New Payroll-Based Journal Requirements
In accordance with Section 6106 of the Affordable Care Act (ACA) skilled nursing facilities are required to electronically submit staffing information to drive accountability and consistency in reporting throughout the industry.Total direct care hours worked, including agency and contract staff, and facility census must be included and auditable. This information will be used to report the level of staff (hours per patient day) plus employee tenure, retention and turnover – all of which have been found to impact the level of care provided to residents.
To facilitate this effort, CMS has developed a system for facilities to submit staffing and census information – Payroll-Based Journal (PBJ). This system will allow staffing information to be collected on a regular and more frequent basis than currently collected. It will also be auditable to ensure accuracy.
Note: Only long-term care facilities that are subject to meeting the Requirements for Participation as specified in 42 CFR Part 483, Subpart B are subject to the PBJ reporting requirements. This requirement does not apply to swing beds.
Why PBJ Is Critical For Providers To Get Right
CMS has stated that the electronic Payroll-Based Journal staffing information is a requirement of participation and as such failure to submit, or reporting inaccurate data can be costly, potentially leading to citation and civil money penalties.
CMS, along with major provider associations, have long identified staffing as a key component in delivering quality care and ultimately positive resident outcomes. So much so, that CMS uses staffing information in the Nursing Home Five 5 Star Quality Rating System to help consumers and referral sources understand the level and differences of staffing in nursing homes when selecting a facility.
For the time being, CMS will continue to require that providers submit Forms CMS 671 & CMS 672 at the time of survey to calculate the Staffing Domain of the Five Star Rating System. The switch to use submitted PBJ information for the Five Star staffing ratings will likely occur in late 2017 or early 2018.
However, the state of Washington recently committed to using submitted Payroll-Based Journal staffing information to measure their minimum 3.4 hours per day of resident care beginning July 1, 2016. The recently published outline of Washington’s new SNF Medicaid reimbursement methodology states, “Using payroll and census data for the CMS Payroll Based Journal, the Department will extract data and conduct a quarterly review. This compliance analysis would be done on a quarterly basis and would look at a staffing per day average for that quarter. The Department will be checking the numbers reported to ensure that they are averaging out to actual daily staffing and that the staffing is not varying wildly throughout the quarter.”
This makes it more likely that other states will follow suit - amplifying the importance for providers to get PBJ reporting right.
PBJ Is Here To Stay
On March 18, 2016 the Centers for Medicare & Medicaid Services (CMS) issued an S&C memo entitled "Payroll-Based Journal (PBJ) – Implementation of required electronic submission of Staffing Data for Long Term Care (LTC) Facilities," to reiterate that the mandatory collection period of Payroll-Based Journal staffing information begins on July 1, 2016. What this means to skilled nursing providers is that the new PBJ reporting requirements are not going away or even being postponed, despite the relatively low number of organizations currently participating in the Payroll-Based Journal voluntary submission program.
CMS also reiterated that the electronic Payroll-Based Journal staffing information is a requirement of participation and as such failure to submit, or reporting inaccurate data can be costly, potentially leading to citation and civil money penalties.
If there is a silver-lining, it is that CMS understands that supplying this data is a big undertaking for providers and has made the following statement on initial enforcement, “As providers are adjusting to this new requirement, we may refrain from imposing enforcement remedies (e.g., for good faith efforts). Additionally, we will provide feedback mechanisms to providers, such as warnings, that will help facilitate compliance with this requirement."
Timeline To Comply
Providers will be required to submit their staffing and census data quarterly. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter in order to be considered timely – making the due date for the first PBJ submission November 14, 2016.
Facilities may view their data submitted through Certification and Survey Provider Enhanced Reports (CASPER) and via the PBJ Online System.
Note: The PBJ system will accept submissions after the deadline. However, these submissions will not be considered timely and will not be used to calculate a facility’s staffing measures.