• CDC Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (11/20)

    By CDC - November 23, 2020

    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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  • Residents With Acute Respiratory Symptoms? CDC Testing and Management Considerations When SARS-COV-2 and Influenza Co-Circulate (11/20)

    By CDC - November 23, 2020
    This document contains practices that should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities.
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  • Capturing Resident Voice and Choice in Activity Care Plans

    By Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA - November 17, 2020

    Constructing person-centered care plans takes time, effort, and person-specific focus on including the resident’s voice and choice. This is especially important when developing care plans from information gathered under section F, Preferences for Customary Routines and Activities. Without this information, activity professionals are only guessing at the type of activities that a resident may be interested in. Often, staff believe it is easier to create a template of an activity care plan and fill it in with activities that are offered at the facility. However, this one-size-fits-all approach defeats the intent of an individualized care plan, as it doesn’t address the needs particular to that resident. Furthermore, where this is currently the process in use, the facility is at risk for survey citations related to lack of individualized care plans under F656, Comprehensive Care Plans. In this article, activity directors and staff involved in activity care planning will review some common reasons why activity care plans get cited under F656, examine what person-centered is defined as in the regulations, and learn three tips to help avoid future citations.


    Survey Deficiencies

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  • OBRA Assessments: What to Watch Out for During the COVID-19 Pandemic

    By Caralyn Davis, Staff Writer - November 17, 2020

    Skilled Nursing Facility Prospective Payment System (SNF PPS) MDS assessments rightfully get a lot of attention during the COVID-19 public health emergency as nurse assessment coordinators (NACs) continue to try to obtain accurate Medicare Part A payments for their facilities. However, OBRA assessments remain important too, impacting payment in Medicaid case-mix states, as well as care area assessment (CAA) development and resident-centered care planning for all residents. The following steps can help NACs navigate OBRA assessments as the pandemic continues to unfold:


    Set ARDs timely

    In theory, the Centers for Medicare & Medicaid Services (CMS) relaxed the MDS assessment and transmission requirements this past spring, issuing a COVID-19 emergency blanket declaration waiver that waived “42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.”

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  • CMS Urgent Call to Action: Staff, Managers Should Complete QSEP Nursing Home COVID-19 Training (11/20)

    By CMS - November 17, 2020

    Agency thanks nursing homes whose staff have completed free CMS training, but urges remaining homes to take advantage of this resource

    The Centers for Medicare & Medicaid Services (CMS) is publicly recognizing the 1,092 nursing homes at which 50% or more of their staff have completed CMS training designed to help staff combat the spread of coronavirus disease 2019 (COVID-19) in nursing homes. CMS applauds these facilities for taking this critical step to equip their staff with the latest information regarding infection control, vaccine distribution, and other topics.

    There are 125,506 individuals from 7,313 nursing homes who have completed the training. This represents approximately 12.5% of the approximately one million nursing home staff in the country. With today’s announcement, CMS is calling on nursing homes to take action, urging them to require their staff to take this free training, as part of the Trump Administration’s continued efforts to keep nursing home residents safe.

    “We’ve provided nursing homes with $20 billion in federal funding, millions of pieces of PPE, free testing machines and supplies, and significant technical assistance and on-the-ground support,” said CMS Administrator Seema Verma. “Ultimately, the ownership and management of every nursing must take it on themselves to ensure their staff is fully equipped to keep residents safe. With coronavirus cases increasing across the country and infection control identified as a major issue, we encourage all nursing homes to take advantage of this no-cost opportunity to train their staff.”

    The training includes multiple modules, with emphases on topics such as infection control, screening and surveillance, personal protective equipment (PPE) usage, disinfection of the nursing home, cohorting and caring for individuals with dementia during a pandemic. CMS developed this training in consultation with the Centers for Disease Control and Prevention (CDC) and expert stakeholders, and announced the training on August 25, 2020. For anyone interested, the training is free to access on a public CMS website; instructions on how to create an account and take the training are available at qsep.cms.gov/welcome.aspx.

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  • SNF QRP/ SNF VBP exceptions related to CA/OR Wildfires and Hurricane Laura (11/20)

    By CMS - November 17, 2020
    The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to hospitals, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, renal dialysis facilities, long-term care hospitals, and ambulatory surgical centers, and Merit-Based Incentive Payment System (MIPS) eligible clinicians, located in areas affected by the California and Oregon Wildfires, as well as by by Hurricane Laura due to the devastating impact of the storm. These healthcare providers and suppliers will be granted exceptions if they are located in one of the California or Oregon counties listed below, all of which have been designated as emergency disaster areas by the Federal Emergency Management Agency (FEMA).

    The scope and duration of the exception under each Medicare quality reporting program is described below; however, all of the exceptions are being granted to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities.

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  • HHS Stark Law and Anti-Kickback Reforms to Support Coordinated, Value-Based Care Could Bring Opportunities for SNFs (11/20)

    By HHS - November 16, 2020
    The Department of Health and Human Services (HHS) published two final rules that aim to reduce regulatory barriers to care coordination and accelerate the transformation of the healthcare system into one that pays for value and promotes the delivery of coordinated care.

    The rules provide greater flexibility for healthcare providers to participate in value-based arrangements and to provide coordinated care for patients. The final rules also ease unnecessary compliance burden for healthcare providers and other stakeholders across the industry, while maintaining strong safeguards to protect patients and programs from fraud and abuse.

    The HHS Office of Inspector General (OIG) issued the final rule “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements,” and the Centers for Medicare and Medicaid Services (CMS) issued the final rule “Modernizing and Clarifying the Physician Self-Referral Regulations.” These rules are part of HHS’s Regulatory Sprint to Coordinated Care, which has examined federal regulations that potentially impede healthcare providers’ efforts that otherwise would advance the transition to value-based care and improve the coordination of patient care across care settings in Federal healthcare programs and the commercial sector. In addition to advancing value-based care, the CMS final rule clarifies and modifies existing policies to ease unnecessary regulatory burden on physicians and other healthcare providers while reinforcing the physician self-referral law’s (often called the “Stark Law”) goal of protecting patients from unnecessary services and being steered to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest.

    The new and amended regulations related to the federal Anti-Kickback statute and the civil monetary penalties law issued by OIG address stakeholder concerns that these laws unnecessarily limit the ways in which healthcare providers can coordinate care with and for federal healthcare program beneficiaries. OIG’s final rule modifies and clarifies the agency’s proposed rule in response to comments, as explained in the preamble to the final rule. 

    For example, OIG’s final rule clarifies how medical device manufacturers and durable medical equipment companies may participate in protected care coordination arrangements that involve digital health technology, and the final rule lowers the level of “downside” financial risk parties must assume to qualify under the new safe harbor for value-based arrangements that involve substantial downside financial risk. In recognition of the urgent problem of cyber threats to the healthcare industry, the rule also broadens the new safe harbor for cybersecurity technology and services to protect cybersecurity-related hardware. 

    OIG’s final rule, and the CMS final rule to the extent the Stark Law is applicable, would facilitate a range of arrangements to improve the coordination and management of patient care and the engagement of patients in their treatment if all applicable regulatory conditions are met, including the following examples:

    • To improve patient transitions from one care delivery point to the next, a hospital may wish to provide physician offices with care coordinators that furnish individually tailored case management services for patients requiring post-acute care.
    • A hospital may wish to provide support and to reward institutional post-acute providers for achieving outcome measures that effectively and efficiently coordinate care across care settings and reduce hospital readmissions.  Such measures would be aligned with a patient’s successful recovery and return to living in the community. 
    • A primary care physician or other provider may wish to furnish a smart tablet that is capable of two-way, real-time interactive communication between the patient and his or her physician.  The patient’s access to a smart tablet could facilitate communication through telehealth and the provision of in-home services.
    • A health system furnishes cybersecurity technology to physician practices to reduce harm from cyber threats to all their systems.
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  • Calendar 2021 CMS Manual Update: Medicare Deductible, Coinsurance and Premium Rates (11/20)

    By MX - November 16, 2020

    Transmittal # R10469GI

    Issue Date 2020-11-20

    Subject Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021

    Implementation Date 2021-01-04

    CR #12024

    Publication #100-01 

    SUMMARY OF CHANGES: This recurring Change Request (CR) provides instruction for Medicare contractors to update the claims processing system with the new Calendar Year (CY) 2021 Medicare rates. This Recurring Update applies to Chapter 3, Sections 10.3, 20.2 and 20.6 of the Medicare General Information, Eligibility, and Entitlement manual.

    EFFECTIVE DATE: January 1, 2021 *Unless otherwise specified, the effective date is the date of service.

    IMPLEMENTATION DATE: January 4, 2021

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  • CDC Long-term Care COVID-19 Resources Updated (11/20)

    By CDC - November 15, 2020

    Preparing for COVID-19 in Nursing Homes

    Updated Nov. 20, 2020

    New Resources: 

    CMS Alert Addressing Holiday Celebrations


    Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating

    Read the complete guidance here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

    Related Documents and Resources

    • Considerations for the Public Health Response to COVID-19 in Nursing Homes
    • Interim Testing in Response to Suspected or Confirmed COVID-19 in Nursing Home Residents and Healthcare Personnel
    • Considerations for Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes
    • Considerations for Memory Care Units in Long-Term Care Facilities
    • Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19
    • CDC Strategy for COVID-19 Testing Nursing Homes.
    • Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)
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  • CMS Will Retire Nursing Home Compare Tool and Fully Transition to Care Compare on December 1 (11/20)

    By CMS - November 15, 2020
    CMS will retire the original Compare Tools on December 1st. Use Medicare.gov’s Care Compare to find and compare health care providers.

    In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, which streamlines our eight original health care compare tools.  Since then, you’ve had the opportunity to use and familiarize yourself with Care Compare while having the option to use the original compare tools, too.  You’ve also been able to share feedback from a survey directly on Care Compare and we’ve received lots of great feedback so far.

    The eight original compare tools – like Nursing Home Compare, Hospital Compare, Physician Compare – will be retired on December 1st, ending this transition period. If you haven’t been using Care Compare, we urge you to:

    ·  Use Care Compare on Medicare.gov and encourage people with Medicare and their caregivers to start using it, too. Go to Medicare.gov and choose “Find care”.

    ·  Update any links to the eight original care tools on your public-facing websites so they’ll direct your audiences to Care Compare.

    Care Compare offers a new design that makes it easier to find the same information that’s on the original compare tools. It gives you, patients, and caregivers one user-friendly place to find cost, quality of care, service volume, and other CMS quality data to help make informed health care decisions.

    Now, instead of having to search through many compare tools, with just one click on Care Compare, you’ll find easy-to-understand information about nursing homes, hospitals, doctors, and other health care providers.

    Please remember that when we retire the 8 original compare tools, you will still be able to find information about health care providers and CMS quality data on Care Compare, as well as download CMS publicly reported data from the Provider Data Catalog on CMS.gov.  Fully transitioning to these tools does not change how CMS measures quality. In addition, we’ll continue to make improvements to Care Compare and the Provider Data Catalog based on stakeholder and consumer feedback now and in the future. 

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  • Medicare Improper Payments and SNFs: CMS Press Release and Fact Sheet (11/20)

    By CMS - November 15, 2020
    Skilled nursing facility claims saw a $1 billion reduction in estimated improper payments in the last year due to a policy change related to the supporting information for physician certification and recertification for skilled nursing facility services, as well as CMS’ Targeted Probe and Educate efforts.
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  • COVID-19 Medicare FAQs Updated (11/20)

    By CMS - November 12, 2020

    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.

    The updates include the following SNF FAQ: If a new benefit period was granted pursuant to the section 1812(f) waiver, and the PHE ends in the middle of that new benefit period, would the beneficiary be entitled to the full 100 days of renewed SNF benefits, or would that entitlement end on the day the PHE ends?

    The Centers for Medicare & Medicaid Services (CMS) released an additional list of Frequently Asked Questions (FAQs) to Medicare providers regarding the Department of Health & Human Services’ (HHS) Provider Relief Fund and the Small Business Administration’s Paycheck Protection Program payments, also referred to as coronavirus disease 2019 (COVID-19) relief payments.  The FAQs provide guidance to providers on how to report provider relief fund payments, uninsured charges reimbursed through the Uninsured Program administered by Health Resources and Services Administration, and Small Business Administration (SBA) Loan Forgiveness amounts. The FAQs also address that provider relief fund payments should not offset expenses on the Medicare Cost Report.  

    Documents included: 

    • Frequently Asked Questions to Assist Medicare Providers
    • Medicare Telehealth Frequently Asked Questions (PDF) (now included in all-inclusive FAQs) 
    • Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction
    • Infographic: Coverage of Monoclonal Antibody Products to Treat COVID-19
    • Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency

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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - November 10, 2020
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  • OSHA Respiratory Protection Guidance for Nursing Homes (11/20)

    By Occupational Safety and Health Administration - November 03, 2020

    Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and Other Long-Term Care Facilities During the COVID-19 Pandemic

    This guidance is designed specifically for nursing homes, assisted living, and other long-term care facilities (LTCFs) (e.g., skilled nursing facilities, inpatient hospice, convalescent homes, and group homes with nursing care). While this guidance focuses on protecting workers from occupational exposure to SARS-CoV-2 (the virus that causes COVID-19 disease) by the use of respirators, primary reliance on engineering and administrative controls for controlling exposure is consistent with good industrial hygiene practice and with OSHA’s traditional adherence to a “hierarchy of controls.”

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  • Making the Most of Resident Interviews

    By Jessie McGill, RN, RAC-MT, RAC-MTA - November 02, 2020

    The scripted resident interviews can be redundant for many residents, but they do not need to be. While the scripted interviews must be followed exactly as written, the resident experience can be improved greatly. 

    Read this article to learn four tips nurse assessment coordinators (NACs) and interdisciplinary team members can utilize to transform the resident interview from a task to an experience.


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