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Changes to LTC, Provider Requirements to Participate In Medicaid, Medicare Payments
. These requirements have not been comprehensively updated since 1991 despite significant changes in the industries.
. The finalized provisions reflect advances in the theory and practice of service delivery and safety and implement sections of the Affordable Care Act(ACA) .
. Focus on each resident achieving their highest practicable physical, mental, and psychosocial well-being.
. Reducing unnecessary hospital readmissions, with a focus on improved Quality of Life!
. Quality of Care and Quality of Life--overarching principles for every service (Department).
. Value-based programs rewarding health care providers with incentive payments for the quality of care they give to people with receiving Medicare
The Goal of Higher Performance in QIS, QUPI Outcomes, Hospital Quality Initiative (HQI), with the understanding CMS, state and federal Survey itself, is a "Quality Indicators Survey (QIS) Process performed to measure a facilities quality indicator are working. There is “No one-size fits all approach”! Skilled nursing facilities (SNFs) and (NFs) are required to be in compliance with the requirements at 42 CFR §483.75, to receive payment under the Medicare or Medicaid program. The Quality Improvement Process reaches beyond Nursing Homes, used as a Quality measures in all activities, and all disciplines that receive Medicaid and Medicare Funds, Hospital Quality Initiative (HQI), Home Health Agencies, and as of November 2017 Behavior Health Centers must also comply with §483.75 Food and Nutrition Services, 482.21 (Hospital) Dietary Service.
This process also may be applied to Standard of Practice within Assisted Living, Home Health Agencies. Application of CMS Quality Indicators in Food Service, building Tools that can be used in all Healthcare settings to prevent negative outcomes.
§ 483.75 (LTC) / 482.21 (Hospital) Quality Assurance and Performance Improvement
(a)Quality assurance and performance improvement (QAPI) program. Each LTC facility, including a facility that is part of a multiunit chain, must develop, implement, and maintain an effective, comprehensive, data-driven QAPI program that focuses on indicators of the outcomes of care and quality of life. The facility must -
(1) Maintain documentation and demonstrate evidence of its ongoing QAPI program that meets the requirements of this section. This may include but is not limited to systems and reports demonstrating systematic identification, reporting, investigation, analysis, and prevention of adverse events; and documentation demonstrating the development, implementation, and evaluation of corrective actions or performance improvement activities;
(2) Present its QAPI plan to the State Survey Agency no later than 1 year after the promulgation of this regulation;
(3) Present its QAPI plan to a State Survey Agency or Federal surveyor at each annual recertification survey and upon request during any other survey and to CMS upon request; and
(4) Present documentation and evidence of its ongoing QAPI program's implementation and the facility's compliance with requirements to a State Survey Agency, Federal surveyor or CMS upon request.
(b)Program design and scope. A facility must design its QAPI program to be ongoing, comprehensive, and to address the full range of care and services provided by the facility. It must:
(1) Address all systems of care and management practices;
(2) Include clinical care, quality of life, and resident choice;
(3) Utilize the best available evidence to define and measure indicators of quality and facility goals that reflect processes of care and facility operations that have been shown to be predictive of desired outcomes for residents of a SNF or NF.
(4) Reflecting on the complexities, uniqueness of care, and services that the facility provides.
(c)Program feedback, data systems and monitoring. A facility must establish and implement written policies and procedures for feedback, data collections systems, and monitoring, including adverse event monitoring. The policies and procedures must include, at a minimum, Quality of Care and Quality of Life.
§483.25(g)(1)(3), 483.25(g)(2), Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents’ choices. Including Tags (F241, Dignity, F242, Self-determination and Participation, F272, Comprehensive Assessments, F278, Accuracy of Assessments, F280, Comprehensive Care Plan Revision…)
§483.15 Quality of Life (Food and Nutrition Services
The facility must promote care for residents in a manner and in an environment, that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality. Promoting resident independence and dignity in dining (such as avoidance of day-to-day use of plastic cutlery and paper/plastic dishware, bibs instead of napkins, dining room conducive to pleasant dining, aides not yelling);
Tools for Food, Dining Service Directors, Managers
1. Based on a 2010 survey 40 percent of the 15,000 long term care facilities failed to meet the bases of 42 CFR. This Webinar will focus on the opportunity for Food Service Operations to better perform within the intended guidelines, as well as understand and interpret intent regulation intent.
2. This webinar may also be used as a means to introduce to managers “Methods”, “Tools”, “Best Practices” for facilities, managers who want to perform higher in the Quality Outcomes. Hospital’s Quality Initiative (HQI), most notably from the Hospital Compare website. These type of quality measures are used in other CMS hospital quality initiatives, requiring all healthcare organizations to both measure, put in place quality improvement measures with similar outcomes.
3. Actual Tools Offered
a. Slides Presentation of Manager Training on CMS Guidelines Quality Indicators
b. Online sources “States Guidance to Surveyors for Long Term Care Facilities, ”
c. Online source of “Actual Forms” (actual inspector notes/inspection)
d. Tools Used in Food Service Audit/Survey, Operation, documents, correct actions, improve overall quality of life for residence
i. Dietary Observations
ii. Monthly Meal Quality Review
iii. Monthly Sanitation/Infection Control Review
iv. Meal Audit Tool
v. Kitchen/Food Service Observation
e. Tools designed to discover how to best use and keep your operation Deficiency Free
i. Food Service Audit Tool
ii. Meal Temperature Logs
iii. Tray Accuracy Tool
iv. Test Tray Audit Tool
v. Mock Survey
vi. Quality Indicators that have corrected Deficient Outcomes in the past.