The Affordable Care Act Section 6101 has directed the Centers for Medicare and Medicaid Services to roll out the submission of "Payroll Based Journals" for Skilled Nursing Facilities and Nursing Facilities effective July 1, 2016.
The requirement effectively mandates that SNFs and NFs will electronically report to CMS daily staffing data, including agency and contracted employees, on a quarterly basis. This latest requirement is an attempt to create more public staffing transparency, enhance the Nursing Home Compare 5 Star public database, allow CMS to track tenure / turnover and to study national/regional staffing patterns as well as variations in staffing among "like" providers in addition to For Profit and Non-Profit staffing disparities.
The ruling is specifically interested in the reporting of direct care staff, not all employees in the facility. Daily staffing data will be collected quarterly: December 31, March 31, June 30 and September 30. The submission deadline is set whereby data must be received by the "45th calendar day (11:59PM Eastern Standard Time) after the last day in each fiscal quarter in order to be considered timely." Facilities will be allowed to transmit data at any time or frequency within the quarter.
Direct care staff is defined as "...those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain the highest practicable physical, mental and psychosocial well-being." It does not include those whose primary duty is maintaining the physical environment of the long term care facility.
CMS is requiring that facilities submit the following data to ensure "complete and accurate" direct care staffing information: category of work performed by the individual, resident census data, information on direct care staff tenure/turnover and the hours of care provided by each category of staff per resident per day (including start date, end date, hours worked, and more). Questions about the submission of data may be directed here.
Reporting requirements will extend beyond what is considered traditional direct care staff (RN, LPN, CNA, CMRT, etc.) to also include Physical Services, Medical Director, DON, Therapy, Dietician, Pharmacy Services, and even more positions.
While voluntary submission of data has been permissible since October 1, 2015, providers that are going to submit beginning July 1, 2016 (again, the mandatory date to begin collecting this data for submission by the quarterly due dates) must first register with CMS. Information on how to register, various training modules and related policy manuals are available at the CMS website.
Now that CMS will have this data, it will be interesting to see what they do with it. Certainly future payment reform models will be discussed. CMS is already examining a potential shift to a Diagnostic Related Group payment based model, similar to DRGs in the acute care setting, in federal year 2019.
In addition to the payroll based journals submission, CMS will also have at its disposal claims/billing information that make up Resource Utilization Group data as well as expenses, revenues, wage index information and direct care cost/hours by discipline (in-house, agency, contracted Nursing and Therapy Services included) as reported on filed Medicare cost reports.
The aggregation of this information will now allow for an examination of RUG rates by component to test Time Study assumptions for the nursing and therapy components. This will additionally allow for further audit scrutiny that will enable CMS to test for possible billing, claims and coding violations.
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