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Sabrena McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, RAC-CTA
🚨 Breaking: CMS Releases Revised Nursing Home Survey & Enforcement Guidance (QSO-26-03-NH) Memorandum Summary: CMS is releasing the following guidance in Chapter 5 of the SOM: *Revisions to Immediate Jeopardy Priority Definition examples for Nursing Homes; and *Clarification of Off-site investigations. CMS has updated and revised guidance in Chapter 7 of the SOM that includes: *Survey Team Composition, Survey Procedures, Plans of Correction, Verifying Corrections, Survey Revisit and Offsite Revisit Paper Review, Off-hours Survey, Enforcement, Nurse Staffing Waivers, Disposition of Civil Money Penalties (CMP), Federal Civil Penalties Inflation Reduction Act, Informal Dispute Resolution (IDR), and Independent Informal Dispute Resolution (IIDR); *Additionally, guidance previously found in Appendix P of the State Operations Manual has been added to Chapter 7; and *Technical changes that include updates for accurate references. https://lnkd.in/gKVuWbSq
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Mark Dudley
For Licensed Nursing Home Administrators (LNHAs), managing your facility's Case Mix Index (CMI) is a critical administrative strategy that directly influences Medicaid reimbursement. Understanding the factors that drive CMI and actively managing them is essential. Key drivers within CMI include: - **Nursing Groups**: While most resident categories remain stable, administrators must be alert to changes in resident conditions that can significantly impact CMI. - **Infection Outbreaks Requiring Isolation**: An active infection necessitating isolation protocols is a major CMI driver. To accurately capture this, the resident must be in a private room or moved to one for the duration of the isolation. - **IV Fluids for Dehydration**: Whether administered during a hospital transfer or within your facility, IV fluids to prevent dehydration can significantly affect CMI. - **Diabetes and Insulin Order Changes**: Any two or more changes to insulin orders for diabetic residents can put them in the Special Care High clinical category. - **Activities of Daily Living (ADLs)**: Accurate ADL coding demands ongoing staff training and interdisciplinary Team (IDT) oversight to validate documentation. Prompt reassessment and documentation following significant changes in condition (such as a fall) are crucial to reflect the resident's current functional needs. - **Restorative Nursing Programs**: Restorative care applies to residents in Reduced Physical Function and Behavioral Symptoms and Cognitive Performance categories. To qualify, a resident must participate in two distinct restorative programs for at least six days within the seven-day look-back period from the MDS’s Assessment Reference Date (ARD). - **Depression Severity**: The depression end split applies to residents in Special Care High, Special Care Low, and Clinically Complex categories. A score of 10 or higher on the PHQ-9 assessment indicates a significant level of depression, qualifying for higher CMI potential. In conclusion, proactive CMI management is essential. Effective management goes beyond maximizing reimbursement; it ensures your facility accurately captures the complexity of care provided,
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