CMS began to collect staffing and census data through the PBJ system on a voluntary basis beginning on October 1, 2015, when the headaches first began. They will begin for real on July 1, 2016, when data submittal utilizing the PBJ system becomes mandatory.
Members have voiced frustration and dissatisfaction with the PBJ system since its October roll-out. It’s a costly, yet unfunded mandate at a time when limited funds are increasingly insufficient for providers facing the challenge of workforce shortages. Technically, providers claim the PBJ system is confusing and prone to reporting errors. Yet CMS has remained steadfast in pursuing the July 1, 2016 mandatory roll-out date.
LeadingAge (national) has been sharing member PBJ concerns with CMS on an on-going basis for months, calling repeatedly for a phase-in or delay in the July 1st roll-out date. Their most recent effort came in a February 16, 2016 letter from President/CEO Katie Sloan to Acting CMS Administrator Andrew Slavitt (see: www.leadingagewi.org/media/34708/lacmspbj.pdf).
The Sloan letter identified problems with the PBJ system in a number of areas, including hours worked v. hours paid submission specifications, labor and job codes, accounting for contract staff, reporting resident census, and voluntary submission and testing.
Sloan’s letter concluded by stating that “LeadingAge respectfully requests that implementation of PBJ be deferred as necessary pending resolution of the above-detailed issues and concerns.”
Slavitt’s response on behalf of CMS came on March 22nd (see: www.leadingagewi.org/media/34705/cmspbj.pdf).
“As with many new programs, we anticipate the PBJ program will evolve over time. We seek to resolve many of these issues you raise, and more, as soon as possible. Since this program is new, we want to analyze the operations and data submitted, in order to make well-informed decisions about these issues to ensure the integrity of the program and equality among nursing homes. As we implement this program, we look forward to collaborating with LeadingAge and other stakeholders to improve the accuracy of the information collected, and the method by which it is submitted,” Slavitt wrote.
But he did not back off the July 1, 2016 implementation date, stating the belief of CMS that the voluntary submission period provided “ample time for all facilities to test their submission process.”
“Once the mandatory submission period begins on July 1st, we will provide feedback mechanisms to providers, such as warnings, that will help facilitate compliance with this requirement,” the CMS response noted.
The only possible olive branch offered by CMS came at the end of the agency’s response, which concluded with the following:
“As with other instances of noncompliance, CMS retains discretion on imposing certain sanctions. For example, as providers are adjusting to this new requirement, we may refrain from imposing enforcement remedies (e.g., for good faith efforts).”