CMS CCSQ/QSOG, effective immediately, is directing SSAs about Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute.

It is adjusting Quality Measure Ratings: CMS will be conducting audits of schizophrenia coding in the MDS data and, based upon the results, adjust the NHCC QM star ratings for facilities whose audits reveal inaccurate coding. CMS’s goal is to reduce the use of unnecessary antipsychotics and improve the accuracy of the QM and the five-star rating system.

Facilities selected for an audit will receive a letter explaining the purpose of the audit, the process that will be utilized, and instructions for providing supporting documentation. During the audit process, facilities will have the opportunity to ask questions and seek any clarification needed. Additionally, at the conclusion of the audit, the facility will have the opportunity to discuss the audit results with CMS.

Facilities that have coding inaccuracies identified through the schizophrenia MDS audit will have their QM ratings adjusted as follows:

• The Overall QM and long stay QM ratings will be downgraded to one star for six months (this drops the facility’s overall star rating by one star).

• The short stay QM rating will be suppressed for six months.

• The long stay antipsychotic QM will be suppressed for 12 months.

CMS plans to offer facilities the opportunity to forego the audit by admitting they have errors and committing to correct the issue.

SNFs should work with their psychiatric providers and medical directors to ensure the appropriate professional standards and processes are being implemented related to diagnosing individuals with schizophrenia. Information is also available in Appendix PP of

the State Operations Manual (F-tags 658, 740, and 758) and the MDS 3.0 RAI Manual (page 2 of the Errata (v2) effective July 15, 2022). Additionally, for assistance in reducing the use of antipsychotic medications, contact the QIO for additional resources, assistance, and tools that are available.

CMS will post deficiency citations under IDR/IIDR in each section of NHCC that currently displays citations, and will indicate if a citation is under dispute. If, based on the results of the IDR/IIDR process, the citations are upheld, they will remain posted and will be included in the calculation of the facility’s star rating if applicable. If the citations are overturned, they will be removed from the website. If the level of scope or severity of a citation is reduced, the citation will be displayed at the reduced level. CMS notes that on average, the majority of citations (approximately 75%) do not change after completion of the IDR/IIDR process.

While the citations will be publicly displayed, CMS will not include them in the calculation of a facility’s star rating until the dispute is complete.

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