04/04/2024
CMS SNF Open Door Forum Update
On April 2, the Centers for Medicare & Medicaid Services (CMS) hosted a SNF Open Door Forum call which included a summary of the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for FY 2025 rule, the QSO-24-08-NH memo, and an open question and answer time. CMS specifically noted the request for information as outlined in the rule. John King, with CMS, stated that CMS intended to update PDPM based on changes in patient population changes in care provision and the area that CMS felt appropriate to start with was the non-therapy ancillary component. CMS also has an RFI for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). CMS notes that while they will not be responding to specific comments in response to this RFI in the FY 2025 SNF PPS final rule, CMS intends to use this input to inform their future measure development efforts. Christopher Palmer with CMS noted that the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program only had administrative updated as they wanted to largely let things rest following last year’s program expansion.
CMS did provide an update on the significant enforcement changes to the imposition of civil money penalties (CMPs) which would allow for more per instance (PI) CMPs to be imposed in conjunction with per-day (PD) CMPs. The proposal will also expand CMS’ authority to impose multiple PI CMPs when the same type of noncompliance is identified on more than one day. CMS notes in the rule that the current enforcement regulation does not allow for PI and PD CMPs to be imposed for the same survey and also makes it difficult for CMS to impose multiple PI CMPs for the same type of noncompliance. Lastly, the proposed revisions will enable CMS or the States to impose a CMP for the number of days of past noncompliance since the last three standard surveys to ensure that identified noncompliance that is subject to a penalty may receive one, if that is the remedy that is imposed.
Rico Lachica, the enforcement subject matter expert for the division at nursing homes, stated that these changes will allow CMS to be more flexible and impose CMP's in a manner that more closely addresses the types of non-compliance and risk for the resident health and safety that occur and that these proposed revisions are not intended to expand the type of deficiencies that are subject to per day and per instance CMP's. Rico noted that CMS would continue to follow the existing criteria for imposing CMP's. He also stated that these changes will incentivize facilities to take meaningful steps to permanently resolve their deficiencies.
MDS updates included a reminder to facilities that the March 2024 Quarterly Confidential Feedback Reports for the FY 2025 SNF VBP Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES) and that questions can be directed to the iQIES Service Center at iqies@cms.hhs.gov. CMS remind providers and the vendor community that the Draft MDS data specifications version 3.020 were posted on the MDS 3.0 technical page on March 4th and that these draft specifications will support the MDS version 1.19.1 which will go into effect October 1 2024. As noted in previous calls, CMS also reminded providers that as of October 1, 2025, CMS will no longer update the iQIES interface which is the manual entry aspect of MDS submissions. Providers will need to use a vendor or third-party company to complete and submit their MDS records.
CMS provided the following list of relevant contacts and resources that can be accessed by clicking here.
LeadingAge Ohio has provided the following Q&A with links embedded for your reference from the Q&A portion of the CMS call.
