Navigating Care Compare Updates

What Providers Need to Know

 

On June 18, 2025, CMS issued QSO-25-20-NH, a memorandum to State Survey Agency Directors outlining significant updates to Nursing Home Care Compare aimed at improving transparency and enhancing performance measurement.

Key Highlights

  • Chain-Level Performance Data
    For the first time, CMS will begin publishing aggregate performance metrics for nursing home chains in a consumer-friendly format on Care Compare.
  • Health Inspection Rating Updates
    CMS will remove the third standard survey from the rating calculation, focusing only on the two most recent surveys.

    • Under the new weighting, the most recent standard survey = 75%
    • Second most recent standard survey = 25%
    • Weights for complaint and infection-control surveys continue to span a three-year period.
  • Updated Long-Stay Antipsychotic Measure
    The quality measure tracking long-stay residents on antipsychotic medications will now incorporate Medicare and Medicaid claims data and encounter records, alongside existing MDS data. The intent is to improve measurement accuracy.
  • Removal of COVID-19 Vaccination Data
    Resident and staff COVID-19 vaccination metrics will be removed from facility profiles on Care Compare.

 

Implementation Timeline

 

ChangeEffective Date
Health Inspection Rating (two-cycle rollout)Begins with the July 2025 Quarterly Refresh
Long-Stay Antipsychotic Measure UpdateBegins with the October 2025 Refresh

 

Implications for Providers

  • Understand chain-level insight
    Aggregated chain data can influence consumer perception and benchmarking. Review how affiliation metrics reflect on your organization.
  • Adjust focus to recent inspections
    With older survey data dropped, performance in recent inspections has heightened impact. Ensure corrective action plans are timely and visible.
  • Prepare for antipsychotic measure changes
    Broader data inputs may alter reported rates. Reassess antipsychotic medication use through both clinical review and coding integrity.

 

Why This Matters Now

These changes mark a meaningful evolution in how performance is measured and communicated to consumers. By placing greater emphasis on current inspection outcomes and incorporating more comprehensive data sources, CMS aims to deliver more accurate, actionable insights. Providers who understand and adapt to the recalibrated system can maintain both compliance and transparency.

Proactively Tackle Changes

  • Provide timely training on updated weightings and data sourcing.
  • Strategically brief staff on chain-level data interpretation and implications.
  • Use performance tracking tools to demonstrate improvement across inspection cycles.
  • Communicate assets to help explain changes to residents and families.

 

Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

Strengthening Employee Screening

Lessons from Recent OIG Audit Findings

 

A recent audit by the U.S. Department of Health and Human Services Office of Inspector General (OIG) revealed serious gaps in verifying nursing home staff background checks in Alabama. While the audit focused on one state, the implications are far-reaching and relevant for operators nationwide.

 

Key Findings from the OIG Audit (Alabama Audit A-04-24-08104)

The audit examined nursing home compliance between January 1, 2022, and April 8, 2024, reviewing 439 employees across sampled facilities. It was discovered that 139 employees did not have properly verified background checks or registry queries performed before beginning work.

Based on these findings, the OIG made four strong recommendations to the Alabama Department of Public Health (ADPH), urging:

  1. Implementation of a process to verify background checks and registry queries before employee onboarding.
  2. Education efforts to inform facilities about the critical importance of timely background verification.
  3. Requirement for facilities to establish formal policies and procedures for registry queries prior to employment.
  4. Conducting ongoing reviews of facility compliance with these requirements.

As of now, all four recommendations remain open and unimplemented, with further action expected by early 2026.

 

Broader Implications & Why This Matters Across States

Although this audit focused on Alabama, the risks and lessons apply universally:

  • Nursing home residents rely on trusted, screened staff. Lapses in background verification can significantly compromise safety.
  • Other states may face similar audits, and the trend toward heightened oversight is increasing, especially around employee screening procedures.
  • Like Alabama, other states could be prompted to institute mandatory pre-employment verification, backed by audits or sanctions.
  • Facilities lacking consistent background screening could face reputational damage, regulatory action, or worse.

 

Are you Compliance Ready?

 

Compliance ItemSuggested Action Item
Policy Audits & Gap AnalysisReview your current employee screening processes and identify areas vulnerable to OIG scrutiny.
Custom Procedure DevelopmentDraft and implement clear, state-compliant procedures ensuring registry and background checks are completed before onboarding.
Staff Education & TrainingDevelop trainings for HR and leadership teams on regulatory expectations and best practices.
Compliance Monitoring ToolsOffer checklists to track completion rates and trigger follow-up actions for missing verifications.

 

The OIG audit serves as a reminder that compliance cannot be reactive and instead must be built into daily operations. Nursing homes that establish robust, proactive screening processes not only reduce regulatory risk but also strengthen trust with residents, families, and communities. By taking action now, providers can position themselves as industry leaders in both resident safety and regulatory readiness.

Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

UPDATED: Final MDS 3.0 Item Sets v1.20.1v3 Released

 

CMS has released the final Minimum Data Set (MDS) 3.0 Item Sets version 1.20.1v3 and the Item Matrix v1.20.1v3, which are now available in the Downloads section on the MDS 3.0 Resident Assessment Instrument (RAI) Manual page. These final updates will go into effect on October 1, 2025.

 

Why This Matters

The MDS drives not only resident care planning but also reimbursement, compliance, and quality reporting in skilled nursing facilities. Each update from CMS carries implications for providers, therapy partners, and facility teams who rely on accurate data collection and assessment.

With the final version now posted, providers should begin:

  • Reviewing the changes in detail, especially updates to Section GG and other areas impacting clinical workflows.
  • Educating interdisciplinary teams to ensure accurate documentation and coding.
  • Collaborating with therapy partners to align on how these updates affect care delivery, compliance, and outcomes reporting.

 

Key Changes

 

HTS Support

At HTS, we closely monitor MDS updates and provide guidance to ensure our partners remain compliant and prepared. Our team will share additional resources and training with our therapists, so they are equipped to navigate the October 2025 transition with confidence.

Visit CMS’ MDS 3.0 RAI Manual page to access the final item sets and matrix.

 

Written by:

Sheena Mattingly, M.S., CCC-SLP, RAC-CT  |  Executive Vice President of Quality & Compliance, HTS

Live Well, Age Well

Thanks to advances in medicine and nutrition, people today are living 10-15 years longer than just a few decades ago. A longer life gives you more time to enjoy hobbies, spend time with loved ones, and make new memories. But healthy aging isn’t just about adding years to your life—it’s about how well you feel during those years. By taking care of your body and mind, you can stay active, strong, and ready to enjoy every stage of life.

Here are some simple habits that make a big difference:

  • Sleep Well: 7–8 hours of sleep each night helps your body recover and keeps your memory sharp.
  • Move More: Sitting too long can affect your heart, muscles, and mood. Stand up and move every 30–60 minutes.
  • Strength Training: You don’t need a gym. Lifting soup cans or using resistance bands can help keep muscles and bones strong.
  • Brain Work: If you read often, try painting. If you do puzzles, learn a new instrument. Changing activities builds new brain connections.
  • Eat Superfoods: Blueberries are packed with antioxidants that help protect brain cells. Salmon is rich in omega-3s, which support heart health.
  • Find Joy: Laughter, music, and hobbies lower stress and boost your mood.

 

How Can Therapy Help?

Our therapy team specializes in helping older adults stay strong, steady, and active. Talk to your doctor about the benefits of therapy and how it can help you keep moving, stay independent and feel your best every day.

Every Step Forward Deserves a Celebration

Join the #ProgressParade

 
HTS is excited to share a fun, special initiative from AHCA/NCAL called The Progress Parade—a grassroots campaign to celebrate the rehabilitation progress and success your residents achieve every day. Whether someone finishes therapy, meets a personal goal, or is heading home, this is a simple but powerful way to make that moment special.
 

See the Progress Parade in Action

Watch the video


Free Resources to Get Started

AHCA/NCAL has created a full Progress Parade Toolkit to make it easy to launch your own celebration.
Read the Full Press Release

Stronger Legs for Better Balance

 

Every year, one in three older adults experiences a fall—and many of these falls can be prevented. One of the biggest reasons for losing balance is muscle weakness, especially in the legs. Our legs support us as we walk, rise from a chair, climb stairs, and stay steady.

Why Leg Strength Matters

Around age 30, we begin to lose muscle mass in a natural process called sarcopenia. Over the decades, this gradual loss adds up. By our 80s, we may have lost up to half of our muscle strength. But here’s the good news: you can rebuild strength at any age. Simple, consistent movements can help you stay active, reduce the risk of falling, and maintain your independence.

 

Easy At-Home Exercises to Strengthen Your Legs

Here are a few ways to work leg muscles without special equipment:

 

March in Place — Do this while watching TV or listening to music. It’s a great way to get more steps in throughout the day.

Use a Stationary Bike — A gentle, low-impact exercise that helps build leg strength without putting pressure on your joints.

 

Chair Stands — Sit in a sturdy chair and stand up, then sit back down—repeat several times a day. This strengthens your thighs and helps with everyday mobility.

Walk While on the Phone — Instead of sitting during phone calls, walk around your home. These mini-walks add up!

 

Therapy Can Help Improve Balance & Prevent Falls

If you’ve had a fall or feel unsteady, talk to your doctor. Our therapy team specializes in strength and balance training to help you move more confidently, reduce your risk of falling, and stay independent.

Is Your Medicare Enrollment at Risk?

CMS requires transparency regarding the ownership and management of certain healthcare facilities. If the required “additional disclosable party” information is not received, the provider’s ability to bill Medicare will be impacted due to potential denial or revocation of their Medicare enrollment.
Under Medicare rules, “additional disclosable parties” are individuals or entities that:
  • Have ownership or managing control interests in the provider or supplier,
  • Exercise operational or managerial control, or
  • Have an indirect ownership interest through another entity.
This disclosure is required to maintain transparency and prevent fraud, waste, and abuse.
Medicare Requirements: The Centers for Medicare & Medicaid Services (CMS) has implemented rules requiring facilities to disclose this information, particularly on the Form CMS-855A, which is used for enrollment and revalidation.

 

Consequences of Non-Compliance

Failure to provide accurate and timely disclosure of this information can lead to:

Call to Action

Assure you have disclosed the requested information on Form CMS-855A by 8/1/2025 so your Medicare enrollment is not at risk.

Stay Strong as You Age

Did you know that adults over 60 can lose between 3% and 8% of their muscle mass per decade? This natural loss, called sarcopenia, can make daily tasks harder and increase the risk of falls and injuries.

Fortunately, strength can be rebuilt at any age! Research shows that adults, even in their 80s and 90s, can gain muscle and improve mobility through regular strength training. You don’t need a gym or fancy equipment. Here are a few simple exercises you can do at home to help stay strong and independent.

 

Everyday Exercises to Build Strength

Aim for 10–15 minutes a day of these strength-building exercises.

Sit-to-Stand: Practice standing up from a chair without using your hands. This builds leg and core strength.

Wall Push-Ups: Stand a few feet from a wall and press your hands into it like a push-up. Great for building upper body strength in your arms and shoulders!

March in Place: Holding the back of a chair, gently lift your knees one at a time to improve balance and leg strength.

Use Resistance Bands: These lightweight bands are easy on joints and can help strengthen arms, legs, and core.

 

How Can Therapy Help?

If staying active feels difficult due to pain, weakness, or concerns about falling, physical and occupational therapy can help. A therapist can create a personalized plan to help you safely rebuild strength, reduce pain, and stay active.

Dementia Denials on the Rise

Why April 1st Medicare Part B Changes Demand Immediate Coding Review

 

Starting April 1, 2025, Medicare Part B quietly implemented a significant update that may already be impacting skilled nursing facility (SNF) claims across the country. The list of unacceptable principal diagnoses has expanded and now includes more ICD-10 codes tied to unspecified dementia and dementia in other diseases classified elsewhere. This is a shift that could lead to increased Part B denials if not addressed promptly.

If your billing teams or software haven’t caught up, your facility may already be at risk for increased claim rejections or delays.

 

What Changed?

CMS has added several dementia-related ICD-10 codes to the list of diagnoses no longer accepted as principal diagnoses under Medicare Part B. These include:

  • F03.90 – Unspecified dementia without behavioral disturbance
  • F03.91 – Unspecified dementia with behavioral disturbance
  • Other dementia codes classified under F02 and F03 categories, especially when paired with vague or unrelated secondary codes

These codes, while clinically accurate in many settings, cannot stand alone as the principal diagnosis on Medicare Part B claims.

CMS’s Rationale: These codes lack the specificity required to justify the skilled level of care under the PDPM model, especially when a more direct underlying condition (e.g., Alzheimer’s disease or Parkinson’s disease) should be driving the skilled need.

For a full list of these codes, click here.

 

Why This Matters

If your team continues to use these codes as the primary diagnosis:

  • Claims may be rejected, slowing reimbursement.
  • Your facility could see a reduction in cash flow or develop a pattern of non-compliance, which could trigger unnecessary audits, especially if used in large volume.

 

What You Should Do Now

  1. Review Current Coding Practices
    Audit how dementia is currently being coded in your assessments and claims. Pull a recent sample of admissions and discharges and identify any use of newly unacceptable ICD-10 codes as primary diagnoses.
  2. Educate Interdisciplinary Teams
    Ensure MDS coordinators and billing departments all understand these coding changes. Dementia may still appear on the claim, but only in the appropriate sequencing.
  3. Update Your Software or Mapping Tools
    Make sure EMR systems, diagnosis selection drop-downs, and auto-mapping tools are current with CMS’s updated ICD-10 PDPM Unacceptable Codes list as of April 1.

 

Call to Action: Protect Your Revenue & Compliance

Now is the time to proactively safeguard your claims. Even if your Part B denials haven’t started yet, they may be coming if outdated codes are still in use.

Review your facility’s coding protocols today and retrain your teams to code dementia with greater specificity. Accurate coding isn’t just a best practice; it’s essential for both compliance and timely reimbursement.

 

Written by:

Sheena Mattingly M.S. CCC-SLP RAC-CT, EVP of Quality & Compliance  |  Healthcare Therapy Services

Stay Safe in the Summer Heat

Ahhh, summer… the season of cookouts, blooming flowers, and sunny strolls!  It’s the perfect time to enjoy the outdoors, but as we get older, our bodies don’t cool down as easily. You may not feel thirsty even when dehydrated, and some medications can increase heat sensitivity.  That’s why older adults are more at risk for heat exhaustion, dehydration, and even heat stroke.  Here are a few simple tips to help you stay safe and enjoy the season.

 

 

Therapy Can Help!

If you’re struggling to stay active, talk with your doctor about the benefits of Physical and Occupational Therapy. Therapy can help you build strength, improve balance, and manage fatigue or joint pain that may worsen in the heat. A therapist can also teach you how to pace yourself, stay cool while moving, and adjust your routine so you can keep doing the things you enjoy.