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Quality Measure Domain Rating Threshold Changes April 2022

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FSQMD

Five-Star: Quality Measure Domain
Rating Threshold Changes April 2022 Refresh

 

The Quality Measure (QM) threshold changes that were scheduled for April 2020 were implemented in the April 2022 refresh.

 

In March 2019, CMS planned to update the Quality Measure (QM) rating thresholds every six months, however, this was delayed due to COVID-19.

The plan includes increasing the thresholds by 50% of the average rate of improvement in Quality Measure (QM) rating scores.

 

For example, if there is an average rate of improvement of 2%, the Quality Measure (QM) rating thresholds would be raised 1%.

 

These new thresholds and actions are aimed to incentivize continuous quality improvement and reduce the need to have larger adjustments to the thresholds in the future.

 

 

PBJ Staffing Domain: Telehealth/Remote Hours (COVID-19)

Top 13 Things to Know

 

  • CMS has stated that for non-nursing staff, if the “typical parameters” of working remotely or via telehealth apply to those worked hours, then the facility may include those hours on the PBJ hours.

 

  • Elaborating on “typical parameters,” meaning the only hours the provider is able to include for:

 

  • PBJ reporting are paid worked hours, and

 

  • Labor Hours must be paid by the facility, i.e., not paid from Medicare, Medicaid or a third-party payor. However, this does not apply to contract therapy hours. Those hours can be paid by a contract therapy company.

 

  • With #6, a benefit to including optional hours in the past has been that PPE distributions and perhaps other decisions have been based on numbers that include these hours.

 

  • Related to telehealth hours, the end of the physician visit and physician delegation waivers May 7th (per QSO-22-15-NH) means that requirements in F712 and F714 are back and the definition that all physician visits be made personally – “actual face-to-face contact with the resident, and at the same physical location, not via a telehealth arrangement”.

 

  • F712:
    • 483.30(c) Frequency of physician visits.
    • 483.30(c)(1) The residents must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 thereafter.
    • 483.30(c)(2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.
    • 483.30(c)(3) Except as provided in paragraphs (c)(4) and (f) of this section, all required physician visits must be made by the physician personally.
    • 483.30(c)(4) At the option of the physician, required visits in SNFs, after the initial visit, may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner or clinical nurse specialist in accordance with paragraph (e) of this section.
    • DEFINITIONS §483.30(c)

Must be seen, for purposes of the visits required by §483.30(c)(1), means that the physician or NPP must make actual face-to-face contact with the resident, and at the same physical location, not via a telehealth arrangement. There is no requirement for this type of contact at the time of admission, since the decision to admit an individual to a nursing facility (whether from a hospital or from the individual’s own residence) generally

 
 
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Topics: 5 star rating, Five-Star, Quality Measures, Regulatory Change, Regulatory


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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