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CMS Regulatory Updates Effective April 2019

The Centers for Medicare & Medicaid Services (CMS) sent several updates recently that will impact providers. See below for more need to know information:

April 2019 Improvements to Nursing Home Compare

  • Freeze ending on Health Inspection Star Ratings – Inspectors will resume the traditional method of calculating health inspection scores by using three cycles of inspections. Inspections occurring on or after November 28, 2017, will be included in each facility’s star rating. Click here to download the Technical User’s Guide (April 2019).
  • Quality Measure (QM) Domain Improvements – Separate ratings for short- and long-stay measures to reflect the level of quality provided. Also, the following will be included:
    • Revising the thresholds for ratings
    • Adding a system for regular updates to thresholds every six months
    • Weighting and scoring individual QMs differently.
    • Adding the long-stay hospitalization measure and a measure of long-stay emergency department (ED) transfers to the rating system.
    • Two measures from the Skilled Nursing Facility Quality Reporting Program (QRP) will be adopted to replace duplicative existing measures
  • Staffing Domain Improvements – Thresholds for staffing ratings will be adjusted. Also, the threshold for the ‘number of days without a registered nurse (RN) onsite’ that triggers an automatic downgrade to one star will be reduced from seven to four days.
  • Read more: Download the PDF from CMS.

Revision to Appendix Q – Immediate Jeopardy

Clarification on how surveyors issue Immediate Jeopardy (IJ) citations has been released by CMS. Key components include:

Mandatory Surveyor Training: For surveyors and non-surveyors to the revised Appendix Q–Core Guidelines to Determining Immediate Jeopardy. The Core Appendix Q focuses on the key components necessary to establish immediate jeopardy (IJ) under the regulations. Click here to view training from CMS.

Enhanced Oversight and Enforcement of Non-Improving Late Adopters

The following highlights the memorandum issued on 3/01/2019 to State Survey Agency Directors.

  • Late Adopters identified – CMS identified approximately 1,500 facilities that had not improved their antipsychotic medication utilization rates for long-stay nursing home residents, referred to as late adopters and notified them in December 2017.
  • Enforcement for A Segment of Non-Improving Late Adopters with Multiple Citations – As of January 2019, there were 235 late adopter nursing homes that had been cited for non-compliance with federal regulations related to unnecessary medications or psychotropic medications two or more times since January 1, 2016, and who have not shown improvement in their long-stay antipsychotic medication rates. If these facilities are determined not to be in substantial compliance with requirements for Chemical Restraints, Dementia Care, or Psychotropic Medications during a survey, they will be subject to enforcement remedies. Download the Late Adopter Data Report (January 2019).
  • Corporate Engagement – CMS is also looking for opportunities to engage with corporate chains that have significant numbers of nursing homes identified as late adopters.
  • Download the complete Memorandum from CMS.

Your Trusted Partner

Pathway Health is your partner in regulatory success. Our experts are ready to immediately support your organization to meet these new regulatory challenges.

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