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Get Ready for PDPM Implementation on October 1

Policy Snapshot
Patient Driven Payment Model (PDPM), Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Payment, Practitioners
September 26, 2019

On October 1, the new Patient Driven Payment Model (PDPM) is replacing the Resource Utilization Group, Version IV (RUG-IV) for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). PDPM improves the accuracy and appropriateness of payments by classifying patients into payment groups based on specific, data-driven patient characteristics, while simultaneously reducing administrative burden.

Changes to the assessment:

  • Both RUG-IV and PDPM use the Minimum Data Set (MDS) 3.0 as the basis for patient assessment and classification, but the assessment
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Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Practitioners
September 26, 2019

Medicare pays Medicare Diabetes Prevention Program (MDPP) suppliers to furnish group-based intervention to at-risk Medicare beneficiaries:

  • Centers for Disease Control and Prevention (CDC)-approved National Diabetes Prevention Program curriculum
  • Up to 2 years of sessions delivered to groups of eligible beneficiaries

Find out how to become a Medicare enrolled MDPP supplier:

  • Obtain CDC preliminary or full recognition: It takes at least 12 months to obtain preliminary recognition and up to 24 additional months to achieve full recognition;
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Society Submits Comments on Participation Requirements for LTC Facilities

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Federal Regulations, Practitioners
September 19, 2019

Last week the Society submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Requirements for Long-Term Care Facilities Proposed Rule. Overall, the Society supported the proposed regulatory updates, as many reflect the work being done with CMS.

CMS’ proposed rule included revisions to guidance regarding use of PRN antipsychotic medications. The Society noted that it supported these changes, which would treat PRN orders for antipsychotic medications the same as for other psychotropic medications. The current requirement limits the use to 14 days and...

Research Firm Looking for QPP Feedback

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Quality Payment Program (QPP)
September 19, 2019

On behalf of the Centers for Medicare and Medicaid Services (CMS), a user research firm is looking for volunteers to provide feedback on the Quality Payment Program (QPP) specific to the PY2019 preliminary scoring feedback experience. The research study will run through September 27, 2019.

If you are interested in providing feedback, please click here to schedule a 50-minute one-on-one...

Save the Date for September 24 Webinar: PDPM Q&A Forum

Policy Snapshot
Patient Driven Payment Model (PDPM), Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Payment, Practitioners
September 12, 2019

The Society is hosting a webinar, Patient Driven Payment Model [PDPM] Question and Answer Forum, on Tuesday, September 24, 2019, from 7:00 to 8:30 PM ET. Society PDPM experts will be available to answer any and all questions you have regarding the upcoming PDPM implementation set to begin on October 1, 2019. Click here for more information and to register for the event.

The Centers for Medicare & Medicaid Services (CMS) also has videos to help you prepare:

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Quality Payment Program: 2019 MIPS Resources

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management
September 12, 2019

The Centers for Medicare & Medicaid Services (CMS) posted new 2019 Merit-based Incentive Payment System (MIPS) resources on the Quality Payment Program (QPP) Resource Library webpage:

  • User Guides: These highlight information on participation, data submission, and scoring for the following topics: 101, 
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Pain Management: CDC Conversation Starters for Patients and Their Doctors

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Opioids, Pain Management, Practitioners
September 12, 2019

The Centers for Disease Control and Prevention (CDC) released four new fact sheets that encourage patients and doctors to discuss pain management options and the potential risks of opioid medication. Information includes:

  • What patients can expect if they are taking opioids
  • Guidance on safer use
  • Prompts for a doctor-patient discussion of treatment goals and plans
  • Non-pharmacologic and non-opioid medication options for pain management

The fact sheets cover the important questions and information you should cover when you talk to...

REMINDER: CMS Dementia Call on September 10

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Dementia, Antipsychotics, Practitioners
September 5, 2019

This is a friendly reminder about the Medicare Learning Network call, Dementia Care: Supporting Comfort and Resident Preferences, which will take place this Tuesday (September 10) from 1:30 to 3 PM ET.

During this call, you’ll be able to gain insight on approaches to care for residents living with dementia that focus on resident preferences, maintaining comfort, and assisting with unmet needs. Additionally, a Centers for Medicare & Medicaid Services (CMS) representative will provide updates on the progress of the ...

CMS Listening Session on Opioids Scheduled for September 17

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Opioids, Practitioners
September 5, 2019

CMS Listening Session on Opioids Scheduled for September 17

Are you a physician, nurse practitioner, other advanced practice nurse, or physician assistant who prescribes opioids? The Centers for Medicare & Medicaid Services (CMS) wants your input during a listening session on September 17 from 4:30 to 6 PM ET on how best to implement Section 6065 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). ...

Quality Payment Program: MIPS Targeted Review Request Deadline September 30

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners
September 5, 2019

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are available for review on the Quality Payment Program (QPP) website. If you believe an error has been made, you can request a targeted review from the Centers for Medicare & Medicaid Services (CMS) until September 30 at 8 PM ET. The MIPS payment adjustment you will receive in 2020 is based on your final score.

For more information:

  • CMS
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