MDS Broadcast

Moving Prior Authorization into the 21st Century 

by CMS Administrator Dr. Mehmet Oz 

A common practice imposed by health insurers on patients and providers is their intrepid need to second-guess clinicians' treatment decisions by requiring prior authorizations before paying a claim. The current prior authorization process creates unnecessary delays for patients, burdens health care providers with excessive paperwork, and erodes trust between payers and health care providers, even though all share the same goal: delivering high-quality patient care.

CMS strongly encourages providers to take an active role in advancing electronic prior authorization by participating in Fast Healthcare Interoperability Resources® (FHIR) Application Programming Interface (API) testing with your electronic health record (EHR) vendor and payer partners. Contact your EHR vendor to learn how you can test to make sure your systems are ready for electronic prior authorization. Early testing and collaboration between your practice, EHR vendor, and payers is essential to ensure seamless, real-world implementation of electronic prior authorization workflows. Engage now to:

• Identify gaps

• Validate workflows

• Build the technical readiness needed to meet upcoming implementation goals

• Improve the experience for your patients and staff

It is way past time to axe the fax, kill the clipboard, and put patients over paperwork. Select the links below for more Information:

• Full blog

• Electronic Prior Authorization webpage

• Video

• Timeline

Spotlight Series: Person Centered Care: Isn't that what we have always done? 

(Sponsored by Advancing Excellence)

June 3, 2026 | 1:00 pm ET

1 CE credit for Nurses, Case Managers, Social Workers (MN) & NAB for live session attendees

Select the above link to register.

Antipsychotic Medication - A New Perspective (Sponsored by PharmScript)

June 4, 2026 | 2:00 pm ET 

1 CE credit for Nurses & NAB for live session attendees

The Centers for Medicare and Medicaid Services continue to focus on nursing home use of antipsychotic and behavioral-altering medications. 

Select the above link to register.

Dementia and Incontinence (Sponsored by Essity/Tena)

1 CE credit for Nurses, Case Managers, Social Workers (MN) for live session attendees

June 9, 2026 | 2:00 pm ET

Dementia affects the brain's ability to process information, control impulses, and perform tasks safely. These shifts can affect continence by impacting memory, movement, judgment, and the neurological systems that regulate bladder and bowel control. This session will cover the connections between dementia, incontinence, falls, and infections, emphasizing proactive strategies to maintain dignity and enhance quality of life. 

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Creating a Culture of Career Pathways for Professional Caregivers - Sponsored by ComForCare Home Care

June 11, 2026 | 2:00 pm ET

1 CE credit for Nurses, Case Managers, Social Workers (MN) & NAB for live session attendees

Workforce instability continues to challenge care delivery across aging services, making retention, engagement, and professional growth more critical than ever. This webinar provides a practical, data-driven roadmap for building a culture of career pathways that supports caregiver satisfaction, reduces turnover, and improves care quality. In recognition of CNA Month, participants will explore evidence-based workforce strategies, training investments, and recognition programs, such as Caregiver of the Month and Caregiver of the Year, that elevate caregiving as a profession and strengthen organizational resilience. 

Select the above link to register.

Game Changers - iQies, VBP, QRP NHSN, Icons, and More! (Sponsored by PharmScript)

July 16, 2026 | 2:00 pm ET

1 CE credit for Nurses & NAB for live session attendees

This interactive discussion and work session will provide attendees with keen insight into new requirements impacting providers.  Attendees will engage in the interactive session, working through scenarios while accessing reports and resources designed to guide leaders through the changes now in play. 

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Quality Measures: Impacting Clinical, Operational, Financial, and Regulatory Outcomes 

(Sponsored by PharmScript)

August 11, 2026 | 2:00 pm ET

1 CE credit for Nurses & NAB for live session attendees

SNFVBP, SNFQRP, Care Compare, CASPER Reports, and state-specific quality measures impact all aspects of skilling nursing facilities today and in the future. This important presentation will provide leaders with key information on the financial, clinical, and regulatory impact of quality measures on their organization.

Select the above link to register.

De-Escalation & Conflict Resolution Approaches for Families & Care Teams 

(Sponsored by ComForCare Home Care)

August 13, 2026 | 2:00 pm ET

1 CE credit for Nurses, Case Managers, Social Workers (MN) & NAB for live session attendees

Conflict and communication breakdowns can derail care plans, strain relationships, and compromise outcomes—especially during care transitions or periods of decline. This highly practical webinar equips care teams with de-escalation techniques, structured communication protocols, and role-play scenarios to manage challenging interactions with families and interdisciplinary partners. 

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Evidence-Based Strategies for Supporting Older Adults with Depression and Anxiety 

(Sponsored by ComForCare Home Care)

October 8, 2026 | 2:00 pm ET

1 CE credit for Nurses, Case Managers, Social Workers (MN) & NAB for live session attendees

Depression and anxiety are frequently underrecognized in older adults, yet they significantly impact functional status, quality of life, and overall health outcomes. Timed with Mental Illness Awareness Week and Pharmacy Month, this webinar highlights evidence-based screening, referral, and intervention strategies to support emotional well-being in aging populations. 

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Building High-Performing, Resilient Care Teams (Sponsored by ComForCare Home Care)

December 3, 2026 | 2:00 pm ET

1 CE credit for Nurses, Case Managers, Social Workers (MN) & NAB for live session attendees

High-performing care teams are the foundation of quality, consistency, and sustainability in aging services. This webinar focuses on practical leadership strategies to build resilient teams through effective coaching, delegation, and performance measurement. 

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CMS uses staffing data to accurately and effectively gauge its impact on the quality of care in nursing homes. Use the Payroll-Based Journal (PBJ) system to submit your staffing information. Review the PBJ Policy Manual (PDF) and FAQs (PDF) (updated June 2025) to learn about policy updates. 

Note: These updates provide additional details about existing policies; they don’t reflect changes to policy or expectations. All updates are in red italics.

More information:

• Staffing Data Submission PBJ webpage

• Email NHStaffing@cms.hhs.gov with questions about these updates 

Understanding the Responsibilities of Licensed Nurses in Long-Term Care

Insights from Amy Beisner Harroff, RN, BSN, MHI,

Senior Consultant, Pathway Health

Licensed nurses in long-term care carry one of the most complex and autonomous roles in healthcare today. Yet many underestimate the full scope of responsibility that comes with accepting an assignment in a skilled nursing or senior living environment. When the role is reduced to “just the med pass,” organizations miss critical opportunities to elevate practice, strengthen outcomes, and protect both residents and licenses.

In today’s regulatory and clinical environment, understanding and supporting the responsibilities of licensed nurses is a leadership imperative.

Select the above link to gain more insight.

Integrating QAPI With Direct Line Staff

Insights from Calvin Reynek, RN, IP-BC, AS-BC, CADDCT, QAPI-BC, Nurse Consultant - Pathway Health

QAPI is explicitly tied to federal regulations and woven throughout CMS’s Critical Element Pathways. Failure to identify systemic issues or implement meaningful performance improvement activities has led to widespread harm citations under QAPI-related F-Tags, including F865. QAPI requires full engagement from every department and staff member, not just leadership, but direct line staff as well.

Select the above link to gain more insight.

All-or-Nothing: Inside CMS Audits of Nursing Home Quality Measures and Their Impact on Reimbursement and Star Ratings 

The all-or-nothing nature of the CMS quality audits means nursing homes could face reductions in reimbursement — and, in the case of hybrid measures such as antipsychotic use, potential star rating downgrades — if they fail to comply with or fully respond to audit requests, experts say. 

Select the above link to gain more insight.