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SPECIAL EDITION PULSE: Updated Sections to the MDS 3.0
As of July 15 2010, CMS has released all updated sections of the
RAI User’s Manual for the MDS 3.0, except for Appendix F. A list of the
major changes to each section included in Chapter 3 of the manual is attached.
PART B PHYSICIAN FEE SCHEDULE EXTENSION SIGNED INTO LAW
The Senate and House passed a short-term extenders bill that will stop the 21.3% cut in the Medicare Physician Fee Schedule (MPFS), which is the same schedule used to pay for Part B therapies in nursing
facilities and replaced it with a 2.2% increase from June 1 through November 30, 2010. President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010”, on June 25th.
Implementation of RUG-IV payment plan in 2010 to be interim measure
Section 10325 of the Patient Protection and Affordable Care Act (PPACA) includes a provision addressing Medicare payments for SNFs in FY 2011. This section mandates a delay in the introduction of the RUG-IV case mix classification system until FY 2012. In addition, it requires that version 3.0 of the Minimum Data Set (MDS 3.0) Resident Assessment Instrument will be implemented as planned in FY 2011.
Healthcare Reform Law and Mandatory Compliance Programs
The Patient Protection and Affordable Care Act (PPACA)
grants to the Secretary of the Department of Health & Human
Services the authority to require health care providers to adopt
compliance programs as a condition to enrollment or
revalidation in the Medicare, Medicaid and CHIP programs.
Congress Passes Legislation to Avoid 21.2% Medicare Cut Thru May 31, 2010
On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010”. This legislation extends through May 31, 2010, the zero percent update to the Medicare Physician Fee schedule (MPFS), which is the same schedule used to pay for Part B therapies in nursing facilities. The zero percent update to the MPFS was in effect for claims with dates of service January 1, 2010 through March 31, 2010.
The law is retroactive to April, 2010.
President Obama signs the healthcare reform bill into law
President Obama signed the healthcare reform bill into law on March 23, 2010. Listed in this special edition of the Polaris Pulse are a summary of key healthcare reform provisions affecting Long Term Care providers
PHYSICIAN FEE SCHEDULE FIX, EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS
The Senate joined the house in approving H.R. 4691, the Temporary Extension Act of 2010, which President Obama signed into law. The Temporary Extension Act of 2010 extends a number of important Medicare provisions through March 31, 2010.
MDS 3.0 Updates - CMS posted the remaining sections of the new RAI User's Manual on January 27, 2010
The recently released sections include Chapter 2 – Assessments for the RAI, Chapter 4 Care Area Assessment (CAA) Process and Care Planning, and Appendix C – CAA Resources. In addition to the final RAI User’s Manual sections, CMS also posted a new version of the MDS 3.0 item subsets and a file that lists the changes that have been made to each of the individual item subsets from the previously posted versions.
2010 Medicare Physician Fee Schedule Updates
Temporary Delay in Part B Fee Schedule Rate Change
On December 19th, the President signed into law H.R. 3326, the "Department of Defense Appropriations Act, 2010," which includes a zero percent Medicare Part B Fee screen update through February 28, 2010. This action staves off a 21% pay cut for Part B fee screens scheduled for January 1, 2010. Congress will continue to work in the new year on a physician fee schedule fix
CMS has published parts of the RAI manual for MDS 3.0.
What is Published and What is Not:
Chapter One: RAI overview is published.
Chapter Two: Instructions and Schedule for when to complete mandated and Medicare assessments is NOT published yet.
Chapter Three: Item by Item coding directions is published.
Chapter Four: Related to Care Area Triggers (CATS) and CAAs (Care Area Assessment) (RAPs) is NOT published yet.
Chapter Five: Submission and Correction procedures is published.
Chapter Six: Medicare Skilled Nursing Home PPS is NOT published yet.
Appendix A: Glossary of terms is published.
Appendix B: State agency and regional office contacts is published.
Appendix C: CAA is NOT published.
Appendix D: Interviewing techniques is published. Nothing surprising but should be helpful.
Appendix E: Cognitive Performance scale is published.
Appendix F: Draft Matrix is published.
Appendix G: References is published.
Coding of Flu Vaccine on the MDS
For the purposes of coding the MDS during the upcoming flu season, Nursing Facilities should only code for the “Seasonal Influenza Vaccine.” You should not code the MDS for the “H1N1 Influenza Vaccine.” Nursing Facilities should follow guidance from the Centers for
Disease Control and Prevention (CDC) for specific guidance for H1N1 Influenza. For the most up to date and accurate information, it is recommended that you frequently check the CDC Influenza Website (http:// www.cdc.gov/flu/). Any additional questions can be directed to mds30comments@cms.hhs.gov.
OIG Work Plan for Fiscal Year 2010 - Nursing Homes
The OIG has released it’s work plan for FY 2010.
There are 17 SNF- related items that will be reviewed.
1) Part B Services in Nursing Homes: Mental Health Needs and Psychotherapy Services
2) Accuracy of Skilled Nursing Facility Resource Utilization Groups Coding
3) Medicare Requirements for Quality of Care in Skilled Nursing Facilities
Federal Guidelines Encourage Employers to Plan Now for Upcoming Influenza
Priority Order of Quality Indicator Survey (QIS)
SPECIAL PRESENTATION—5 Star Quality Rating System
RAC Attack! Are you ready for a RAC Audit?
Proposed Changes to the Prospective Payment System and Rate Year 2010 Rates
Medicare Announces Sites for Pilot Program to Improve Quality as Patients Move Across Care Settings
CMS Releases Updated Special Facility Focus List
Revised Quality of Care Guidance at F309
OIG Supplemental Compliance Program Guidance for Nursing Facilities
New HIPAA Privacy Rule Guidance for Providers
Revised Guidance to Surveyors - F325 & F371
2009 Medicare Premiums Deductibles and Coinsurance
ICD-9-CM ANNUAL UPDATE
Fiscal Year 2009 Skilled Nursing Facility Prospective Payment System
(SNF PPS) Final Rule

Medicare Improvements for Patients and Providers Act, 2008
SPECIAL EDITION PULSE - Update on Therapy Caps
June 27, 2008 special edition
Therapy Cap Exception Process Update
June 25, 2008 edition
Exceptions to Therapy Caps Restricted July 1, 2008
June 11, 2008 edition
Assignment of Providers to MACs
May 5, 2008 edition
2008 Medicare Deductible, Coinsurance and Therapy Caps
January 8, 2008
Fiscal Year 2008 OIG Work Plan
October 24, 2007
CMS Issues New Survey Tag F373 - Paid Feeding Assistants
August 23, 2007
Skilled Nursing Facility (SNF) Payment Rates for Fiscal Year 2008
August 10, 2007
Revised F-Tags 323 adnd 324 - Accidents and Hazards
CMS Announces NPI Data Dissemination Policy
June 13, 2007
CMS Proposes SNF Payment Increase for Fiscal Year 2008
May 10, 2007
CMS Issues Contingency Plan for the National Provider Identifier (NPI) Rule
April 11, 2007
Medicare Payment Advisory Commission (MedPAC) Recommendations to Congress
March 28, 2007
CMS Renames the Medicare/Medicaid Provider Number
March 13, 2007
NPI - Do You Have It? Are You Sharing It? Are You Using It?
February 23, 2007
Part B Therapy Cap Relief for 2007
January 3 , 2007
Physician Fee Schedule 2007 - Final Rule
November 9, 2006
Flu Season is Here -
Are you ready for the New Regulations and Quality Measures?

October 26, 2006
Medicare Nursing Home Payments to Increase in 2007
August 1, 2006
CMS Issues DRAFT Revision to Surveyor Guidance at F-Tag 309 - Pain
July 14, 2006
CMS Issues Guidance for Benefits Exhaust and No-Payment Bills
June 12 , 2006
Who, What, When, Why & How of the National Provider Identifier (NPI)
May 31 , 2006
New, Revised and Draft Guidance to Surveyors Apr. 19, 2006
Therapy Cap Exception Process Feb. 16, 2006
Outpatient Therapy Caps Return for 2006 Jan. 16, 2006
Rehab Plus Extensive Services – Criteria to Achieve and RUG Assignment Anomalies Dec. 16, 2005
Medicare Part D & Its Impact on Nursing Home Surveys Nov. 10, 2005
Revisions to the State Operations Manual for Long Term Care
Oct. 27, 2005
CMS FAQs Related to Hurricane Katrina Sept. 20, 2005
RUG Refinements Posed to Significantly Impact Your 2006 Budget
August 23, 2005
Hepatitis B Transmission in Nursing Homes July 11, 2005
New Independent, Expedited Review Process for SNF Notices of Non-Coverage June 15, 2005
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