This week the Centers for Medicare & Medicaid Services expanded the agency’s Five Star Quality Rating System for nursing homes, and proposed new conditions of participation for home health agencies.
Beginning in January 2015, CMS will implement five key improvements to the Nursing Home Five-Star Quality Rating System:
Nationwide focused survey inspections: CMS and states will begin conducting focused survey inspections nationwide for a sample of nursing homes. The inspections intended to enable better verification of the staffing and quality measure information that is part of the Five-Star QRS. In Fiscal Year 2014, the agency piloted special surveys of nursing homes that focused on investigating the coding of the Minimum Data Set, which are based on resident assessments and are used in the quality measures. Payroll-based staffing reporting: The Five-Star QRS will rely on a new quarterly electronic reporting system that is auditable back to payrolls to verify nursing home staffing information. The new system is intended to increase the accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing. Funding for the system was provided in the recently enacted Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014. Additional quality measures: The agency is increasing both the number and type of quality measures used in the Five-Star QRS. The first additional measure, starting January 2015, will be the extent to which antipsychotic medications are in use. Future additional measures will include claims-based data on re-hospitalization and community discharge rates. Timely and complete inspection data: CMS is strengthening requirements to ensure that states maintain a user-friendly website and complete inspections of nursing homes in a "timely and accurate manner" for inclusion in the rating system. Improved scoring methodology: The agency also plans to revise the scoring methodology by which it calculates each facility’s quality measure rating, which is used to calculate the overall Five Star rating.[See also: Home health case may have significant impact on organized labor.]
Home health CoPs
CMS has proposed Home Health Conditions of Participation would strengthen patient rights and improve communication that focuses on patient wellbeing. Currently there are more than 5 million people with Medicare and Medicaid benefits that receive home healthcare services each year from approximately 12,500 Medicare-certified home health agencies.
The proposed regulation, displayed Monday, October 6, at the Federal Register, would modernize the home health regulations for the first time since 1989. Elements in the regulation include expansion of patient rights requirements; refocusing of the patient assessment on physical, mental, emotional, and psychosocial conditions; improved communication systems and requirements for a data-driven quality assessment; and performance improvement (QAPI) program.