Nursing Home ACA PBJ Reporting

While peanut butter and jelly sandwiches are not mentioned in the Patient Protection and Affordable Care Act (ACA), almost everyone knows that individual and employer sponsored health insurance mandates are. However, many people often do not realize that many other healthcare areas are addressed, as well. Nursing homes are now mandated to report additional payroll based journal (PBJ) information to the Centers for Medicare and Medicaid Services (CMS).

CMS has long identified staffing as a vital component of a nursing home’s ability to provide quality care. CMS utilizes staffing data to accurately and effectively gauge its impact on quality of care in nursing homes. CMS posts staffing information on its website, and uses it in its Nursing Home Five Star Quality Rating System.

How PBJ Reporting Instructions Should Be Similar to Making a Sandwich

The ACA requires nursing homes to electronically submit direct care staffing information (including agency and contract staff) based on payroll and other auditable data. Known as the PBJ reporting system, staffing data combined with census information will be used to report facility staff levels, employee turnover, and tenure.

As with most things, communication will be key. As an example, place the supplies for making a peanut butter and jelly sandwich on a table and ask two friends to stand back-to-back, with one person facing the table. Ask the person facing away from the table to give the sandwich maker step-by-step instructions for making a PB&J sandwich. (Hopefully the instructor will think to suggest using a knife to apply the ingredients!) Not unlike the sandwich-making exercise, PBJ reporting will require very precise instructions and communications given its use of data components from various sources including time and attendance systems, third-party consultants, therapy companies, and resident census records.

CMS estimates that PBJ data collection and submission chores—if completed manually—will require up to two full-time, well trained employees. To streamline your process, follow the recipe outlined below, work with time & attendance vendors and third-parties to gather the required electronic ingredients, and use middleware software for blending.


90+/- daily time records for each direct care employee
3 resident census totals each quarter
90+/- time records for each care consultant every day
90+/- daily time records for each medical director

90+/- daily time totals for each therapy company employee

1 CMSNet User ID
1 Juniper software client

1 data blender software (hand mix if preferred)
1 dash of patience (up to a bushel to taste)

Separate and discard any non-care related records. Mix remaining time in data blender each quarter to the required consistency. Add the resident census totals. Enter personal baker ID’s in your Juniper software client. Upload the results to the CMS kitchen. CMS chefs will evaluate the results and award star rankings as your prize.

CRI Can Help Nursing Homes Satisfy PBJ Needs

Judicious use of the PBJ data you collect can help improve the quality of care provided to your nursing home residents. CRI’s knowledgeable advisors are focused on the challenges faced by long-term care providers. Contact us for guidance with implementing CMS’s PBJ reporting requirements and evaluating staffing effectiveness—maybe we can even discuss it over lunch!