CMS call takes listeners back in time for MDS compliance but offers nothing new on staffing mandate

The Centers for Medicare & Medicaid Services invited the nation’s nursing home stakeholders to a conference call Thursday afternoon but played its cards close to the vest regarding its pending release of a first-ever nursing home minimum staffing mandate. 

The call’s moderator pre-empted any would-be questioners about the staffing rule at the very start, advising that the topic would not be addressed and questions about it would not be entertained.

What followed was an exhaustive, general review of previously announced CMS rules and actions for the minority of attendees who might not have already known of them, and a lengthy Q&A session, centering mostly on MDS details.

If nothing else, the call illustrated that the nation’s providers still have plenty of questions about the Oct. 1 rollout of the biggest overhaul to the MDS in years.

But not a word was shared about the White House’s staffing mandate, which moved closer to being released Thursday, when it was discovered that the Office of Management and Budget website had marked its review of the proposals as “concluded.”

That was preceded on Tuesday by the accidental temporary release of a CMS study report on the issue. The anticipatory pump on the most intensely watched nursing home issue of 2023 was further primed Wednesday, when it was revealed regulator meetings on the staffing mandate scheduled for September had disappeared from the OMB website, ostensibly canceled.

So Thursday’s Open Door conference had an undeniable buzz of expectation well before it began. A CMS moderator, however, quickly doused any hopes of talk about the looming staffing mandate, which providers have estimated could cost up to $11.7 billion extra annually.

“We know that many of you may have questions about the forthcoming minimum nursing home staffing standards,” the moderator informed the crowd both verbally and in writing before starting the main program. “CMS is committed to improving safety and quality of care for nursing home residents and looks forward to sharing the proposal with you soon. Please hold all questions related to the proposal as we will not be addressing the topic today.”

Although there is nothing to stop regulators from holding the proposed rule back for days or even weeks, on Thursday policy experts widely expected it to be released Friday. It would cap an 18-month process that began with the announcement of a sweeping nursing home reform package the day before President Biden’s first State of the Union Address in 2022.

Back to the future with MDS

Six CMS subject matter experts spoke during the hourlong call. Much of their time was devoted to nuances of the MDS 1.18.11, the overhauled version of the resident assessment tool that will go live Oct. 1.

Recordings of the Open Door Forum calls  can be found on the CMS website.

Providers need to continue educating their staff members on the significant changes that are coming, emphasized Ellen Berry, deputy director of the Division for Quality Systems for Assessments and Surveys in CMS’s Center for Clinical Standards and Quality.

Crossover training and execution regarding Oct. 1 is especially important, she said.

“The two versions of the MDS (the current and post-Oct. 1 formats) are extremely different and are not interchangeable,” Berry said. “This is similar to October 2019. We will, therefore, handle the same way with the crossover rules.”

This means, Berry explained, that providers may not modify the target date of an assessment completed prior to Oct. 1 to a target date on or after Oct. 1, and vice versa. 

“For example, if a provider submitted an MDS assessment with a target date of Sept. 29, and determined that the target date should have been Oct. 2, you may not modify the MDS,” she noted. “You must code and complete a new MDS, which in this example, would be 1.18.11.” 

Information for this has been included in Chapter 5 of the RAI manual, she added.

August has seen a flurry of activity to get MDS-related training and informational materials in the hands of nursing home personnel. On Aug. 2, CMS posted key training materials, including recordings of training webinars and workshops. Last week, on successive days, the agency posted the final MDS 3.0 v1.18.11 users manual, a post-event QA document with responses to questions received through the agency’s training campaign, and the final MDS 3.0 item sets.

Providers can send questions to CMS information experts at [email protected].