by HHS, available at Another commenter suggested that we adopt a risk-adjustment or incentive payment policy for facilities that accept residents that other facilities will not. Geographic Differences in COVID-19 Cases, Deaths, and IncidenceUnited States, February 12April 7, 2020. This document is the first of multiple steps to automating our dissemination process. We received public comments on these proposals. We are also revising the compliance date for the Transfer of Health Information measures and certain standardized patient assessment data elements. Antibiotic stewardship programs in nursing homes: A systematic review. (Sec. Coronavirus Treatment Acceleration Program (CTAP). Response: 109. Hereditary Alpha Tryptasemia), if there are symptoms or manifestations of this condition that require skilled care, then those symptoms should be provided as the primary diagnosis for the SNF stay, rather than the underlying condition which, often times, may be treated using oral medications. We received public comments on these proposals. One commenter suggested that we add administrative and facility turnover to reduce management turnover, which the commenter believed contributes to lower quality of care. Retrieved from We believe this reporting schedule, outlined in section VI.G.2. SNFs are experiencing a significant downward trend in admissions compared with their pre-COVID-19 admission rates. These proposed revisions reflect that the application of the wage index would be made on the basis of the location of the facility in an urban or rural area as defined in 413.333, and that starting on October 1, 2022, we would apply a cap on decreases to the wage index such that Gold, J.A.W., Wong, K.K., Szablewski, C.M., Patel, P.R., Rossow, J., da Silva, J., et al. Addressing Systemic Factors Related to Racial and Ethnic Disparities among Older Adults in Long-Term Care Facilities. Response: We will continue to evaluate the impact on SNFs' behaviors, staffing levels, and quality outcomes as the measure is implemented in the Program. Start Printed Page 47600 Further, the commenters noted that such data collection could allow for examination of SNF performance stratified for factors associated with healthcare disparities, such as race and ethnicity. Another commenter stated that not all turnover is detrimental and that it may be beneficial to dismiss staff that do not have the patience or disposition to work in a nursing facility. One commenter agreed with our approach but noted that removing COVID-19 patients from the measure may reduce the sample sizes and result in excluding more facilities from the Program, which may mean missing important indicators of quality performance. In the FY 2022 SNF PPS proposed rule (86 FR 19987 through 19989), we solicited comments from interested parties on a potential methodology for recalibrating the PDPM parity adjustment to account for these potential effects without compromising the accuracy of the adjustment. No one is actually dead until the ripples they cause in the world die away. A discussion of the assessment schedule and the MDS effective beginning FY 2020 appears in the FY 2019 SNF PPS final rule (83 FR 39229 through 39237). Federal Register Since the Final Specifications for SNF QRP Quality Measures and SPADEs document has been available to SNFs since July 31, 2019, we believe IT vendors will have enough time to update their software prior to October 1, 2023. Jarvis, his wife, and Mary get into the car with John to go the mortuary. [209210211212213] Access Resources. In addition, the HAI definition excludes infections that meet any of the following criteria: Preexisting infections that fall within the CDC's National Healthcare Safety Network (NHSN) Repeat Infection Timeframe (RIT) of 14 days. through the NHSN. Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study. Castle N. Nursing home caregiver staffing levels and quality of care: a literature review. 37(5), 2224-2235. https://www.covid19treatmentguidelines.nih.gov/whats-new/. [163] (iii) The cost data are standardized for facility variation in case-mix using the case-mix indices and other data that indicate facility case-mix. In adopting the CBSA geographic designations, we provided for a 1-year transition in FY 2006 with a blended wage index for all providers. Response: We codified this policy at 413.338(d)(1)(iv) of our regulations. Based on the 60 percent payback percentage, we estimated that we will redistribute approximately $296.44 million (of the estimated $494.07 million in withheld funds) in value-based incentive payments to SNFs in FY 2026, which means that the SNF VBP Program is estimated to result in approximately $197.63 million in If used in a musical context, it refers to a composition that has a melancholy tone to it. Section 1899B(e)(2)(A) of the Act requires that, absent an exception under section 1899B(e)(2)(B) of the Act, each measure specified under section 1899B of the Act be endorsed by the entity with a contract under section 1890(a) of the Act, currently the NQF. 254. [50] In accordance with section 1888(e)(6)(A)(i) of the Act, the Secretary must reduce by 2 percentage points the APU applicable to a SNF for a fiscal year if the SNF does not comply with the requirements of the SNF QRP for that fiscal year. 85. One commenter supported our proposed removal of the LVA policy. on 267. For this reason, we proposed to adopt the Total Nurse Staffing measure, which includes the time worked by RNs, LPNs, and nurse aides, in the FY 2026 Program. Section 321 is not codified in the U.S.C., but can be found in a note at 42 U.S.C. Riester, M.R., Bosco, E., Bardenheier, B.H., Moyo, P., Baier, R.R., Eliot, M., Silva, J.B., Gravenstein, S., van Aalst, R., Chit, A., Loiacono, M.M., & Zullo, A.R. This measure would facilitate patient care and care coordination during the discharge planning process. This is because patients with a history of COVID-19 during the 12 months prior to the SNF admission are generally much sicker and have a substantially higher number of average comorbidities (15) compared to patients with COVID-19 during the PPH (10). A forecast error of this final rule, our goal is to resume use of the scoring methodology we finalized for the program prior to the PHE beginning with the FY 2024 program year. We previously estimated that 10 percent of facilities would need to pursue additional candidates that meet the new qualifications for a director of food and nutrition services. In 1977 Samuelson employed the saying while writing in the journal Economica: [6] Still, as we know from Thomas Kuhns paradigm on the historical development of science. medRxiv. We view this change to the measure-level scoring as a necessary update to the SNF VBP Program's scoring methodology to incorporate additional quality measures and to allow us to add more measures in the future. Start Printed Page 47563 This measure is calculated using 2 years of data. 54. As discussed in the proposed rule and in section VIII.B.2.c. These data, which include information on SDOH, provides information that is expected to improve quality of care for all, and is not already found in assessment or claims data currently available. We also updated the Phase One Review and Correction deadline and codified that update at 413.338(e)(1). Beginning January 1, 2016, the data will also contain fee schedule amounts for certain procedure codes that have been adjusted using information from the competitive bidding programs. We note that issues with food and nutrition requirements are the 3rd most frequently cited deficiencies in LTC facilities. Comment: and Upon finding a melted wax Abraham Lincoln, Mabel decides to build a sculpture of Stan to replace it. Table 2 shows the forecasted and actual market basket increases for FY 2021. lock The burden associated with the proposed measure is the time it takes to sign into the NHSN, complete the required NHSN forms and submit the data. As described in section VII.C.2.a., the May 8th COVID-19 IFC only delayed the compliance date for these reporting requirements. As a fractured nation mourned, a manhunt closed in on his assassin, the twenty-six-year-old actor. Desai, R., Williams, C.E., Greene, S.B., Pierson, S., & Hansen, R.A. (2011). (2) CMS will calculate the value-based incentive payment adjustment factor for each SNF using a performance score of zero and will then calculate the value-based incentive payment amount for each SNF using the methodology described in paragraph (c)(2)(ii) of this section. 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