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January 2015

CMS Changes Five-Star Quality Rating Process for 2015

There will be changes to how CMS determines a nursing home's Five-Star rating. Rather than just relying on a facility's self-reporting of staffing, nursing homes will be required to submit quarterly reports of their actual staffing which will be verified by payroll data. In addition, surveys will be conducted to validate MDS coding accuracy against what actually is observed, other documentation, and resident and staff interviews. The Five Star Quality rating will be based more on what can be verified by independent reviewers rather than the nursing home's own reports.


New Recommendations for Pneumococcal Vaccination

The Advisory Committee on Immunization Practices issued a new recommendation for pneumococcal vaccination for adults age 65 and over:

  • Those who have never received any type of pneumococcal vaccine should receive PCV13 first, followed by PPSV23 6-12 months later.
  • Thosewho have already received PPSV23 should also be given one dose of PCV13; this should be given at least a year after receiving PPSV23
  • Thosewho need PPSV23 revaccination should wait at least 5 years after the last dose of PPSV23 and 6-12 months after receiving PCV13 to revaccinate.

Currently, Medicare does not cover routine use of a second pneumococcal vaccine. (Pneumococcal vaccination is covered under Medicare Part B, not under Medicare Part D.) CMS rules routinely cover only one dose of pneumococcal vaccine for all Medicare beneficiaries; for those at high risk, revaccination with PPSV23 is also covered.