With the submission and review of our VBP SPA, CMS has requested that Indiana consider removing the “Percentage of long-stay residents who self-report moderate to severe pain” metric from the current State Plan Amendment (SPA) TN 19-010. After a review of the CMS request, Indiana believes that the submitted SPA language ultimately aligns with the wishes of CMS in the long term and therefore we do not recommend changes to the current SPA submission.
In order to honor the process that has previously been completed and agreed upon by the Associations and various other stakeholders, Indiana believes it is appropriate to calculate the annual rate setting effective for July 1, 2019 utilizing the quality metric for long-stay residents who self-report moderate to severe pain as the information exists for the current rate year.
For the annual rate period beginning July 1, 2020, the current SPA submission will effectively eliminate the use of this quality metric, as no quality metric information is or will be published by CMS for the calendar year 2019 for the quality metric of long-stay residents who self-report moderate to severe pain. As such, facilities will not receive a score for this metric, and it will be effectively eliminated from the value-based purchasing program. The SPA also contains language that specifically accounts for this lack of score by grossing up the facility’s total score of the remaining quality measures.
Therefore, we believe the current SPA provisions align in the long term with the wishes of CMS to ultimately remove or replace this metric.
We anticipate the SPA’s approval to be imminent as it has moved to the final set of reviewers for the approval process.
After approval of TN 19-010, we will establish a stakeholder workgroup with the intention of re-evaluating and modifying the value-based purchasing program to align with Medicare measures and officially remove the quality metric for long-stay residents who self-report moderate to severe pain. These changes would be most likely take effect for annual rate setting periods beginning July 1, 2021 and after.