HHAs, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs) have different quality measure domains.

All four settings must report standardized data using the assessment instruments  on at least five of the following eight quality measure domains:

• functional status, cognitive function, changes in function,
• skin integrity and changes in skin integrity,
• medication reconciliation,
• incidence of major falls,
• communicating the existence of and providing for the transfer of health information and care preferences.

Standardized data in patient assessment domains are also required, and Long-term Care Hospitals, Inpatient Rehabilitation Facilities and Skilled Nursing Facilities  are required to being reporting such assessment domain data standardized data to CMS starting Oct. 1, 2018, and for Home Health Agencies, January 1, 2019.

LTCH Home Health

SNF IRF

Measures for the other domains will be addressed through future rulemaking. CMS received feedback on four future, cross-setting measure constructs to potentially meet requirements of the IMPACT Act domains of:

• All-condition risk-adjusted potentially preventable hospital readmission rates,
• Resource use, including total estimated Medicare spending per beneficiary,
• Discharge to the community, and
• Medication reconciliation


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