Category Archives: Blog

All posts for the blog.


Hot Topics: FINAL version of MDS 3.0 Data Specs Available

The Centers for Medicare & Medicaid (CMS) posted the FINAL version (V3.00.1) of the MDS 3.0 Data Specifications yesterday. This version is scheduled to become effective October 1, 2019.

Leadership Actions/Considerations:

  1. Please note that revisions since the errata can be identified by looking for “post-errata” in the version notes for the items and edits.
  2. The lookup file for the allowable ICD codes in item I0020B has been updated, and it is posted as a separate ZIP file.
  3. Download files directly from (see the downloads section)
  4. Quickly access the files by clicking on the links below:


MDS 3.0 Data Specs (V3.00.1) FINAL 04-22-2019 [ZIP, 13MB]

PDPM_ICD_Codes_for_I0020B_FY2020 [ZIP, 764KB]


Pathway Health experts are reviewing the FINAL revisions and resources, education and products to ensure their alignment with the changes. For further information, contact us.


Lisa Thomson
Chief Strategy and Marketing Officer




What Leaders Need to Know: The Final Rule – Impacts to the MDS Process

The Medicare payment classification system change to the Patient Driven Payment Model (PDPM) for SNFs is October 1, 2019. Medicare payments will be based on the PDPM classification system instead of the RUGS IV classification system.
Centers for Medicare & Medicaid Services (CMS) published Final Rule updates to the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2020, making minor revisions to the regulation text to reflect the revised assessment schedule under PDPM. Additionally, there are revisions to the definition of group therapy under the SNF PPS, and the implementation of a sub-regulatory process for updating the code lists (ICD-10 codes) used under PDPM. Lastly, updated requirements for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program are also included. Click to download update from the Federal Register>

Below are a few “need to know” updates.

Q. What changes were made to the PDPM adjusted base rates?

A. Two major revisions were made:
1. The SNF Market Basket percentage increase was updated based on the second quarter 2019 forecast. The revised update is 2.8%.

2. PDPM Case-Mix indexes (CMI) and Adjusted Federal rates for each CMI for urban and rural facilities were updated and published.

Q. What are CMS’ clarifications to the Interim Payment Assessment (IPA)?

A. CMS clarified that the IPA is to be used as the SNF determines after the initial Medicare MDS (5-day) to address a resident’s clinical changes throughout the Medicare stay; “to provide excellent skilled nursing and rehabilitative care and continually monitor and document patient status. Moreover, the discussion of the IPA in the FY 2019 SNF PPS final rule (83 FR 39233) clearly envisions a role for this assessment that is not strictly limited to payment alone.”

Q. What are the SNF Quality Reporting Program (QRP) impacted areas?

A. Key updates were made to the following:
1. Transfer of Health Information to the PROVIDER – Post-Acute Care effective FY2022: The FY 2021 PPS assessments will be revised to collect data about the transfer of a reconciled medication list to the next post-acute care provider when a resident discharge from a SNF Medicare stay.

2. Transfer of Health Information to the PATIENT – Post-Acute Care effective FY2022: The FY 2021 PPS assessments will be revised to collect data about the transfer of a reconciled medication list to the resident at the time of discharge from a SNF Medicare stay.

3. The Discharge to COMMUNITY – Post-Acute Care:The Quality Measure for the SNF QRP will be adjusted for FY2020 to exclude residents of the SNF in 180 preceding their hospitalization and SNF stay.

4. Drug Regimen Review Conducted with Follow-Up for Identified Issues – Post-Acute Care: Will be posted to Nursing Home Compare for FY 2020.

5. Definition of the RAI Manual: The official definition of RAI Manual is the Manual instructions, the interpretive guidance and policy clarifications posted in the MDS website. Click here to view>

PDPM Insight, Expertise and Knowledge.

Pathway Health PDPM experts can assess your organization’s readiness and provide a detailed action plan for enhancing or improving these processes. Our PDPM consulting services and tools can support your busy leaders and staff to effect a smooth transition to the PDPM system. Pathway Health also offers expert PDPM training – classroom, onsite and web-based. Contact us to learn more.


Karolee Alexander
Director of Reimbursement and Clinical Consulting


Learn About Diagnosis Coding for Payment in PDPM with LeadingAge Minnesota

Learn About Diagnosis Coding for Payment in PDPM with Pathway Health’s Karolee Alexander and LeadingAge Minnesota. The webinar will review the general coding guidelines for ICD-10 and briefly examine the ICD-10 mapping for the PDPM system.

Also, diagnosis management for billing will be explained, including a review of the diagnosis code locations on the UB-04 billing form.

The webinar will take place on August 27, 11 a.m. – 12 p.m.

Sign up for the webinar here.


Check out more educational opportunities from Pathway Health »


Pathway Health’s Robin Storey Will Present at the MHCA Annual Convention

Pathway Health’s Robin Storey will host the session: “Phase 3 Requirements of Participation – The Final Phase” at the MHCA 71st Annual Convention and Trade Show.

The session will provide participants with guidance on implementing the Phase 3 Federal Regulatory Requirements as well as helpful tools and resources to successfully implement the final phase by November 28, 2019.


  • Understand the required elements of the skilled nursing requirements for the implementation of Phase 3 regulations
  • Identify appropriate assessment elements for care planning cultural preferences and needs
  • Describe and create a plan for implementing an effective compliance and ethics program
  • Determine the base competency and training requirements for licensed, certified, and unlicensed staff members

The convention will be held August 25 – 28 in Branson, MO. Learn more about the convention here.


Check out more educational opportunities from Pathway Health »


Pathway Health’s Lisa Thomson to Speak at the Kansas Adult Care Executives (KACE) Annual Convention

Lisa Thomson, Pathway Health’s Chief Strategy and Marketing Officer, will be the keynote speaker at this year’s Kansas Adult Care Executives (KACE) Annual Convention, with a talk titled, “Leadership by Inspiration: Ignite the Passion Within.”

Lisa will also be discussing retention and recruitment strategy during her morning talk, “Creating a Winning Retention and Recruitment Strategy,” and best uses of data in her afternoon talk, “The Data Dilemma: How to Use Organizational Data to Achieve Quality Outcomes.”

Learn more about the KACE Annual Convention here.


Check out more educational opportunities from Pathway Health »


Participate in the Two-Day ICD-10 Workshop with the Washington Health Care Association and Pathway Health


Pathway Health will present a two-day ICD-10 training event to provide training on coding terms, conventions, official coding guidelines, basic coding knowledge, coding case studies for each chapter in ICD10-CM and education on diagnosis management. Participants should be able to learn and improve their coding skills and understand coding for the rehab stay.


  • Comprehend definitions of coding terminology
  • Understand official coding guidelines
  • Demonstrate the ability to assign correct medical codes
  • Utilize resource materials for accurate coding
  • Be familiar with all chapters of ICD-10-CM
  • Be familiar with diagnosis management
  • Describe how ICD-10-CM coding affects the MDS and billing

The training will take place on August 20 – 21 in Spokane Valley, WA. For more details about the training click here.


Check out more educational opportunities from Pathway Health »


Pathway Health Will Be at the AHFSA 2019 Annual Conference

Pathway Health will be an exhibitor at the AHFSA Annual conference, August 4 – 7. Also, Lisa Thomson, Pathway Health’s Chief Strategy and Marketing Officer, will be co-presenting with Otis Woods on August 5. Their talk is titled “Receiverships, Closures, Temporary Management and Change of Ownerships: Perspectives and Best Practice Strategies.”


This year’s conference celebrates the 50th anniversary of AHFSA. Learn more about the conference by visiting the AHFSA website.



Trauma Informed Care and Mental Health First Aid: Complimentary Webinar

RoP Phase 3 implementation is right around the corner, and it is time to prepare your education for staff members. Long Term Care providers must comply with behavioral health regulations by November 28, 2019. Join Pathway Health’s Leah Killian-Smith during her complimentary webinar, “Trauma Informed Care and Mental Health First Aid,” and prepare for the new regulations.

Webinar Objectives:

  • Understand three required elements for behavioral health services for Phase 3 of the Requirements of Participation for skilled nursing facilities
  • Learn ways to identify symptoms of trauma and PTSD
  • Analyze how mental health first aid techniques are the answer to providing a trauma-informed approach to caring for older adults

This session will provide participants with a FREE handout to assist with trauma-informed care planning. Join us to receive helpful information, tips and tricks for taking care of residents with psycho-social needs.


The webinar will take place on August 7, 2 p.m. ET.

Attendance is limited to the first 500 registrants, so register early!

Check out more educational opportunities from Pathway Health »



Fireside Training Courses in August

Pathway Health offers multiple opportunities to strengthen your education in August. Register now for the following Fireside Training classes:


Learn more and register now »


By striving to improve yourself and your colleagues, your facility grows the quality of its care and the effectiveness of its staff.

Explore the multiple options for furthering your education with Pathway Health and visit our Education page for more insight, expertise and knowledge.


Staff Competency Starts with Knowing Your KSAs

The complexity of the health care environment requires that staff in the facility participate in educational programs that ensure they have the knowledge, skills and abilities (KSAs) to provide individualized care promoting the health, safety and welfare of the resident population.

There are competencies required by federal nursing home regulations, state nursing home regulations and other governing institutions for persons working in healthcare organizations. Some of the organizations overseeing rules and laws that apply to staff and leaders include the Occupational Health and Safety Administration, the U.S. Equal Employment Opportunity Commission, the Medicare and Medicaid Integrity Program, State and Federal labor laws, State and Federal Building codes, and practice rules for licensed, certified and registered professionals.

The Requirements of Participation outline specific competencies needed by nursing and all staff within a facility. The Implementation Checklist outlines the specific F Tags in which nursing staff and all staff competencies are described. Designing training and education programs, that coordinate with resident population needs, facility requirements, state and federal regulations and standards of practice, is expected. The overall premise is that staff have the knowledge, skills and resources to provide care and services to the resident population.

Need to Know Definitions:

Competency – is a measurable pattern of knowledge, skills, abilities, behaviors, and other characteristics that an individual needs to perform work roles or occupational functions successfully. This is not dependent solely upon qualifications or licensure.[1]

Knowledge, Skills and Abilities (KSAs) – KSAs are knowledge, skills, and abilities that a staff member needs to possess in order to perform the duties of their position, aligning with their respective roles and responsibilities.

Knowledge – the understanding of concepts, the subjects, topics, and items of information that a staff member should know at the time of employment, annually or as determined necessary.

Skills – capabilities or proficiencies developed through training or hands-on experience. Skills should be measurable and observable.

Abilities – traits or talents that a person brings to their role or the facility or the job position.

All personnel who work in a long-term care facility are required to have specific knowledge and demonstrate their understanding of specific topics. There are many types of competencies expected of health care team members. While research indicates numerous functional and core competencies, skilled nursing facilities have specific competencies that are:

  • Mandatory for all Staff – These include the mandatory competencies from the Requirements of Participation
    • Preventing and reporting abuse, neglect, and exploitation
    • Change of Condition identification and notification
    • Dementia management
    • Infection Control
    • Resident rights
    • Person-centered care
    • Communication
    • Cultural competency
    • Other areas as identified through the Facility Assessment
    • HIPAA
    • QAPI
    • Emergency response (Fires, etc.)
    • Fall Prevention
    • Operation of exit alarms
    • Reporting changes in residents’ conditions
    • Competencies identified by the assessment of residents’ needs
    • OSHA
  • Mandatory for Nursing Staff – In addition to the mandatory competencies for all staff, the RoP outlines other nursing competencies
    • Competencies related to an approved nurse aide training and evaluation program
    • Medication management
    • Basic nursing skills
    • Basic restorative services
    • Skin and wound care
    • Pain management
  • Clinical Knowledge – Standards of Practice
  • Core Clinical Competencies
    • Clinical systems
    • Incident/Accident
    • Dialysis
    • Nutrition
    • Physical Assessment
    • MDS Process and Care Planning
    • Respiratory care
    • Other areas as identified through the Facility Assessment
  • Annual Training Requirements and Competencies – Per federal, state and job specific requirements
  • Facility Identified Competencies
    • Other areas as identified through the Facility Assessment
    • Facility Mission and Strategic Goals
    • Market place needs
    • Partnership requirements and expectations
    • Quality outcomes
    • QAPI outcomes and PIPs
  • State-Specific Requirements, as applicable

Leadership Considerations

The above is not an all-encompassing list; rather, providers must review its served resident population, clinical systems, technology, resources and standards of practice to develop the competency requirements for licensed and non-licensed staff.

  1. Providers must identify the residents’ needs and determine, beyond the required topics, what knowledge, skills, abilities, behaviors and other characteristics are needed.
  2. For each job category, determine the mandatory and core competencies necessary for optimal performance and quality outcomes. These competencies need to align with the respective job description.
  3. To determine competency levels and needs for staff, facility leaders may follow the below general process to target specific competencies and training needs, including:
    • Based upon the facility assessment and mandatory requirements
    • Competencies are related to your facility mission
    • Current policies and procedures for resident care and quality outcomes
    • Utilize policies and procedures as a foundation for competency development
    • Follow the KSA approach needed for individual performance and improvement needs
    • Incorporate competency process into your overall training plan
    • Align competencies with staff job descriptions
    • Incorporate competency review and monitoring process per the facility Quality Assurance and Performance Improvement Plan

Competence is a complex concept, especially in health care. At the very least, competency in health care requires evaluation of both an employee’s ability to meet job expectations and subsequently to deliver continuous, effective care and quality outcomes for your residents.


Director of Education


[1]Centers for Medicare & Medicaid Services State Operations Manual, Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 173, 11-22-17):


Pathway Health provides your organization the insight, expertise and knowledge to help ensure quality clinical outcomes to reach your desired goals.

Visit or 877-777-5463.