Erroneous Schizophrenia Coding Will Decrease Nursing Home Star Ratings and New Information To Be Included In Nursing Home Care Compare

On January 18, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Memorandum to all state survey agency directors addressing erroneous schizophrenia coding and increased transparency of Nursing Home Care Compare. 

Erroneous Schizophrenia Coding

CMS is concerned that inaccurate Minimum Data Set (MDS) coding of schizophrenia among nursing home residents may lead to the use of unnecessary antipsychotic medications. Decreasing the use of antipsychotic medications in nursing homes is consistent with the White House’s goal of improving safety and quality of care in nursing homes, as identified in a White House Fact Sheet released in February 2022.
The Memorandum identifies that effective immediately after the publication, CMS will begin auditing nursing home schizophrenia MDS coding. If the MDS coding is determined to be inaccurate, the nursing home’s quality measure rating will be suppressed and the star ratings will be adjusted.
For nursing homes with errors identified in an audit, CMS will:

  1. Downgrade the Overall Quality Measures (QM) and long stay QM ratings to one star for six months, which will drop the nursing home’s overall star rating by one star;
  2. Suppress the short stay QM rating for six months; and
  3. Suppress the long stay antipsychotic QM for 12 months.

CMS will provide an opportunity to nursing homes chosen for an audit to admit that there are errors and commit to correcting the issues. If a nursing home agrees to admit there are errors and foregoes an audit, CMS will consider imposing a lesser action than if an audit had been completed and identified errors. CMS will monitor all nursing homes where errors are identified on audit or where the nursing home has admitted to errors.

Increased Transparency to Nursing Home Care Compare

In the Memorandum, CMS also notes that any deficiency citation received by a nursing home will now be shown in Nursing Home Care Compare, regardless of whether the citation is being disputed. CMS acknowledges that the number of disputes under Informal Dispute Resolution/ Independent Informal Dispute Resolution (IDR/IIDR) is relatively small, however, CMS also identified that some serious deficiencies, including immediate jeopardy, are included in these deficiencies, and consumers should have knowledge of these citations.
If the citation is under dispute, Nursing Home Care Compare will identify that the citation is under dispute, and the disputed citations will not be included in the nursing home’s star ratings, if applicable, until the IDR/IIDR process is completed. If the citation is upheld after the IDR/IIDR process is completed, the citation will remain posted and will be included in the nursing home’s star rating. These citations will also be included on the Quality, Certification and Oversight Report (QCOR) website. If the citation is overturned, the citation will be removed from Nursing Home Care Compare. CMS notes that approximately 75% of the citations remain unchanged after the IDR/IIDR process is completed.

Nursing homes will need to be more vigilant with their assessments, coding, and treatment of patients with schizophrenia to ensure that the coding is accurate and antipsychotic medications are utilized only when necessary. Nursing homes will also need to be prepared to explain deficiency citations to residents, prospective residence, and families since now all citations, even the ones that are in dispute, will be identified in Nursing Home Care Compare.
ArentFox Schiff is tracking the latest developments in nursing home scrutiny and transparency and is prepared to assist clients in meeting heightened compliance requirements.


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