Centers for Medicare &
Medicaid Services
Electronic Staffing Data Submission
Payroll-Based Journal
Long-Term Care Facility
Policy Manual
Version 2.6
June 2022
TABLE OF CONTENTS
1.1 Introduction................................................................................................................................1-1
1.2 Submission Timeliness and Accuracy.........................................................................................1-3
1.3 Registration................................................................................................................................1-4
1.4 Methods of Submission .............................................................................................................1-4
2.1 Employee Record .......................................................................................................................2-1
2.2 Staffing Hours Record ................................................................................................................2-4
2.3 Labor and Job Codes and Descriptions ....................................................................................2-10
2.4 Census Record..........................................................................................................................2-15
Note: Changes from the previous version of this policy manual are identified in red/italics.
June 2022
CMS’s PBJ Version 2.6 Policy Manual CH 1: Overview
CHAPTER 1: Overview
1.1 Introduction
The Centers for Medicare and Medicaid Services (CMS) has long identified staffing as
one of the vital components of a nursing home’s ability to provide quality care. Over
time, CMS has utilized staffing data for a myriad of purposes in an effort to more
accurately and effectively gauge its impact on quality of care in nursing homes. Staffing
information is also posted on the CMS Nursing Home Compare website, and it is used in
the Nursing Home Five Star Quality Rating System to help consumers understand the
level and differences of staffing in nursing homes.
Section 6106 of the Affordable Care Act requires facilities to electronically submit direct
care staffing information (including agency and contract staff) based on payroll and
other auditable data. The data, when combined with census information, can then be
used to not only report on the level of staff in each nursing home, but also to report on
employee turnover and tenure, which can impact the quality of care delivered.
A final rule implementing the requirement for long-term care facilities to submit staffing
data was published August 4, 2015. This rule amended 42 CFR §483.70 by adding the
following section:
(p) Mandatory submission of staffing information based on payroll data in a uniform
format. Long-term care facilities must electronically submit to CMS complete and
accurate direct care staffing information, including information for agency and contract
staff, based on payroll and other verifiable and auditable data in a uniform format
according to specifications established by CMS.
(1) Direct Care Staff. Direct Care Staff are those individuals who, through
interpersonal contact with residents or resident care management, provide care
and services to allow residents to attain or maintain the highest practicable
physical, mental, and psychosocial well-being. Direct care staff does not include
individuals whose primary duty is maintaining the physical environment of the
long term care facility (for example, housekeeping).
(2) Submission requirements. The facility must electronically submit to CMS
complete and accurate direct care staffing information, including the following:
June 2022 Page 1-1
CMS’s PBJ Version 2.6 Policy Manual CH 1: Overview
(i) The category of work for each person on direct care staff
(including, but not limited to, whether the individual is a
registered nurse, licensed practical nurse, licensed vocational
nurse, certified nursing assistant, therapist, or other type of
medical personnel as specified by CMS);
(ii) Resident census data; and
(iii) Information on direct care staff turnover and tenure, and on the
hours of care provided by each category of staff per resident per
day (including, but not limited to, start date, end date (as
applicable), and hours worked for each individual).
(3) Distinguishing employee from agency and contract staff. When reporting
information about direct care staff, the facility must specify whether the
individual is an employee of the facility, or is engaged by the facility under
contract or through an agency.
(4) Data format. The facility must submit direct care staffing information in the
uniform format specified by CMS.
(5) Submission schedule. The facility must submit direct care staffing information
on the schedule specified by CMS, but no less frequently than quarterly.
For more information, please see
https://www.federalregister.gov/articles/2015/08/04/2015-18950/medicare-program-
prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities.
Therefore, 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.
This document provides basic information to be used for submitting staffing and census
information through the PBJ system. Questions about this manual can be submitted to
NHstaffing@cms.hhs.gov. There are additional materials that provide technical
specifications and instructions on how to submit data manually or upload automatically
from a payroll or time and attendance system. Information about where to find these
materials is found below in section 1.4.
June 2022 Page 1-2
CMS’s PBJ Version 2.6 Policy Manual CH 1: Overview
1.2 Submission Timeliness and Accuracy
Direct care staffing and census data will be collected quarterly, and is required to be
timely and accurate. Please refer to Table 1 for a complete list of direct care staff that
must be included.
Report Quarter: Staffing and census data will be collected for each fiscal quarter.
Staffing data includes the number of hours paid to work by each staff member each day
within a quarter. Census data includes the facility’s census on the last day of each of the
three months in a quarter. The fiscal quarters are as follows:
Fiscal
Quarter
Date Range
1
October 1 – December 31
2
January 1 – March 31
3
April 1 – June 30
4
July 1 – September 30
Deadline: Submissions must be received by the end of the 45
th
calendar day (11:59 PM
Eastern Time) after the last day in each fiscal quarter in order to be considered timely.
Facilities may enter and submit data at any frequency throughout a quarter. The last
accepted submission received before the deadline will be considered the facility’s final
submission. Facilities may view their data submitted through Certification and Survey
Provider Enhanced Reports (CASPER) and via the PBJ Online System. Please note, once
the final data file is uploaded, the facility must check their Final File Validation Report,
which can be accessed in their CASPER folder, to verify that the data was successfully
submitted. It may take up to 24 hours to receive the validation report, so facilities must
allow for time to correct any errors and resubmit, if necessary. The PBJ system will not
accept any submissions after the deadline.
Accuracy: Staffing information is required to be an accurate and complete submission
of a facility’s staffing records. Facilities should run the staffing reports that are available
in CASPER to verify the accuracy and completeness of their final submission prior to the
submission deadline. CMS will conduct audits to assess a facility’s compliance related to
this requirement.
Facilities that do not meet these requirements will be considered noncompliant and
subject to enforcement actions by CMS. Note: If a facility uses a vendor to submit
information on behalf of the nursing home, the nursing home is still ultimately
responsible for meeting all the requirements.
June 2022 Page 1-3
CMS’s PBJ Version 2.6 Policy Manual CH 1: Overview
1.3 Registration
Submission of staffing information through PBJ will be accessed through the Quality
Improvement & Evaluation System (QIES). To connect to PBJ through QIES you must
have a CMSnet user ID. Most long-term care facilities will already have connectivity to
QIES and CMSNet through submitting minimum data set (MDS) or other CMS data.
Individuals at facilities, vendors (e.g., payroll vendors), and/or corporate staff will need
to register to submit data into the PBJ system. This is very similar to the process that
has been in place with MDS data for years, and was recently updated to support both
electronic plan of correct (ePOC) and hospice data submissions.
Registration information for the PBJ system through QIES is available through the
following websites:
• https://www.qtso.com/cmsnet.html
• https://mds.qiesnet.org/mds_home.html
• https://www.qtso.com/webex/qiesclasses.php
1.4 Methods of Submission
The PBJ system has been designed to accept two primary submission methods – 1)
Manual data entry, and 2) Uploaded data from an automated payroll or time and
attendance system (XML format only). In addition, users can use either methods, or
combinations of these methods, for submitting data as needed or desired.
1) Entering information manually will require an individual(s) at a facility to key in
information about employees, hours paid to work, and census information directly
into the PBJ User Interface. The system has been designed to be user-friendly and
intuitively guide users to successfully complete the process. Sample screens of the
user interface are included below.
2) Uploading data directly from an automated payroll or time and attendance system
will function very similarly to how MDS data are submitted currently. The data will
be required to meet very specific technical specifications in order to be successfully
submitted. These requirements can be found at
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html.
Additionally, technical questions from vendors or software developers related to the
PBJ Data Submission Specifications should be sent to i[email protected]s.gov.
June 2022 Page 1-4
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
CHAPTER 2: Definitions
2.1 Employee Record
Figure 1: Sample Employee Entry Screen
a) Employee ID
All staff (direct employees and contract staff) must be entered into the system by
assigning each staff member an Employee ID. Employee names and any personally
identifiable information (PII) will not be stored in the system. The ID must be a unique
identifier and not duplicated with any other current or previous staff. This ID shall also
not contain any PII, such as a Social Security Number (SSN).
For example (employee named Dylan Smith):
Employee ID: 54bgs714
Hire Date: June 20, 2013
Termination Date: February 19, 2016
No other staff can be assigned the Employee ID of 54bgs714. Also, Dylan’s ID shall not
change during his employment. However, if the facility or provider’s business process or
June 2022 Page 2-1
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
system allows for reuse of an employee ID, when an individual leaves (terminated) and
then returns to valid employment, the previous ID can be reused.
In situations where a facility switches vendors, the facility shall do everything
possible to retain the same employee ID numbers. However, if it is not possible,
facilities have the capability to link an old employee ID with a new one. In order to
maintain the reporting of an employee’s hours through an employee ID change,
CMS added a method that facilities MUST use to link an old employee’s ID to a new
one. This feature was implemented on November 20, 2017.
The method in which this was implemented in PBJ is through a Linking table. The PBJ
system will assign a system generated ID to each employee ID. When a facility links a
new employee ID to an old employee ID, the system will link both of these IDs to the
same system ID. Therefore, the two or more individual Employee IDs each can have
hours logged to it, and both will be tied to the same system ID.
Employee IDs are used to calculate each facility’s staff turnover measures by identifying
when each employee starts and stops working at a facility. If a facility changes an
employee’s ID, that event is viewed the same as an employee ending their work at a
facility. Therefore, it is essential that facilities link old and new employee IDs together
when they change. If a facility does not do this, it will artificially increase its staff
turnover measures (i.e., viewed as worse performance). Employee IDs must be linked in
the same quarter they are updated to provide the most accurate reporting for each
facility.
NOTE: For purposes of existing PBJ Reports and screens, the individual Employee IDs will
continue to appear on the reports as two or more Employee IDs assigned by the facility.
The new field, System Employee ID, is being added, which will show the individual
Employee IDs together on reports under one System Employee ID, if this option is
selected.
The process for creating and submitting the employee ID linking file is the same as all the
other XML submissions.
• The technical submission XML file template and instructions to create linked IDs
is located here:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/NursingHomeQualityInits/Downloads/PBJ-Admin-Excel-to-XML-
Template-V-1-00-0.zip
Depending on your machine settings, this may open as a download, and not in
Excel directly.
June 2022 Page 2-2
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
• An XML Schema Definition (XSD) file can be located here:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/NursingHomeQualityInits/Downloads/PBJ-XSD-Admin-file-V1-00-
0.zip
The XSD defines the layout of the XML document, acting as a "data contract" so
those providing the XML know what format is to be expected.
• Detailed instructions for submitting the XML file are located in section 4 of the
PBJ Provider User's Guide located here:
https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-
providers/reference-manuals
NOTE: Linking Employee Identifiers (ID) is ESSENTIAL for accurate tenure and turnover
quarterly reporting.
.
b) Hire Date (Optional)
The first date of a staff member’s employment and is paid for services delivered, either
through direct employment or under contract. For contract staff, the start date is the
first date worked and billed for at the facility. If staff transfer to a new facility, their hire
date shall be the first date that they provide services at the new facility.
c) Termination date (Optional)
The last date of a staff member’s employment and is paid for services delivered, either
through direct employment or under contract. For contract staff, the end date is the
date the facility or the agency communicates that the contract individual will no longer
be providing services at that facility (either voluntary or involuntary).
Note: Hire and termination dates are reported at the facility level, not the company
level. These dates must reflect the time each staff member worked at an individual
facility, and not the dates hired and terminated at a company. Entering dates in the
Hire Date and Termination Date fields are now optional; however, if facilities still want
to enter dates in these fields, please refer to 2.1.b and 2.1.c above for further
instructions.
June 2022 Page 2-3
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
2.2 Staffing Hours Record
Figure 2: Sample Staffing Hours Entry Screen
a) Time
Time entered is calculated in fractions, not as direct hours and minutes. Users will need
to round to the nearest 10th when converting minutes to fractions. When entering an
employee’s hours enter them using the following conversions:
01 to 06 Minutes = 0.1
07 to 12 Minutes = 0.2
13 to 18 Minutes = 0.3
19 to 24 Minutes = 0.4
25 to 30 Minutes = 0.5
31 to 36 Minutes = 0.6
37 to 42 Minutes = 0.7
43 to 48 Minutes = 0.8
49 to 54 Minutes = 0.9
55 to 60 Minutes = 1.0
June 2022 Page 2-4
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
Facilities may opt to round to the nearest 100th when entering hours. Please note,
actual minutes worked shall not be reported. For example, if an employee works 7
hours and 33 minutes, 7.33 shall not be reported. The correct time to report would be
7.6 hours or 7.55 hours.
b) Work Day, Date
The day and date associated with the number of hours paid to work. When reporting
hours per day, hours reported shall be by the calendar day. Midnight is the cutoff for
each day reported. For example, if an employee works a shift which starts at 11:00 PM
on 4/5/2016 and ends at 7:00 AM on 4/6/2016, 1 hour would be recorded for 4/5/2016
and 7 hours for 4/6/2016.
c) Hours
Facilities must submit the number of hours each staff member (including agency and
contract staff) is paid to deliver services for each day worked. Do not count meal break
hours (see Meal Break Policy below) or hours paid for any type of leave or non-work-
related absence from the facility or for any unpaid time worked. For example, if a
salaried employee works 10 hours but is only paid for 8 hours, only 8 hours shall be
reported. If a facility is paying a salaried employee a bonus for additional hours worked,
those hours shall be reported under the following conditions: The payment must be
directly correlated to the hours worked and must be distinguishable from other
payments. (e.g., cannot be a performance-based or holiday bonus). Additionally, the
bonus payment must be reasonable compensation for the services provided.
Meal Break Policy
Meal times, paid or unpaid, shall not be reported for all staff (exempt, nonexempt, and
contract). Facilities must deduct the time allotted for meals from each employee’s daily
hours. For each full shift that staff (exempt, non-exempt, or contract) are paid to work, a
30-minute meal break must be deducted from their shift (whether or not the employee
actually takes a meal break). For example:
For staff with unpaid meal-times, who work:
• Shifts of 8 hours and are paid to work 7.5 hours (with a 30-minute unpaid meal-
break), then 7.5 hours shall be reported.
• Shifts of 8.5 hours and are paid to work 8 hours (with a 30-minute unpaid meal-
break), then 8 hours shall be reported.
• Shifts of 12 hours and are paid to work 11.5 hours (with a 30-minute unpaid
meal-break), then 11.5 hours shall be reported.
June 2022 Page 2-5
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
• Shifts of 16 hours (two 8-hour shifts) and are paid to work 15 hours (with two 30-
minute unpaid meal-breaks), then 15 hours shall be reported.
• Shifts of 17 hours (two 8.5-hour shifts) and are paid to work 16 hours (with two
30-minute unpaid meal-breaks), then 16 hours shall be reported.
For staff with paid meal-times, who work:
• Shifts of 8 hours and are paid to work 8 hours (including a 30-minute paid meal-
break), then 7.5 hours shall be reported.
• Shifts of 8.5 hours and are paid to work 8.5 hours (including a 30-minute paid
meal-break), then 8 hours shall be reported.
• Shifts of 12 hours and are paid to work 12 hours (including a 30-minute paid
meal-break), then 11.5 hours shall be reported.
• Shifts of 16 hours (two 8-hour shifts) and are paid to work 16 hours (including
two 30-minute paid meal- breaks), then 15 hours shall be reported.
• Shifts of 17 hours (two 8.5-hour shifts) and are paid to work 17 hours (including
two 30-minute paid meal- breaks), then 16 hours shall be reported.
The above examples are the minimum requirements for deducting hours for meal
breaks. If staff take a meal break that is longer than 30 minutes during a shift, the actual
time of the meal break should be removed and only hours actually providing services
should be reported. For example, if an employee works a shift of 8 hours and takes a 45-
minute meal break, then 7.25 hours (7 hours and 15 minutes) shall be reported.
Similarly, we expect facilities to deduct time for meal breaks for staff that work less than
an 8-hour shift, and only report the hours that staff are paid to deliver services to
residents.
Labor Classification/Job Title
Reporting shall be based on the employee’s primary role and their official categorical
title. It is understood that most roles have a variety of non-primary duties that are
conducted throughout the day (e.g., helping out others when needed). Facilities shall
still report just the total hours of that employee based on their primary role.
CMS recognizes that staff may completely shift primary roles in a given day. For
example, a nurse who spends the first four hours of a shift as the unit manager, and the
last four hours of a shift as a floor nurse. In these cases, facilities can change the
designated job title and report four hours as a nurse with administrative duties, and four
hours as a nurse (without administrative duties).
June 2022 Page 2-6
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
Medical Directors and Consultants
For medical directors, CMS understands it may be difficult to identify the exact hours a
physician spends performing medical director activities versus primary care activities.
Data reported shall be auditable and able to be verified through either payroll, invoices,
and/or tied back to a contract. Facilities must use a reasonable methodology for
calculating and reporting the number of hours spent conducting primary responsibilities.
For example, if a medical director is contracted for a certain fee (e.g., per month) to
participate in Quality Improvement meetings and review a certain number of medical
records each month, the facility shall have a reasonable methodology for converting
those activities into the number of hours paid to work.
For consultants, data reported shall be auditable and able to be verified through either
payroll, invoices, and/or tied back to a contract. We understand it may be difficult to
identify the exact hours a specialist contractor (e.g., non-agency nursing staff) provides
services to residents. However, there shall be some expectation of accountability for
services provided. Facilities must use a reasonable methodology for calculating and
reporting the number of hours spent conducting primary responsibilities, based on
payments made for those services. Reminder: Practitioner (e.g., physician, nursing
practitioner) visits to residents billed to Medicare or another payer, hours for services
provided by hospice staff and private duty nurses shall not be reported.
Physical, Occupational, Respiratory, and Speech Therapy
Hours for physical, occupational, respiratory, and speech therapy services, regardless of
payer, shall be reported. If the therapist provides therapy to a nursing home resident
from 1pm to 2pm, and then therapy to a resident from 2pm to 3pm, then 2 hours would
be reported. If the therapy is being conducted concurrently or for a group, only the
absolute hours shall be reported. For example, if two residents are receiving 60 minutes
of therapy at the same time from 1pm to 2pm, only 1 hour shall be reported (not 2
hours for 120 minutes). Also, hours for services provided to non-nursing home
residents shall not be reported. For example, hours for outpatient therapy services
provided to community-based individuals shall not be reported.
Co-Located Facilities (e.g. Hospital-Based SNF)
Facilities need to report the hours that are allocated to the SNF/NF residents and shall
not include hours for staff providing services to non SNF/NF residents. For example, for
hospital-based facilities or assisted living communities that share staff with the nursing
June 2022 Page 2-7
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
home, only those hours of the staff that are dedicated to the residents of the nursing
home shall be reported.
Corporate Staff
If someone from the corporate office is in the facility and is performing duties involving
resident care, the hours spent performing that care can be reported, even though the
person may be paid through the corporate payroll, rather than the facility’s payroll. This
would include instances when a corporate nurse is filling in for the Director of Nursing
when she/he is on vacation. However, facilities shall not include hours that a corporate
nurse spends performing monitoring tasks, such as helping the facility prepare for a
survey or resident chart reviews. Additionally, only hours paid to work on-site shall be
reported.
Staff in Training
Hours for staff (e.g. CNA) who are attending training (either onsite or offsite) and are
not available to perform their primary role, such as providing resident care, shall not be
reported. Also, if another staff member is called in to fill in for staff (e.g. nurse) that is
participating in training, the hours for the called-in nurse shall be submitted. However,
the hours for the nurse in training shall not be submitted.
Universal Care Workers
Some facilities use staff called, “universal care workers.” These staff are typically CNAs
that provide other non-CNA services, such as cleaning or cooking. For these staff,
facilities must use a reasonable methodology to separate the time that the universal
care worker spends performing their primary role, from their time that is spent
performing other activities. For example, assume a universal care worker is paid to work
7.5 hours each day (excluding a 30-minute meal-time). Of the 7.5 hours, 5.5 hours are
spent performing CNA-related duties, one hour is spent providing cooking services, and
one hour is spent providing cleaning services. In this situation, the facility shall only
report 5.5 hours of CNA time. Additionally, the facility may report one hour of
housekeeping time, and one hour of “other services” time, however, reporting of these
categories is optional (see Table 1 below).
d) Job Title Code
A code identifying the CMS defined Job Title(s) that matches the role(s) of the staff
member for the associated number of hours that the role(s) was performed (see Table
1).
June 2022 Page 2-8
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
e) Labor Category Code
A code identifying the CMS defined labor category groupings of associated Job Titles
(see Table 1). Note: the Labor Category Code is not needed for electronic uploads; only
the Job Title Code is needed.
f) Pay Type Code
Classification of whether the staff member is a direct employee of the facility (exempt
or non-exempt), or employed under contract paid by the facility.
Employees whose jobs are governed by the Fair Labor Standards Act (FLSA) are either
"exempt" or "nonexempt." Non-exempt employees are entitled to overtime pay.
Exempt employees are not.
Contract staff includes individuals under contract (e.g., a contracted physical therapist)
as well as individuals who provide services through organizations that are under
contract (e.g., an agency to provide nurses). All contract and agency staff must each
have a unique Employee ID when entered into the system.
NOTE: Only staff that meet these criteria are to be recorded. For example, physicians
that are salaried by the facility shall be recorded. Whereas physicians who provide
services to many residents in a facility, but bill Medicare directly, shall not.
Pay Type Code
Pay Type Description
1
Exempt
2
Non-Exempt
3
Contract
June 2022 Page 2-9
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
2.3 Labor and Job Codes and Descriptions
Table 1 below provides the labor code, job code, and a description of the services associated with each type of staff to be
recorded in the PBJ system.
Table 1: Labor and Job Codes and Descriptions
Labor
Category
Code
Job Title
Code
Labor Description
Job Description
Description of Services
1
1
Administration Services
Administrator
Administrators and Assistant Administrators, licensed by the state,
responsible for facility management as required under 483.70(d).
2
2
Physician Services
Medical Director
A physician designated as responsible for implementation of resident
care policies and coordination of medical care in the facilityin accordance
with 483.70(h).
2
3
Physician Services
Other Physician
A salaried physician, other than the medical director, who supervises the
care of residents when the attending physician is unavailable, and/or a
physician(s) available to provide emergency services 24 hours a day.
2
4
Physician Services
Physician Assistant
A graduate of an accredited educational program for physician assistants
who provides healthcare services typically performed by a physician,
under the supervision of a physician.
3
5
Nursing Services
Registered Nurse Director of Nursing
Professional registered nurse(s) administratively responsible for
managing and supervising nursing services within the facility. Do not
additionally reflect these hours in any other category.
3
6
Nursing Services
Registered Nurse with Administrative
Duties
Nurses (RN) who, as either a facility employee or contractor, perform
the Resident Assessment Instrument function in the facility and do not
perform direct care functions. Also include other RNs whose principal
duties are spent conducting administrative functions. For example, the
Assistant Director of Nursing is conducting educational/in-service.
3
7
Nursing Services
Registered Nurse
Those persons licensed to practice as registered nurses in the State
where the facility is located. Includes geriatric nurse practitioners and
clinical nurse specialists who primarily perform nursing, not
Physician-delegated tasks. Do not include Registered Nurses' hours
reported elsewhere.
June 2022 Page 2-10
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
Labor
Category
Code
Job Title
Code
Labor Description
Job Description
Description of Services
3
8
Nursing Services
Licensed Practical/Vocational Nurse with
Administrative Duties
Those persons licensed to practice as licensed practical/vocational nurses
in the State where the facility is located, and do not perform direct care
functions. Also include other nurses whose principal duties are spent
conducting administrative functions. For example, the LPN Charge Nurse
is conducting educational/in-service, or other duties which are not
considered to be direct care giving.
3
9
Nursing Services
Licensed Practical/Vocational Nurse
Those persons licensed to practice as licensed practical/vocational nurses
in the State where the facility is located. Do not include those hours of
LPN/LVNs reported elsewhere.
3
10
Nursing Services
Certified Nurse Aide
Individuals who have completed a State approved training and
competency evaluation program, or competency evaluation program
approved by the State, or have been determined competent as provided
in 483.150 and who are providing nursing or nursing-related services to
residents. Do not include volunteers.
3
11
Nursing Services
Nurse Aide in Training
Individuals who are in the first 4 months of employment and who are
receiving training in a State approved Nurse Aide training and
competency evaluation program and are providing nursing or
Nursing related services for which they have been trained and are under
the supervision of a licensed or registered nurse. Do not include
volunteers.
3
12
Nursing Services
Medication Aide/Technician
Individuals, other than a licensed professional, who fulfill the State
requirement for approval to administer medications to residents.
2
13
Physician Services
Nurse Practitioner
A registered nurse with specialized graduate education who is licensed
by the state to diagnose and treat illness, independently or as part of a
healthcare team.
3
14
Nursing Services
Clinical Nurse Specialist
A registered nurse with specialized graduate education who provides
advanced nursing care.
4
15
Pharmacy Services
Pharmacist
The licensed pharmacist(s) who a facility is required to use for various
purposes, including providing consultation on pharmacy services,
establishing a system of records of controlled drugs, overseeing records
and reconciling controlled drugs, and/or performing a monthly drug
regimen review for each resident.
June 2022 Page 2-11
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
Labor
Category
Code
Job Title
Code
Labor Description
Job Description
Description of Services
5
16
Dietary services
Dietitian
A person(s), employed full, part-time or on a consultant basis, who is
either registered by the Commission of Dietetic Registration of the
American Dietetic Association, or is qualified to be a dietitian on the basis
of experience in identification of dietary needs, planning and
implementation of dietary programs.
5
17
Dietary services
Paid Feeding Assistant
Person who meets the requirements specified in C.F.R. Section
483.60(h)(1)(i) and 483.60(h)(1)(ii) and who is paid to feed residents by a
facility, or who is used under an arrangement with another agency or
organization. Paid feeding assistants can only feed residents who do not
have complicated feeding problems that would require the training of a
nurse or nurse aide. Paid feeding assistants must not feed any residents
with complicated feeding problems or perform any other nursing or
nursing-related tasks. A feeding assistant must work under the
supervision of an RN or an LPN.
6
18
Therapeutic Services
Occupational Therapist
Persons licensed/registered as occupational therapists according to State
law in the State in which the facility is located. Include OTs who spend
less than 50 percent of their time as activities therapists.
6
19
Therapeutic Services
Occupational Therapy Assistant
Person(s) who, in accord with State law, have licenses/certification and
specialized training to assist a licensed/certified/registered Occupational
Therapist (OT) to carry out the OT's comprehensive plan of care, without
the direct supervision of the therapist. Include OT Assistants who spend
less than 50 percent of their time as Activities Therapists.
6
20
Therapeutic Services
Occupational Therapy Aide
Person(s) who have specialized training to assist an OT to carry out the
OT's comprehensive plan of care under the direct supervision of the
therapist, in accord with State law.
6
21
Therapeutic Services
Physical Therapist
Persons licensed/registered as physical therapists, according to State
law where the facility is located.
6
22
Therapeutic Services
Physical Therapy Assistant
Person(s) who, in accord with State law, have licenses/certification and
specialized training to assist a licensed/certified/registered Physical
Therapist (PT) to carry out the PT's comprehensive plan of care, without
the direct supervision of the PT.
6
23
Therapeutic Services
Physical Therapy Aide
Person(s) who have specialized training to assist a PT to carry out the
PT's comprehensive plan of care under the direct supervision of the
therapist, in accordance with State law.
June 2022 Page 2-12
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
Labor
Category
Code
Job Title
Code
Labor Description
Job Description
Description of Services
6
24
Therapeutic Services
Respiratory Therapist
Persons(s) who are licensed under state law (except in Alaska) as
respiratory therapists.
6
25
Therapeutic Services
Respiratory Therapy Technician
Person(s) who provide respiratory care under the direction of
respiratory therapists and physicians
6
26
Therapeutic Services
Speech/Language Pathologist
Persons licensed/registered, according to State law where the facility is
located, to provide speech therapy and related services (e.g., teaching a
resident to swallow).
6
27
Therapeutic Services
Therapeutic Recreation Specialist
Person(s) who, in accordance with State law, are licensed/registered and
are eligible for certification as a therapeutic recreation specialist by a
recognized accrediting body.
6
28
Therapeutic Services
Qualified Activities Professional
Person(s) who meet the definition of activities professional at
483.24(c)(2)(i) and 483.24 (c)(2)(ii) (A) or (B) or (C) or (D) and who are
providing an on-going program of activities designed to meet residents'
interests and physical, mental or psychosocial needs. Do not include
hours reported as Therapeutic Recreation Specialist, Occupational
Therapist, OT Assistant, or other categories listed above.
6
29
Therapeutic Services
Other Activities Staff
Persons providing an on-going program of activities designed to meet
residents' needs and interests. Do not include volunteers or hours
reported elsewhere.
6
30
Therapeutic Services
Qualified Social Worker
Person licensed to practice social work in the State where the facility is
located, or if licensure is not required, persons with a bachelor's degree
in social work, a bachelor's degree in a human services field including
but not limited to sociology, special education, rehabilitation counseling
and psychology, and one year of supervised social work experience in a
health care setting working directly with elderly individuals.
6
31
Therapeutic Services
Other Social Worker
Person(s) other than the qualified social worker who are involved in
providing medical social services to residents. Do not include volunteers.
7
32
Dental Services
Dentist (NOT REQUIRED/OPTIONAL)
Persons licensed as dentists, according to State law where the facility is
located, to provide routine and emergency dental services.
8
33
Podiatry Services
Podiatrist (NOT REQUIRED/OPTIONAL)
Persons licensed/registered as podiatrists, according to State law where
the facility is located, to provide podiatric care.
June 2022 Page 2-13
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
Labor
Category
Code
Job Title
Code
Labor Description
Job Description
Description of Services
9
34
Mental Health Services
Mental Health Service Worker
Staff (excluding those included under therapeutic services) who provide
programs of services targeted to residents' mental, emotional,
psychological, or psychiatric well-being and which are intended to:
• Diagnose, describe, or evaluate a resident's mental or emotional
status;
• Prevent deviations from mental or emotional well-being from
developing; or
• Treat the resident according to a planned regimen to assist him/her in
regaining, maintaining, or increasing emotional abilities to function.
Among the specific services included are psychotherapy and counseling,
and administration and monitoring of psychotropic medications
targeted to a psychiatric diagnosis.
10
35
Vocational Services
Vocational Service Worker (NOT
REQUIRED/OPTIONAL)
Evaluation and training aimed at assisting the resident to enter, re-enter,
or maintain employment in the labor force, including training for jobs in
integrated settings (i.e., those which have both disabled and nondisabled
workers) as well as in special settings such as sheltered workshops.
11
36
Clinical Laboratory
Services
Clinical Laboratory Service Worker (NOT
REQUIRED/OPTIONAL)
Entities that provide laboratory services and are approved by Medicare as
independent laboratories or hospitals.
12
37
Diagnostic X-ray Services
Diagnostic X-ray Service Worker (NOT
REQUIRED/OPTIONAL)
Radiology services, ordered by a physician, for diagnosis of a disease or
other medical condition.
13
38
Administration & Storage
of Blood Services
Blood Service Worker (NOT
REQUIRED/OPTIONAL)
Blood bank and transfusion services.
14
39
Housekeeping Services
Housekeeping Service Worker
(NOT REQUIRED/OPTIONAL)
Services, including those of the maintenance department, necessary to
maintain the environment. Includes equipment kept in a clean, safe,
functioning and sanitary condition. Includes housekeeping services
supervisor and facility engineer.
15
40
Other Services
Other Service Worker (NOT
REQUIRED/OPTIONAL)
Record total hours worked for all personnel not already recorded (For
example, librarian).
June 2022 Page 2-14
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
2.4 Census Record
Figure 3: Sample Census Data Entry Screen
Entering resident census for the last day of each month is now optional. If facilities still
want to enter census data, please refer to the information below for further instructions.
CMS will use Minimum Data Set (MDS) data to calculate a daily resident census for each
facility.
a) Month End Date:
Facilities may enter the resident census for the categories below for the last date of
each month. For facilities entering census data manually, the Payroll-Based Journal
system will list the last date of each month for facilities to enter the associated census.
Facilities uploading data from another system will need to adhere to the requirements
in the technical specifications. As with the staffing data (chapter 1.2 of this manual), the
census information must be electronically uploaded or manually entered by the end of
the 45th calendar day (11:59 PM Eastern Time) after the last day in each fiscal quarter in
order to be considered timely.
June 2022 Page 2-15
CMS’s PBJ Version 2.6 Policy Manual CH 2: Definitions
b) Medicaid: Number of residents whose primary payer is Traditional Medicaid.
c) Medicare: Number of residents whose primary payer is Traditional Medicare.
d) Other: Number of residents whose primary payer is neither Medicaid nor Medicare.
(This includes Medicare and Medicaid MCOs and HMOs.)
June 2022 Page 2-16
