April 12, 2022
In this Issue:
- CMS Issues FY 2023 Skilled Nursing Facilities Prospective Payment System Proposed Rule, Seeks Comment
- CMS Phasing Out Some Temporary Emergency Declaration Waivers
- National Academies' Report Supports Historic Biden Administration Nursing Home Reforms
- New Program from Cornell University on Resident-to-Resident Conflict
CMS Issues FY 2023 Skilled Nursing Facilities Prospective Payment System Proposed Rule, Seeks Comment
The Centers for Medicare & Medicaid Services (CMS) issued its fiscal year 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule. The proposed rule builds upon the Biden-Harris Administration's vision of improving the quality of nursing homes. The SNF PPS provides Medicare payments to over 15,000 nursing homes, serving more than 1.5 million people. Through the SNF PPS proposed rule, CMS seeks to transform the SNF payment system to a more patient-centered model by making payments based on the needs of the whole patient, rather than focusing on the volume of services a patient receives.
In the SNF PPS proposed rule, CMS is soliciting input in the following areas:
- Establishing minimum staffing requirements that nursing homes will need to meet to ensure all residents are provided good care and nursing home workers have the support they need. The input will be used in conjunction with a new research study being conducted by CMS to determine the optimal level and type of nursing home staffing needs. The agency intends to issue proposed rules on a minimum staffing level requirement for nursing homes within one year.
- Examining staff turnover levels in nursing homes for possible inclusion in CMS’ SNF Value-Based Purchasing (VBP) Program, which rewards facilities with incentive payments based on the quality of care they provide to people with Medicare. CMS will use the stakeholder feedback to inform a proposal of this measure to include in the SNF VBP Program in the future.
- The role health equity plays in improving health outcomes and the quality of care in nursing homes. Specifically, CMS is seeking comment on how to arrange or classify measures in nursing home quality reporting programs by indicators of social risk to better identify and reduce disparities.
Comments are due June 10, 2022.
For more information, read the fact sheet on the FY 2023 SNF PPS proposed rule.
CMS Phasing Out Some Temporary Emergency Declaration Waivers
The Centers for Medicare & Medicaid Services (CMS) announced it will be phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 Public Health Emergency (PHE). During the PHE, CMS used a combination of emergency waivers, regulations, and guidance to offer health care providers flexibility in responding to the acute and extraordinary circumstances of the pandemic. As COVID-19 vaccination rates increase among nursing home residents and staff, and with nursing homes' improved ability to respond to COVID-19 outbreaks, CMS is seeking to re-establish certain minimum standards for compliance with CMS requirements.
Among the waivers being lifted by CMS are: requirements for training and certification of nurse aides, in-service training for nurse aides, required training for paid feeding assistants; the ability of resident groups to meet; physician visits and delegation of tasks; and information sharing for discharge planning.
CMS has found issues in recent onsite long-term care surveys related to resident weight loss, depression, and pressure ulcers. CMS understands that lack of certain minimum standards, such as training for nurse aides, may be contributing to these issues. Ending temporary waivers will help providers redirect efforts back to meeting regulatory requirements and ensuring residents' needs are met.
For more information, read the memo from CMS.
National Academies' Report Supports Historic Biden Administration Nursing Home Reforms
A report released on April 6, 2022 by the National Academies of Sciences, Engineering, and Medicine (NASEM) includes recommendations that strongly support the Biden Administration's historic nursing home reforms announced on February 28, 2022. Consumer Voice is pleased that the report, "The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff,” calls for minimum staffing standards, heightened enforcement and oversight, increased transparency and accountability of finances, operations, and ownership, and support for nursing home workers.
The report brings attention to long-standing problems that have plagued nursing homes for decades and resulted in the catastrophic impact of COVID-19 on nursing home residents, such as inadequate staffing, failures in oversight and regulation, poor infection control, and deficiencies that result in resident harm. The report’s authors, the Committee on the Quality of Care in Nursing Homes, write "that immediate action is necessary to initiate fundamental change," and that "the way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable."
Consumer Voice applauds the Committee for recognizing the many shortcomings in the current system and for proposing specific actions to ensure that residents receive the high quality, person-centered care that they deserve.
New Program from Cornell University on Resident-to-Resident Conflict
Cornell University has created a new, evidence-based program designed to prevent and treat resident-to-resident conflict and aggression in nursing homes and assisted living facilities. The free Improving Resident Relationships in Long-Term Care (IRRL) Program includes in-service training sessions and an opportunity to put the skills to use. Topics include identifying resident-to-resident aggression, understanding its causes, and a step-by-step method to intervene when aggression occurs. Attend their webinars April 27th and 28th to learn more information about this program. For questions or additional information, email firstname.lastname@example.org.