CMS, OIG, and Other Agency Resources
- Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries, Office of the Inspector General (March 3, 2014)
A recent OIG report examined potentially avoidable adverse events at SNFs as part of a series of studies about hospital adverse events. The report concludes that a third of Medicare beneficiaries in skilled nursing facilities experienced “adverse events” or “temporary harm” during their stays — and that 59 percent of these adverse events and temporary harm events were preventable. While the inspector general recommends that the Obama administration emphasize education and patient safety awareness at skilled nursing facilities, it fell short of recommending any legislative response, previous recommendations have been suggested by MedPAC, Simpson-Bowles Commission, and the President.
- Video Stream Broadcast: Launch of Initiative to Improve Behavioral Health and Reduce Use of Antipsychotic Medications in Nursing Home Residents, Thursday, March 29, 2012, 1-2pm ET
CMS is developing a national action plan to improve behavioral health management and to safeguard nursing home residents from unnecessary antipsychotic drug use. Through a multidimensional approach including research, public reporting, raising public awareness, regulatory oversight and technical assistance/training, we hope to enhance person-centered care for nursing home residents, particularly those with dementia-related behaviors.
- Questionable Billing By Skilled Nursing Facilities, Office of the Inspector General (December 2010)
Skilled nursing facilities increasingly billed Medicare for higher paying resource utilization groups from 2006 to 2008, even though beneficiary characteristics remained largely unchanged, according to this report from the Department of Health and Human Services' Office of Inspector General. For-profit SNFs were more likely than non-profit or government SNFs to bill for higher paying RUGs, the report adds. Among other recommendations, OIG said the Centers for Medicare & Medicaid Services should monitor overall payments to SNFs and adjust RUG rates annually if necessary; consider requiring each SNF to use the beneficiary's hospital diagnosis and other information from the hospital stay to better predict the beneficiary's therapy needs; and strengthen monitoring of SNFs that are billing for higher paying RUGs.
- CMS National Provider Call: Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV) (Held November 9, 2010)
- MDS 3.0 Training Materials Updated July 12, 2010 - Under the Downloads section of the MDS 3.0 Training Materials page
- Section 148 of The Medicare Improvements for Patients and Providers Act (MIPPA) (May 8, 2009)
CMS has published a MedLearn Matters article (attached) specific to MIPPA Section 148 regarding CAHs that bill Medicare FIs or MACs for services provided to Medicare beneficiaries. Rural health clinics (RHCs), federally qualified health clinics (FQHCs), and skilled nursing facilities (SNFs) may also want to review this article, which clarifies information regarding payment to these entities for laboratory tests performed at an RHC, an FQHC, or a SNF.
If you have any questions, please contact your FI or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS website.
New AHRQ Resources Can Help States and Local Communities With Disaster Planning and Response Involving Nursing Homes. Press Release, July 19, 2007. Agency for Healthcare Research and Quality, Rockville, MD
CMS Minimum Data Set (MDS 3.0)
A draft version of the MDS 3.0 item set has been posted. It can be accessed at http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp.
The final version is still scheduled for publication in October 2009.
Medicare Payment Advisory Commission
MedPAC is an independent federal body that advises the US Congress on issues affecting the Medicare program. MedPAC's recommendations often address issues related to SNF payments and can be found in their twice yearly reports to Congress and MedPAC meetings minutes.