Skilled nursing facility quality reporting program measure calculations and reporting user’s manual

The Centers for Medicare and Medicaid Services (CMS) announced that the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Quality Measure Calculations and Reporting User’s Manual Version 4.0 is now available. In addition, the following accompanying documents are also available: 

• Change Table 
• Risk Adjustment Appendix File 
• Hierarchical Condition Categories to International Classification of Diseases (ICD) -10 Crosswalks 
• ​SNF-Mobility-Model-ICD10-HCC-Crosswalk 
• ​SNF-Self-Care-Model-ICD10-HCC-Crosswalk 

These documents serve as an update to the specifications used to calculate quality measures that are included in the SNF QRP effective October 1, 2022. 

For more information, please visit the CMS SNF QRP Measures and Technical Information website​.​

The purpose of this manual is to present the methods used to calculate quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).

Click HERE for the manual!

The purpose of this webpage is to provide information on the measures reported by SNFs in accordance with the SNF QRP. On this page, you will find descriptions of each measure, links to measure specifications, measure updates and other measure-related information. This page is updated as measure updates become available.

What are the SNF QRP Measures?

Measures adopted for and removed from the SNF QRP are listed below. Several are endorsed by the National Quality Forum (NQF), a consensus-based entity contracted by the Secretary to guide the selection of performance measures for federal health programs. Data for the SNF QRP measures are collected and submitted through three methods:

• Minimum Data Set (MDS) 3.0
• Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN)
• Medicare Fee-For-Service Claims

MDS Assessment-Based Measures

Data collected using the MDS 3.0 and submitted to the Centers for Medicare & Medicaid Services (CMS) through the Assessment Submission and Processing (ASAP) system to the Quality Improvement and Evaluation System (QIES):

SNF QRP Measure #1: Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (NQF #0674)

This measure was finalized in the fiscal year (FY) 2016 SNF Prospective Payment System (PPS) Final Rule which was published in the Federal Register on August 4, 2015 (80 FR 46440 through 46444). Data collection for this measure began 10/1/2016. Public reporting began 10/24/2018.

SNF QRP Measure #2: Application of Percent of Long Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function

This measure was finalized in the FY 2016 SNF PPS Final Rule which was published in the Federal Register on August 4, 2015 (80 FR 46444 through 46453). Data collection for this measure began 10/1/2016. Public reporting began 10/24/2018.

SNF QRP Measure #3: Drug Regimen Review Conducted with Follow-Up for Identified Issues—PAC SNF QRP

This measure was finalized in the FY 2017 SNF Final Rule which was published in the Federal Register on August 5, 2016 (81 FR 52034 through 52039). Data collection for this measure began 10/1/2018. Public reporting began 10/28/2020.

SNF QRP Measure #4: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury

This measure was finalized in the FY 2018 SNF PPS Final Rule which was published in the Federal Register on August 4, 2017 (82 FR 36572 through 36577). Data collection for this measure began 10/1/2018. Public reporting began 10/28/2020.

SNF QRP Measure #5: Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633)

This measure was finalized in the FY 2018 SNF PPS Final Rule which was published in the Federal Register on August 4, 2017 (82 FR 36578 through 36593). Data collection for this measure began 10/1/2018. Public reporting began 10/28/2020.

SNF QRP Measure #6: Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634)

This measure was finalized in the FY 2018 SNF PPS Final Rule which was published in the Federal Register on August 4, 2017 (82 FR 36580 through 36593). Data collection for this measure began 10/1/2018. Public reporting began 10/28/2020.

SNF QRP Measure #7: Application of IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635)

This measure was finalized in the FY 2018 SNF PPS Final Rule which was published in the Federal Register on August 4, 2017 (82 FR 36583 through 36593). Data collection for this measure began 10/1/2018. Public reporting began 10/28/2020.

SNF QRP Measure #8: Application of IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

This measure was finalized in the FY 2018 SNF PPS Final Rule which was published in the Federal Register on August 4, 2017 (82 FR 36584 through 36593). Data collection for this measure began 10/1/2018. Public reporting began 10/28/2020.

SNF QRP Measure #9: Transfer of Health Information to the Provider Post-Acute Care

This measure was finalized in the FY 2020 SNF PPS Final Rule which was published in the Federal Register on August 7, 2019 (84 FR 38755 through 38761). Data collection for this measure will begin on October 1, 2023.

SNF QRP Measure #10: Transfer of Health Information to the Patient Post-Acute Care

This measure was finalized in the FY 2020 SNF PPS Final Rule which was published in the Federal Register on August 7, 2019 (84 FR 38761 through 38764). Data collection for this measure will begin on October 1, 2023.

For more detailed information on data collection and submission deadlines, please refer to the SNF QRP Data Submission Deadlines webpage. For more information on the data sets and guidance related to the collection and reporting of assessment data, please refer to the MDS Resident Assessment Instrument (RAI) manual located on the MDS 3.0 RAI Manual webpage.

CDC NHSN Measures

Data for this measure is submitted via the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN):

SNF QRP Measure #11:  COVID-19 Vaccination Coverage among Healthcare Personnel (HCP)

This measure was finalized in the FY 2022 SNF PPS Final Rule, which was published in the Federal Register on August 4, 2021 (86 FR 42480 through 42489). Data submission for this measure began October 1, 2021.

SNF QRP Measure #12:  Influenza Vaccination Coverage among Healthcare Personnel (HCP)

This measure was finalized in the FY 2023 SNF PPS Final Rule, which was published in the Federal Register on August 3, 2022 (87 FR 47537 through 47544). Data submission for this measure will begin on October 1, 2022.

Information related to the procedures using the CDC NHSN for data submission for the COVID-19 Vaccination Coverage among HCP measure can be found on the NHSN web site. 

For NHSN questions: .

Medicare Fee-For-Service Claims-Based Measures

Data for these measures are collected from claims, and no additional data need to be submitted by the SNF.

SNF QRP Measure #13: Medicare Spending Per Beneficiary – Post-Acute Care (PAC) SNF QRP

This measure was finalized in the FY 2017 SNF PPS Final Rule which was published in the Federal Register on August 5, 2016 (81 FR 52014 through 52021). Public reporting began 10/24/2018.

SNF QRP Measure #14: Discharge to Community - PAC SNF QRP

This measure was finalized in the FY 2017 SNF PPS Final Rule which was published in the Federal Register on August 5, 2016 (81 FR 52021 through 52029). Public reporting began 10/24/2018.

SNF QRP Measure #15: Potentially Preventable 30-Day Post-Discharge Readmission Measure – SNF QRP

This measure was finalized in the FY 2017 SNF PPS Final Rule which was published in the Federal Register on August 5, 2016 (81 FR 52030 through 52034). Public reporting began 10/24/2019.

SNF QRP Measure #16:  SNF Healthcare-Associated Infections (HAI) Requiring Hospitalization

This measure was finalized in the FY2022 SNF PPS Final Rule, which was published in the Federal Register on August 4, 2021 (86 FR.42473 through 42480).  This measure is scheduled to be publicly reported in CY 2022.

Measures Removed from SNF

Percent of Residents or Patients With Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678)

This measure was finalized in the FY 2016 SNF PPS Final Rule which was published in the Federal Register on August 4, 2015 (80 FR 46433 through 46438). Data collection for this measure began10/1/2016. Public reporting began 10/24/2018. As finalized in the FY 2018 SNF PPS Final Rule published in the Federal Register on 08/04/2017 (82 FR 36572 through 36577), this measure was replaced in the QRP by a modified version of the measure entitled Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury beginning with the FY2020 SNF QRP.

Updates

September 2, 2022

SNF QRP Quality Measure Calculations and Reporting User’s Manual V4.0, Change Table, Risk Adjustment Appendix File, and HCC ICD-10 Crosswalks – Now Available

The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Quality Measure Calculations and Reporting User’s Manual Version 4.0 is now available. This document serves as an update to the specifications used to calculate quality measures that are included in the SNF QRP. Additionally, the SNF QRP Measure Calculations and Reporting User’s Manual Change Table Version 4.0 is now available. This document provides a summary of measure-related changes between Version 4.0 of the SNF QRP Measure Calculations and Reporting User’s Manual and Version 3.0.1 of the SNF QRP Measure Calculations and Reporting User’s Manual Addendum specified in change table format. Furthermore, the Risk Adjustment Appendix File for the SNF QRP Measure’s Calculations and Reporting User’s Manual Version 4.0, which contains risk-adjustment values used to calculate the risk-adjusted quality measures, and Crosswalks of Hierarchical Condition Categories (HCC) to International Classification of Diseases (ICD)-10 codes used in risk-adjustment models for the Change in Self-Care, Change in Mobility, Discharge Self-Care, and Discharge Mobility measures (NQF #2633, NQF #2634, NQF #2635, and NQF #2636, respectively) are available.

These files are effective October 1, 2022 and can be accessed in the Downloads section of this webpage.

August 19, 2021

SNF QRP Risk Adjustment Appendix File and ICD-10 HCC Crosswalks are now available.

An update to the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Risk Adjustment Appendix File is now available. This document has been updated to reflect the risk adjustment coefficients for quality measure calculation to be used in conjunction with the SNF QRP Measure Calculations and Reporting User’s Manual (Version 3.0) and its corresponding addendum (Version 3.0.1). Additionally, the International Classification of Diseases, Tenth Revision (ICD-10) Hierarchical Condition Category (HCC) Crosswalks for SNF Mobility (NQF #2634 and #2636) and Self-Care (NQF #2633 and #2635) functional outcome measures are available. These files can be accessed in the Downloads section of this webpage.

September 8, 2020

SNF QRP Measure Calculations and Reporting User’s Manual V3.0.1

The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Measure Calculations and Reporting User’s Manual Version 3.0.1 and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available in the Downloads section below.

This document serves as an addendum that communicates quality measure updates to the SNF QRP Measure Calculations and Reporting User’s Manual V3.0. The SNF QRP Measure Calculations and Reporting User’s Manual V3.0.1 is effective on October 1, 2020 and provides information on measure-related changes in a change table format in lieu of a complete update to the overall manual. Additionally, we have included the updated Risk Adjustment Appendix File for the SNF QRP Measures Calculations and Reporting User’s Manual V3.0.1, which contains the risk-adjustment values used to calculate the risk-adjusted quality measures, and Crosswalks of ICD-10 codes to HCC categories used in the risk-adjustment models for the Change in Self-Care, Change in Mobility, Discharge Self-Care, and Discharge Mobility measures (NQF #2633, NQF #2634, NQF #2635, and NQF #2636, respectively).

We would like to describe several changes to the quality measure specifications, including updates to the exclusion criteria for the SNF Functional Outcome measures and Discharge to Community measure.

Specification updates for all four SNF Functional Outcome Measures:

1. Exclusion criteria: The age exclusion criterion for these measures has been updated from 21 years to 18 years, such that any resident younger than 18 years of age will be excluded from measure calculations.

 Specification updates for the SNF Discharge to Community Measure:

1. Exclusion criteria: This measure has been updated to exclude residents who had a long-term nursing facility (NF) stay in the 180 days preceding their qualifying hospitalization and SNF stay, with no intervening community discharge between the long-term NF stay and qualifying hospitalization.

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