1. Open Door Forum: SNF Quality Reporting Program Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum FY 2016 SNF PPS NPRM Tara McMullen, PhD Division of Chronic and Post Acute Care May 14, 2015

2. The IMPACT Act of 2014 sets forth the requirements for Skilled Nursing Facilities (SNFs) to submit data to CMS. Beginning FY 2018, providers [SNFs] that do not submit required quality reporting data to CMS will have their annual update reduced by 2 percentage points. SNFs are providers that meet Medicare requirements for Part A coverage. The 60-day public comment period for the FY 2016 SNF PPS NPRM ends on June 19, 2016. Note: Details presented here are proposals and are subject to change in the Final Rule. CMS welcomes public comments. Introduction: SNF Quality Reporting Program FY 2016 SNF PPS NPRM (CMS-1622-P) 2

3. Please refer to the FY 2016 Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection; Proposed Rule for complete information available at: https://www.federalregister.gov/articles/2015/04/2 0/2015-08944/medicare-program-prospective- payment-system-and-consolidated-billing-for- skilled-nursing-facilities https://www.federalregister.gov/articles/2015/04/2 0/2015-08944/medicare-program-prospective- payment-system-and-consolidated-billing-for- skilled-nursing-facilities FY 2016 SNF PPS NPRM (CMS-1622-P) on Display As of April 20, 2015 3

4. Three proposed post-acute care (PAC) cross-setting measures addressing the following domains: – Skin integrity and changes in skin integrity – Incidence of major falls – Functional status, cognitive function, and changes in function and cognitive function Proposed data submission compliance deadlines and thresholds: – Failure to submit required quality reporting data to CMS will result in a 2% reduction to the FY 2018 market basket percentage Proposed SNF QRP Submission Exception and Extension Requirements: – Written request required within 90 days of the date extraordinary circumstances occurred SNF Quality Reporting Program FY 2016 SNF PPS NPRM (CMS-1622-P) Policy Proposals 4

5. NQF Measure ID Measure Title Data Collection Timeframe Data Submission Deadline NQF #0674Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) 10/01/16- 12/31/16 May 15, 2017 NQF #0678Percent of Patients or Residents with Pressure Ulcers that are New or Worsened 10/01/16- 12/31/16 May 15, 2017 NQF #2631*Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function 10/01/16- 12/31/16 May 15, 2017 *Status: Under NQF Review FY 2016 SNF QRP NPRM (CMS-1622-P) Quality Measures 5

6. NQF #2510 Skilled Nursing Facility 30-Day All- Cause Readmission Measure Application of the Payment Standardized Medicare Spending Per Beneficiary (MSPB) Percentage residents/patients at discharge assessment, who are discharged to a higher level of care or to the community. Possible Quality Measures for Future Years 6

7. Additional information on the proposed SNF quality measures is available at the following website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/SNF-Quality- Reporting-Program-Measures-and-Technical-Information.html Measure Information 7

8. Requires SNFs, HHAs, IRFs, and LTCHs to report standardized assessment data on:  Specified Assessment Instrument Domains: functional status; cognitive function and mental status; special services, treatments, and interventions; medical conditions and co-morbidities; impairments; and other categories  Quality Measure Domains: functional status; cognitive function and changes in function and cognitive function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; transfer of health information when the individual transitions from the hospital/critical access hospital to post- acute care (PAC) provider or home, or from PAC provider to another settings Requires the submission of Data On:  Resource Use, and Other Measures: Total estimated Medicare spending per beneficiary discharged to the community, all condition risk-adjusted potentially presentable hospital readmission rates Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

9. The Implementation of Measures Will Evolve Over Time To meet the October 2016 implementation date for the measure domains specified under the Act for that time frame the following considerations were given: Addresses a current area for improvement tied to a stated domain Consideration of measures previously support by the Measures Application Partnership (MAP) Endorsed, implemented/finalized for use in the post-acute care quality reporting programs (QRPs), e.g., NQF #0678 Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened; NQF # 0674 Percent of Residents Experiencing One or More Falls with Major Injury Minimize added burden to the providers Where possible, avoid any impact on current assessment items already collected Avoid duplication of existing assessment concepts Pathway Toward Transformation:

10. Please submit public comments by 5pm on June 19, 2015 electronically at http://www.regulations.gov OR You may mail comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: PCMS–1622–P, P.O. Box 8016, Baltimore, MD 21244–8016 More information on the IMPACT Act is available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and- Cross-Setting-Measures.html http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and- Cross-Setting-Measures.html Important Dates & Resources 10

11. Questions? 11