Regulatory changes set to affect long-term care

With continuous regulatory changes and updates as the Centers for Medicare and Medicaid Services (CMS) seeks to improve health care delivery, there’s one bright side for nursing leaders and directors: you’re never going to get bored in your work.

“Do you ever feel like you’re on a regulatory treadmill that CMS keeps churning out all these regulations, and we keep responding with hurried fervor?” asked Judi Kulus, MSN, MAT, RN, NHA, DNS-CT, RAC-MT, QCP, vice president of curriculum development at the American Association of Directors of Nursing Services (AADNS), during a recent Lippincott® Solutions webinar for nursing directors in long-term care. “If you’re anything like me, you just want to know what’s coming at me, how do I need to understand it, [and] what do I need to do the prepare.”

Kulus took the opportunity to update her audience on regulatory changes expected to influence skilled nursing facilities (SNFs) in the coming months. Here are a few she addressed.

SNF value-based purchasing

Under value-based purchasing for Medicare Part A, CMS will start withholding 2% of a skilled nursing facility’s (SNF) Medicare payments to fund an incentive payment pool beginning Oct. 1, 2018. Some 60% of the incentive payment pool funds will be distributed back to SNFs based on value-based purchasing quality measure rankings, Kulus explained, but the bottom 40% of SNFs will receive less money in incentive payments than they would have received without value-based purchasing.

SNF quality reporting program

Beginning in October, public reporting of the following will begin under the SNF Quality Reporting Program on the Nursing Home Compare website:

• Percent of patients with pressure ulcers that are new or worsened (short stay),
• Percent of long-term care hospital patients with an admission and discharge functional assessment and a care plan that addresses function,
• Percent of residents experiencing one or more falls with major injury (long stay), and
• Claims-based measures, including discharge to community, potentially preventable 30-day post-discharge readmission measure, and Medicare spending per beneficiary.

Payroll-based journal public reporting

The Payroll-Based Journal (PBJ) program aims to improve the accuracy of nursing home staffing information for the public, some of which is already appears on the Nursing Home Compare website. Recently, symbols have been added to the website to quickly identify nursing homes that have — and have not — submitted staffing data. SNFs that miss two PBJ reporting deadlines in a row will have “suppressed” ratings, Kulus warned.

Resident classification system (RCS-I)

The proposed RCS-I reimbursement payment system is geared to replace RUG-IV and completely overhaul the Medicare A payment system, according to the webinar. Under RCS-I, residents would be classified into a single group: physical and occupational therapy, speech therapy, non-therapy ancillary, or nursing.

Only three types of assessments would be required under RCS-I: a 5-day scheduled assessment, a significant-change-in-status assessment, and an SNF Part A discharge assessment.

The bigger picture

By keeping aware of these and other expected regulatory changes, nurse leaders can prepare their facilities to stay in compliance, Kulus said. Then, they can continue to focus on the most important aspect of all — the residents — and go home at the end of the day satisfied with a job well done.

Full details of the regulatory changes likely to affect SNFs throughout the next year or so are available in the recorded archive of the “’I Didn’t Know That!’ A Regulatory Review of 2017 for the DNS and What to Expect in 2018” webinar.

If you missed the live presentation, click HERE to access the free recorded archive.