Nursing Home News 2025Dec18
Audit Documentation
PLEASE NOTE: MLTC reports that Myers & Stauffer is having some difficulty in acquiring the General Ledger reports as requested for supporting documentation of reported costs. This is a requirement that DHHS implemented in response to recent audit findings.
It is the expectation of the DHHS that any documentation of expenses/variances will be supported as requested. Please refer to regulation 471 NAC 45-010 Audits (below). Failure to provide proper documentation will lead to removal of the unsupported costs.
45.010. AUDITS. The Department will perform at least one initial desk audit and may perform subsequent desk audits or a periodic field audit of each cost report. Selection of subsequent desk audits and field audits will be made as determined necessary by the Department to maintain the integrity of the Nebraska Medical Assistance Program. The Department may retain an outside independent public accounting firm, licensed to do business in Nebraska or the state where the financial records are maintained, to perform the audits. Audit reports must be completed on all field audits and desk audits. All audit reports will be retained by the Department for at least three years following the completion and finalization of the audit. An initial desk audit will be completed on all cost reports. Care classification maximums and average base rate components are computed using audited data following the end of the Cost Report Period. Subsequent desk and field audits will not result in a revision of care classification maximums or average base rate components. All cost reports, including those previously desk audited but excluding those previously field audited, are subject to subsequent desk audits. The primary period or periods and subject or subjects to be desk-audited are indicated in a notification letter sent to the provider to initiate a subsequent desk audit. The provider must deliver copies of schedules, summaries, or other records requested by the Department as part of any desk audit. All cost reports, including those previously desk-audited but excluding those previously field-audited, are subject to field audit by the Department. The primary period or periods to be field-audited are indicated in a confirmation letter, which is mailed to the facility before the start of the field work. A field audit may be expanded to include any period otherwise open for field audit. The scope of each field audit will be determined by the Department. The provider must deliver to the site of the field audit, or an alternative site agreed to by the provider and the Department, any records requested by the Department as part of a field audit.
CMS Shifts Service-Level MA Data Collection to a Voluntary Pilot. On December 16, a CMS memorandum answered our question of when a new Medicare Advantage data collection initiative would be implemented by outlining its decision to roll out this required data collection first as a voluntary pilot in 2026 and then to all plans sometime in the future. In September, the Centers for Medicare and Medicaid Services (CMS) finalized with approval from the Office of Management and Budget (OMB) a requirement for Medicare Advantage (MA)plans to report service-level data regarding their initial determinations and appeals related to both coverage and claims payment decisions. At the time that it was finalized, the implementation year was left blank. Although CMS suggests that this approach is to basically work out any kinks before a full-scale implementation, LeadingAge and other provider organizations question whether this is another step in CMS rolling back MA requirements that support MA plan compliance with and accountability for following Medicare regulations and as such, may never be implemented fully. LeadingAge felt this was an important policy victory when this data collection was finalized as CMS adopted many of our recommendations on what data elements should be collected. This data if collected on all MA plans could provide a comprehensive picture across plans of their prior authorization and payment denial patterns and evidence to point to where future reforms to MA plan practices should focus.
5 Star Reports: After a slight delay in reporting by CMS, SNF data has become available to update the latest 5 Star Reports. Your 5 Star Analysis Report will soon be available in the LeadingAge Report Portal. For those with multiple providers, reports will be sent to you by the end of the week. With the new SNF data, the MDS QMs and staffing data are from 2025Q2, the claims QMs are using 2025Q1, while the QRP QMs vary in the measure period depending on the QM.
SMK Medical 2026 QAPI Self-Audit flipbook. The QAPI Self-Audit Calendar provides a structured, month-by-month approach to self-auditing your facility’s compliance with the most frequently cited F-tags. Dr. Demetrius Kirk and the SMK Medical team are providing this complimentary resource for LeadingAge Nebraska members. Access here.
Seeking Feedback on Long-Stay Antipsychotics Measure. LeadingAge is seeking feedback on the impact of the long-stay antipsychotics quality measure on Nursing Home Care Compare. This measure provides information on rates of antipsychotic usage in nursing homes and is utilized in the Five Star Quality Rating System. LeadingAge is a member of Project PAUSE, a coalition advocating for changes to the quality measure due to the relative failure of the measure to distinguish between appropriate and inappropriate antipsychotic usage and we would like your feedback. What has been the impact of this quality measure in your nursing home? Have your star ratings suffered, and what has been the impact of that? Is your nursing home more reluctant to admit potential residents who are already prescribed antipsychotics? Have you felt pressured to deprescribe for residents who were appropriately prescribed antipsychotics? Please share your input by emailing Jodi Eyigor jeyigor@leadingage.org. Note that we will not share any identifying information – we are simply looking for concrete examples of the impact of this measure.
Measures Under Consideration (MUC) List 2025 is Out. The Measures Under Consideration (MUC) List for 2025 was released on December 15. This list, released annually by December 1 and delayed this year by the federal government shutdown, details quality measures currently under consideration for the Centers for Medicare & Medicaid Services (CMS) various quality programs. Among the 24 measures under consideration in 2025, there is one measure under consideration for the Home Health Quality Reporting Program (QRP), Skilled Nursing Facility (SNF) QRP, and SNF Value-Based Purchasing (VBP). This measure, Advance Care Planning, is under consideration for many of the quality programs and varies only slightly by setting. There are currently no measures under consideration for the Hospice QRP. Public listening sessions and public comments will take place in early January 2026. To view the measures and learn more, check out the CMS Measure Management Systems (MMS) Hub.
Supporting Documentation for POI: Providers are reminded to submit supporting documentation for your plan of improvement to the dhhs.healthcarefacilities@nebraska.gov email address. Recently several providers have attached these documents in the iQIES system, which is incorrect. The state does not receive notification that these attachments are present and is unable to access them.
Be on the lookout! Provider renewals for nursing homes will begin distribution in January. License renewals for long term care are due on March 31st
