Issues and Updates
CMS Clarifies Rural Eligibility Status For CAHs, RHCs, Swing-beds
The Centers for Medicare & Medicaid Services has provided clarification on the eligibility requirements for certain rural providers. A hospital seeking critical access hospital designation must be located outside a metropolitan statistical area or be treated as rural in accordance with 42 CFR 412.103. A hospital seeking swing-bed status or a clinic seeking rural health clinic certification must be located outside an area delineated as “urbanized” by the U.S. Census Bureau. For purposes of hospital swing-bed and RHC eligibility, an “urban cluster” is not an “urbanized” area.
CMS Issues Revised Guidelines For CAH Observation Beds
In a recent transmittal, the Centers for Medicare & Medicaid Services made substantial changes to the way beds are counted against the 25-bed maximum for a critical access hospital. Under the new changes, a CAH can maintain beds used solely for outpatient observation services without counting them toward the statutory maximum of 25 inpatient beds.
Rural Health Care: Its Effect On Rural Communities
Healthcare Environment in Transition: Opportunities for Rural Health Systems
Rural Missouri Success Stories Panel Presentation
- Click here for video recordings of Al Greimann, Michael French and Craig Eichelman.
Rural Missouri Success Stories Reactor Panel
Health Care Workforce Legislative Panel
Rural Health Care Summit Proceedings
OB Harm Regional Meetings
Early Elective Delivery
OB Harm Collaborative Resources
Perinatal Care Measures Webinar by Celeste Milton, TJC (1/27/15)
OB Harm Webinar (8/20/14)
OB Harm Webinar - Presentation, Recording (7/9/14)
OB Harm Additional Resources
Prematurity, Infant Mortality Task Force Issues Final Report
The Missouri Task Force on Prematurity and Infant Mortality sent Gov. Jay Nixon and members of the Missouri General Assembly its final report of the status and recommendations for improving infant and maternal outcomes in the state. The Missouri legislature established the Missouri Task Force on Prematurity and Infant Mortality in 2011 to seek evidence-based and cost-effective approaches to reduce Missouri’s pre-term birth and infant mortality rates.
Critical Congenital Heart Disease Screening
Missouri Newborn Screening Program
Patient Safety Resources
The most common retained foreign object in hospitals are sponges during vaginal deliveries. The following resources are designed to prevent retention of foreign objects during vaginal deliveries.
Road Map to Preventing Retained Objects in Vaginal Deliveries
Road Map to Preventing Retained Objects in the O.R.
Share Pregnancy and Infant Loss Support Inc.
Long-Term Care Hospitals
Issues and Updates
Rule Finalizes LTCH Quality Reporting Program Measures
In the fiscal year 2014 final rule for the inpatient and long-term care hospital PPS, the Centers for Medicare & Medicaid updated several previously finalized measures used for the LTCH quality reporting program and finalized new measures for FYs 2017 and 2018. No date has been set for public reporting of LTCH quality measures.
For the FY 2016 LTCH QRP, CMS will collect the health care personnel flu vaccination measure from Oct. 1, 2014, through March 31, 2015. For the patient influenza vaccination measure, CMS has changed the data collection time frame to Oct. 1 through April 30. Both measures require data submission by May 15 of each year. CMS also finalized three new measures for the FY 2017 LTCH QRP.
- Methicillin-resistant Staphylococcus aureus bacteremia using the National Healthcare Safety Network’s system
- Clostridium difficile using NHSN’s system
- Unplanned all-cause readmissions for 30 days post-discharge from LTCHs will use the same approach as the hospitalwide all-cause unplanned readmission measure currently in the hospital inpatient quality reporting program. The measure excludes some “planned” readmissions (i.e., chemotherapy, labor/delivery, transplantation, amputations, removal of feeding and tracheostomy tubes and some colorectal procedures).
CMS finalized one new measure for the FY 2018 LTCH QRP — the percentage of patients experiencing one or more major falls with injury. CMS has approved changes to the LTCH CARE Data Set (version 2.01, effective April 2014) for pressure ulcer, patient influenza and fall measures.
Section 3004 of the Affordable Care Act
The Centers for Medicare & Medicaid Services has created a website to support Section 3004 of the Affordable Care Act - Quality Reporting for Long Term Care Hospitals, Inpatient Rehabilitation Hospitals and Hospice Programs.
The Long-Term Care Hospital moratorium regulations at 42 CFR 412.23(e)(6) –(7) adopted as part of the FY 2015 Inpatient Prospective Payment System and LTCH Prospective Payment System final rule were effective on October 1.
The Centers for Medicare & Medicaid Services Regional Offices will determine whether a hospital seeking to convert to LTCH status, or an LTCH seeking to add a satellite, qualifies for one of three exceptions to the moratorium outlined in the survey and certification memo 15-03 Hospitals issued on Oct. 10.
Skilled Nursing Facility
A Long-Term Care Survey Manual prepared by staff of the University of Missouri nursing home consultant program is available on the Quality Improvement Program for Missouri's Long-Term Care Facilities website.
Home Health and Hospice
CMS issued a survey and certification memo, 14-14-HHA, on March 14 which includes revisions to Appendix B – Guidance to Surveyors: Home Health Agencies and to the State Operations Manual Chapter 2, sections 2180 to 2202.19. In addition, CMS has developed a new SOM Chapter 9 to provide guidance to surveyors on available alternative sanctions including civil money penalties and an informal dispute resolution process.
Hospice State Operations Manual Appendix M
Issues and Updates
Rule Finalizes IRF Quality Reporting Program Measures
The Centers for Medicare & Medicaid Services’ final rule for the inpatient rehabilitation facility PPS for fiscal year 2014 updated the measures for the IRF quality reporting program. No date has been set yet for the public reporting of quality measures for long-term care hospitals.
For the FY 2016 IRF QRP, the IRFs will collect the health care personnel flu vaccination measure from Oct. 1, 2014, through March 31, 2015, using the National Healthcare Safety Network’s system. Changes for FY 2017 include the following.
- Patient Influenza Vaccination Measure — IRFs will be required to report the influenza vaccination measure for the entire calendar year using the IRF patient assessment instrument. Measure performance will be calculated based on flu season (Oct. 1 through March 31).
- Unplanned all-cause readmissions for 30 days post-discharge to short-stay acute care hospitals and long-term care hospitals will use the same approach as the hospitalwide all-cause unplanned readmission measure that is currently used in the hospital inpatient quality reporting program.
With the implementation of the revised IRF-PAI scheduled Oct. 1, 2014, CMS will collect only three quarters of data for the FY 2016 program (Jan. 1, 2014, through Sept. 30, 2014).