Good Afternoon Everyone.
FYI, CMS quietly posted a revised 5-Star User’s guide on October 27th. The new user’s guide is dated October 2021 and can be found at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/usersguide.pdf
There was one major change to table A related to the short stay claims based measure, “Rate of successful return to home and community from a SNF”, and some wording changes for clarification on page 8 related to exclusions for staffing days for improbable PBJ situations. Here is a synopsis.
Page 8 Old:
CMS uses a set of exclusion criteria to identify facilities with highly improbable PBJ staffing data and neither staffing data nor a staffing rating are reported for these facilities (“Data Not Available” is displayed on the Care Compare website). These exclusion criteria are as follows:
- Total nurse staffing (job codes 5-12), aggregated over all days in the quarter with both nurses and residents is excessively low (<1.5 hours per resident day)
- Total nurse staffing (job codes 5-12), aggregated over all days in the quarter with both nurses and residents is excessively high (>12 hours per resident day)
- Nurse aide staffing (job codes 10-12) aggregated over all days in the quarter with both nurses and residents is excessively high (>5.25 hours per resident day)
Page 8 New (clarified highlighted language) :
CMS uses a set of exclusion criteria to identify facilities with highly improbable PBJ staffing data and neither staffing data nor a staffing rating are reported for these facilities (“Data Not Available” is displayed on the Care Compare website). These exclusion criteria are as follows:
- Total nurse staffing (job codes 5-12), aggregated over all days in the quarter with non-zero resident census is excessively low (<1.5 hours per resident day)
- Total nurse staffing (job codes 5-12), aggregated over all days in the quarter with non-zero resident census is excessively high (>12 hours per resident day)
- Nurse aide staffing (job codes 10-12) aggregated over all days in the quarter with non-zero resident census is excessively high (>5.25 hours per resident day)
Page 1 of the October Revised Manual indicates the following.
The “Rate of successful return to home and community from a SNF” measure will be updated in October, although the time period that the measure covers will continue to be October 1, 2017 through September 30, 2019. Due to this change the point thresholds (cut-points) for this measure will be changed to maintain the same distribution of rating points for this measure, and the new values are provided in Appendix Table A2 of this document .
I suspect that the reason this change occurred is that the measure has been revised to not include residents discharged from a Part A stay back to the non-skilled stay in the nursing facility, now no longer considered return to the “community”.
Table A Old
Table A New
There’s never a dull moment. These kinds of updates will always keep us on our toes.
