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Resources: Medicaid Prior Authorization Guidance, Quarterly Reports and more

Posted by Admin Posted on Mar 28 2022

Medicaid Prior Authorization Guidance

The Department for Medicaid Services (DMS) is reinstating the therapy PA’s effective May 1, 2022.

Click here to view the letter from DMS.


March 2022 Interim Quarterly Confidential Feedback Reports

The March 2022 Interim Quarterly Confidential Feedback Reports for the fiscal year (FY) 2023 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports (CASPER) reporting system. These reports contain interim stay-level data for the SNF 30-Day All-Cause Readmission Measure (SNFRM) for 10/1/2020-6/30/2021 (Quarter 1-Quarter 3 of the FY 2023 SNF VBP Program performance period, FY 2021). The interim data contained in these reports are not final and are subject to change, and thus are not eligible for the SNF VBP Program's Review and Correction process.

The March 2022 reports contain stay-level data protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Any disclosure of protected health information (PHI) should only be in accordance with, and to the extent permitted by, the HIPAA Privacy and Security Rules and applicable law. When referring to the contents of the report, use the Line Number (located in the leftmost column of the '2 - Eligible Stays' tab) of the stay in question.

For questions about accessing your SNF's report, which can only be accessed via CASPER, please contact the QIES Technical Support Office Help Desk at

Click here for more information about the SNF VBP Program from the CMS website.

If you have any additional questions, please contact the SNF VBP Program Help Desk by emailing:


Biden’s Planned Nursing Home Reform: FACT SHEET: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes

All people deserve to be treated with dignity and respect and to have access to quality medical care. The President is committed to ensuring that all Americans, including older Americans and people with disabilities, live in a society that is accessible, inclusive, and equitable. To accomplish that goal, the Administration continues to be committed to home- and community-based services and ensuring that in no case should a health care facility be causing a patient harm. The President believes we must improve the quality of our nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve. That’s why he is announcing a set of reforms—developed by and implemented through the Department of Health and Human Services (HHS)—that will improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care.

To do this, the reforms the President is announcing will ensure that:

•    Every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care;
•    Poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut off from taxpayer dollars; and
•    The public has better information about nursing home conditions so that they can find the best available options.

Click here for more information from the White House.


Common Working File (CWF) will observe Dark Days in April 2022

To accommodate the anticipated duration to install the April 2022 release, the CWF Host will observe Dark Days beginning on Friday, April 1, 2022, through Sunday, April 3, 2022.

What this means to you:

•    It is customary for contractors to hold claims for several days following a quarterly release. Claims that are submitted prior to the release that would have been processed through the CWF during this period will be held until the nightly system cycle on Monday, April 4, 2022.
•    We anticipate claims will still be processed within a normal timeframe and these slight delays will not affect the timeliness of your payments.
•    This will not affect your ability to access beneficiary eligibility information through myCGS or the IVR, but the information will not update during the dark day period.

Note for Home Health and Hospice Providers: Notices of Admission (NOAs) and Notices of Election (NOEs) can still be submitted to CGS during this period. If you feel that a late submission of an NOA/NOE was caused by the dark day, appropriate documentation must be submitted.

Click here for more information from the CGS Medicare website.


NEW Grant Opportunity, Per the Office of Inspector General: Revised 3/10/22

Per the Office of Inspector General February 2002 newsletter, there is a NEW grant opportunity for purchase of aids to increase or improve air quality for in-person visitations. Certified nursing facilities may apply for up to an additional $3,000 of Civil Money Penalty (CMP) Nursing Home Visitation Aid Grant funds for the purchase of indoor portable fans and/or indoor portable air cleaners with high-efficiency particulate air (HEPA, H-13 or -14) filters, to increase or improve air quality to aid in-person visitation for residents. Expenses incurred on or after the release of Memorandum QSO-20-39-NH FAQ Revised, February 2, 2022, are eligible for reimbursement.

For more information and to apply for CMP Nursing Home Visitation Aid Grant funds:

1. CMP Application for In-Person Visitation Aid Requests FAQ

2. Application Form for Visitation Aid Project

3. QSO-20-39-NH

Contact Lena Mullins-Datko, CMP Grant Administrator with questions of the COVID-19 Visitation Aid Grant

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