CMS Open Door Forum Recap

The overall tone of the forum was frustration. Several skilled nursing facility workers expressed frustration regarding communications with Medicare Advantage organizations during the Open Door Forum (ODF) on Wednesday. Centers for Medicare & Medicaid Services representatives acknowledged that provider frustration in this area has been an ongoing issue, but they were not able to offer a resolution.

John Kane, a CMS skilled nursing facility program analyst, began the Open Door Forum call by stating that the agency has continued to receive provider questions regarding residents paying for nursing home care through Medicare Advantage. He reminded providers on the call that CMS is not able to address these questions, which must be directed to Medicare Advantage organizations directly. Under Medicare Advantage, health maintenance organizations or similar entities contract with the government to provide managed care services to beneficiaries enrolled in this system rather than traditional fee-for-service.

Still, a number of callers posed Medicare Advantage-related questions. This also has occurred on other Open Door Forum calls in recent months. The officials on the call continued to direct callers to contact MAOs, and the providers emphasized that these organizations are not responsive, leaving them with little to no answers.

Also on the call, CMS confirmed that the next update to the MDS 3.0 RAI Manual will be released around Sept. 5.

Click here to access a recording of the call.


One Comment

  1. Linda Krueger

    I don’t understand how John Kane can say that CMS is not able to answer those questions when it was their letter directing the MCOs to report the HIPPS codes in the first place. CMS is the one that stated it had to be the code from the OBRA admission assessment. They also said to use the code from the discharge assessment when the discharge assessment does not generate a RUGs code. I feel it should be up to CMS to clarify the instructions.

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