• COVID-19 Infection Prevention and Wandering: Can the Two Co-Exist?

    By Caralyn Davis, Staff Writer - May 20, 2020

    In the March 13 revised Quality, Safety, and Oversight (QSO) memo QSO-20-14-NH, the Centers for Medicare & Medicaid Services (CMS) advised nursing homes to restrict all visitors except for compassionate-care situations and to “cancel communal dining and all group activities, such as internal and external group activities.” Adjusting to these changes has been difficult for every nursing home resident, but social distancing is especially hard for residents with dementia who wander and are eased by group activities.

     

    “That’s not who these people are,” acknowledges Teepa Snow, MS, OTR/L, FAOTA, founder and CEO of Positive Approach to Care, a global dementia care services and products company based in Efland, NC. “Nurses are being asked to do the impossible with the inadequate.”

     

    While physicians and physician extenders may be willing to prescribe an antipsychotic medication as an emergency measure in an acute or emergency situation as allowed under F758 (Free From Unnecessary Psychotropic Meds/PRN Use) in Appendix PP of the State Operations Manual, giving residents with dementia antipsychotics to make them immobile not only increases their risk of adverse events, such as cerebrovascular accidents (CVA) and even death, it also increases their risk of respiratory symptoms, including shortness of breath—one of the primary symptoms of COVID-19, points out Snow. “Providers may also consider taking away wheelchairs and other mobility aids. However, doing that puts residents with dementia at greater risk for falls and fall-related injuries, potentially resulting in a trip to the emergency department where they may be exposed to SARS-CoV-2, the virus that causes COVID-19.”

    Read more
  • COVID-19: CMS QSO Memo Details Nursing Home Reopening Recommendations for State and Local Officials (5/20)

    By CMS - May 19, 2020

    • Recommendations for State and Local Officials: CMS is providing recommendations to help determine the level of mitigation needed to prevent the transmission of COVID19 in nursing homes. The recommendations cover the following items:

    o Criteria for relaxing certain restrictions and mitigating the risk of resurgence: Factors to inform decisions for relaxing nursing home restrictions through a phased approach.

    o Visitation and Service Considerations: Considerations allowing visitation and services in each phase.

    o Restoration of Survey Activities: Recommendations for restarting certain surveys in each phase.

    Read more
  • CMS COVID-19 Stakeholder Engagement Calls – Week of 5/18/20

    By CMS - May 18, 2020

    CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

    Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. 

    Read more
  • LTCSP Survey Resources: Surveyor Tools Updated to Include COVID-19 (5/20)

    By CMS - May 18, 2020

    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).

     

     05/14/2020 COVID-19 Focused Survey folder Updated the following:

    • F-Tag Job Aid- changed font color of F761 to black. Removed asterisks from F885.

    • Added updated F-Tag job aide to survey resources zip file.

     

    05/08/2020 COVID-19 Focused Survey folder Updated the following:

    • Summary of the COVID-19 Focused Survey for Nursing Homes Added to offsite survey activities-telephonic interviews of residents, representatives and families. Added review communication with residents, representatives and families. In the onsite survey activity section added in the interview section-information provided to residents concerning COVID-19. In the Facility Self-Assessment added Reporting to residents, families and representatives to priority areas. Added Reporting to CDC to priority areas.

    • COVID-19 Focused Survey Protocol Added information about the review of F884 by CMS Federal Surveyors. Added ACO coding information to off-site prep. Expanded information under offsite and onsite activities.

    • Entrance Conference Worksheet Clarified language under #9. Added #13 requesting information on facility’s mechanism for reporting COVID-19 to residents, representatives, and families.

    • COVID-19 Focused Survey for Nursing Homes Added two critical elements (CE) and adjusted the CE order. #7 CE Reporting to Residents, Representatives & Families, #8 Reporting to CDC, and #9 Emergency Preparedness.

    • F-Tag Job Aid- Added tags F884 and F885

    Read more
  • LTCSP Survey F-Tag List by Regulatory Grouping UPDATED and Additional Resources (5/20)

    By CMS - May 17, 2020
    These resources from CMS include a list of F-tags by regulatory grouping used in the Long-term Care Survey Process (LTCSP) effective Nov. 28, 2017, and a crosswalk between old and new F-tags. CMS updated the tag list in May 2020.
    Read more
  • Release of Updated MDS With New Standardized SPADEs (and Supporting Training) Delayed Due to COVID-19 Public Health Emergency (5/20)

    By CMS - May 13, 2020

    CMS is delaying the release of the updated versions of the Minimum Data Set (MDS) needed to support the Transfer of Health (TOH) Information Quality Measures and new or revised Standardized Patient Assessment Data Elements (SPADEs) in order to provide maximum flexibilities for providers of Skilled Nursing Facilities (SNFs) to respond to the COVID-19 Pubic Health Emergency (PHE).

    The release of updated versions of the MDS will be delayed until October 1st of the year that is at least 2 full fiscal years after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on September, 20, 2020, SNFs will be required to begin collecting data using the updated versions of the item sets beginning with patients discharged on October 1, 2022.

    Following the PHE, CMS will announce training opportunities for providers via this webpage and announcements sent out via email distribution lists and posted on the Medicare Learning Network.

    Read more
  • CMS QSO Memo updates F-tags and COVID-19 Focused Survey Tools to Include Reporting Requirements (5/20)

    By CMS - May 07, 2020
    Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes

    Memo # QSO-20-29-NH

    Posting Date 2020-05-06

    Fiscal Year 2020

     

    Summary

    • CMS is committed to taking critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

    • On May 8, 2020, CMS will publish an interim final rule with comment period. • COVID-19 Reporting Requirements: CMS is requiring nursing homes to report COVID-19 facility data to the Centers for Disease Control and Prevention (CDC) and to residents, their representatives, and families of residents in facilities.

    • Enforcement: Failure to report in accordance with 42 CFR §483.80(g) can result in an enforcement action.

    • Updated Survey Tools: CMS has updated the COVID-19 Focused Survey for Nursing Homes, Entrance Conference Worksheet, COVID-19 Focused Survey Protocol, and Summary of the COVID-19 Focused Survey for Nursing Homes to reflect COVID-19 reporting requirements.

    • COVID-19 Tags: F884 and F885.

    • Transparency: CMS will begin posting data from the CDC National Healthcare Safety Network (NHSN) for viewing by facilities, stakeholders, or the general public. The COVID-19 public use file will be available on https://data.cms.gov/.

    Read more
  • To IPA or NOT To IPA: That Is an Important Question

    By Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC - May 05, 2020

    Healthcare professionals were relieved when CMS agreed to make the Interim Payment Assessment (IPA) optional instead of a requirement. This meant that skilled nursing facilities (SNFs) could decide when or if they would complete these payment assessments. CMS anticipated that SNFs would perform IPAs during each Medicare Part A stay both to improve Medicare payment during the stays and to monitor patients’ clinical status. However, data shows that few IPAs are being completed.

     

    One likely reason why: the complexity of the new Patient-Driven Payment Model (PDPM) makes it difficult to know when an MDS would improve the final payment. John Kane, CMS’s SNF Payment Team Lead, stated during one of CMS’s train-the-trainer sessions that there could be as many as 1,900 possible payment combinations per PPS MDS.

     

    So how can you know whether an IPA would improve the Medicare payment? First, let’s consider the impact of CMS’s original plan to require the IPAs. CMS proposed that IPAs would be completed when there was a change in one of the first-tier classification criteria in any of the proposed payment components. For example, if the resident had been classified into the Major Joint Replacement category for the PT/OT component and their primary diagnosis changed to Medical Management, the IPA would have been required. Likewise, when a resident’s Nursing component category changed from Extensive Services to Special Care Low, an IPA would have been required. We are grateful that assessments are not mandatory in these circumstances, but they provide a useful starting point for understanding when an IPA could be financially beneficial.

     

    In the SNF PPS Final Rule for FY 2020, CMS included the following table showing the FY 2020 federal unadjusted urban base rates for each of the six PDPM payment components:

    Read more
  • Part A Physician Certs/Recerts: CMS Confirms How to Count Days

    By Caralyn Davis, Staff Writer - May 05, 2020

    To bill under traditional fee-for-service Medicare Part A, skilled nursing facilities (SNFs) must obtain appropriate, timely physician certifications and recertifications of posthospital inpatient extended-care services. The physician cert/recert policy did not change with the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019.

     

    However, the Centers for Medicare & Medicaid Services (CMS) did adjust the instructions in the Medicare Online Manual System to explain when providers need to obtain a new physician certification vs. when they should continue using the existing cert/recert to account for the interrupted stay policy that was implemented in conjunction with PDPM. This adjustment brought to light the fact that some SNFs may be counting calendar days instead of Medicare days to determine when certs/recerts are due—a practice that is incorrect CMS officials tell the American Association of Nurse Assessment Coordination (AANAC).

     

    “The regulations at 42 CFR 424.20(d) state that the first recertification is required no later than ‘the 14th day of post-hospital SNF care.’ This would have the schedule track with the days of the stay (i.e., covered days) rather than calendar days,” explain officials. Note: Review the physician cert/recert section of the Code of Federal Regulations in the box at the end of this article.

     

    “This also tracks with previous statements we have made comparing the recertification timeline with the variable per-diem schedule, and interrupted stays have similar impacts on both, as noted in response to FAQ 13.21,” say officials. Here is the FAQ excerpted from Patient-Driven Payment Model: Frequently Asked Questions (FAQs):

    Read more
  • National Healthcare Safety Network Long-term Care Facility COVID-19 Reporting Module Website (5/20)

    By CDC - May 05, 2020

    CDC’s NHSN provides healthcare facilities, such as long term care facilities (LTCF) with a customized system to track infections and prevention process measures in a systematic way.

    Tracking this information allows facilities to identify problems, improve care, and determine progress toward facility and national healthcare-associated infection goals.

    The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response by introducing a new COVID-19 Module for Long Term Care Facilities. Facilities eligible to report into the COVID-19 Module include nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities.

    The COVID-19 Module for LTCFs consists of four pathways within NHSN’s Long-term Care Facility Component:

    • Resident Impact and Facility Capacity
    • Staff and Personnel Impact
    • Supplies and Personal Protective Equipment
    • Ventilator Capacity and Supplies

    The Module enables an assessment of the impact of COVID-19 in LTCFs through facility reported information, including: 1) counts of residents and facility personnel with suspected and laboratory positive COVID-19; 2) counts of suspected and laboratory positive COVID-19 related deaths among residents and facility personnel; 3) staffing shortages; 3) status of personal protective equipment (PPE) supplies; and 4) ventilator capacity and supplies for facilities with ventilator dependent units.  The Module does not collect staff or resident-level information.

    Participation in the COVID-19 Module for LTCFs requires facilities to be actively enrolled in NHSN. LTCFs that are currently enrolled in NHSN’s LTCF Component have immediate access to the new module and may begin reporting. If your facility previously enrolled, but is no longer able to gain access, contact NHSN user support at nhsn@cdc.gov for assistance. Please do not re-enroll a previously enrolled facility.

    LTCFs that are not enrolled in NHSN may gain access to the COVID-19 Module by completing the enrollment process outlined in the Enrollment section of this page. Upon completion, the facility will gain same-day access to NHSN.

    While daily reporting will provide the timeliest data for response purposes, retrospective reporting of prior day(s) is encouraged if daily reporting is not feasible. LTCF data submission options include manual entry, CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities.  NHSN, in turn, will enable state and local health departments and the Centers for Medicare and Medicaid Services (CMS) to gain immediate access to the COVID-19 data for LTCFs in their jurisdictions. COVID-19 data submitted to NHSN also will be used by CDC’s emergency COVID-19 response and by the U.S. Department of Health and Human Services’ (HHS’) COVID-19 tracking system maintained in the Office of the Assistant Secretary of Preparedness and Response.

    Read more
  • May 8: CMS Interim Final Rule Requirements re: COVID-19 Reporting and the SNF QRP Go Into Effect (5/20)

    By CMS - May 04, 2020

    Note that the COVID-19 reporting and SNF QRP reporting changes both will go into effect on May 8 since the effective date is the publication date.

    Medicare and Medicaid Programs, Basic Health Program, and Exchanges: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program

    ACTION: Interim final rule with comment period.

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     


    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

     

    We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

    SNF QRP

    We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.

     

    Read more
  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (4/20)

    By CMS - April 30, 2020

    CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated twice in October 2019.


    April 2020 Revisions: Temporary Changes due to COVID-I9 

    On March 23, CMS announced a new, targeted inspection plan designed to help keep nursing home residents safe in the face of the COVID-19 pandemic. The plan called for focused inspections on urgent patient safety threats (called “immediate jeopardy”) and infection control. These targeted inspections allow CMS to focus inspections on the most urgent situations, so the agency can get the information it needs to ensure safety, while not getting in the way of patient care. Due to this action, there is a great shift in the number of nursing homes inspected, and how the inspections are conducted. Without action, this would disrupt the inspection domain of the Five Star Quality Rating System because many nursing homes that would normally be inspected, will not, thereby over-weighting and impacting the ratings of those facilities that are inspected. This could then potentially mislead consumers. Therefore, we will temporarily maintain and hold constant the health inspection domain of the rating system. Specifically, health inspections conducted on or after March 4, 2020, will be posted publicly, but not be used to calculate a nursing home’s health inspection star ratings. This action will start with the scheduled update to the Nursing Home Compare website on April 29, 2020. The surveys will be posted through a link on the front page of the Nursing Home Compare website in the upcoming months (as the survey data is finalized and uploaded).

     

    January 2020 addition: Technical specifications for claims-based measures

    Read more
  • Coronavirus Commission for Safety and Quality in Nursing Homes to Focus on Identifying Best Practices, Strengthening Regulations and Enforcement (4/20)

    By CMS - April 30, 2020

    On April 30, the Centers for Medicare & Medicaid Services (CMS) announced that an independent Commission will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will be convened and lead by a CMS contractor and will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. 

    The convening of the Commission is the next step in improving quality and safety within nursing homes. The Commission will help inform efforts to safeguard the health and quality of life of vulnerable Americans as CMS continues to battle COVID-19. The Commission will include residents, families, resident/patient advocates, leading industry experts, clinicians, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other experts selected through a nomination process.

    It is expected to convene in May and develop recommendations on three key tasks: 

    • Putting nursing home residents first by ensuring they are protected from COVID-19 and improving the responsiveness of care delivery to meet the needs of all residents to maximize quality of life for residents.

    • Strengthen regulations to enable rapid and effective identification and mitigation of COVID-19 transmission in nursing homes; and 

    • Enhance federal and state enforcement strategies to improve compliance with infection control policies in response to COVID-19. 

    Additionally, the Commission will focus on identifying potentially innovative approaches for using existing and newly available nursing home (and other) data to enable better coordination between federal surveyors and state and local entities to address the current spread of COVID-19 within nursing homes as well as to analyze the impact of efforts to stop or contain the virus within these facilities. 

    Participants will help to identify best practices to address COVID-19, which CMS or states may incorporate into a larger regulatory framework for effective oversight to better inform federal and state officials as well as nursing homes across the country, to better achieve compliance through improved enforcement solutions, and to improve the quality of life and overall health status of nursing home residents during the pandemic. 

    Read more
  • CMS Freezes Five-Star Inspection Domain, Releases New FAQs, and Posts New Staffing Data for Every Facility (4/20)

    By CMS - April 28, 2020

    Ref: QSO-20-28-NH

    DATE: April 24, 2020

    TO: State Survey Agency Directors

    FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the threat of the COVID-19.

    • Nursing Home Compare website & Nursing Home Five Star Quality Rating System: We are announcing that the inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.

    • Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website.

    • Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.

    • Frequently Asked Questions (FAQ): We are releasing a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

    Read more
  • COVID-19’s Impact on the SNF QRP and SNF VBP: What It Means for NACs

    By Caralyn Davis, Staff Writer - April 21, 2020

    On March 27, the Centers for Medicare & Medicaid Services (CMS) issued a memo describing the scope and duration of exceptions and exemptions to reporting requirements under certain Medicare quality reporting and value-based purchasing programs. This memo followed up on a March 22 announcement of this relief in response to healthcare providers’ ongoing fight against 2019 Novel Coronavirus (COVID-19). Additional changes could occur depending on how the COVID-19 pandemic unfolds, but these documents lay out the initial exceptions for both the Skilled Nursing Facility Quality Reporting Program (SNF QRP) and the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program.

     

    Here are the highlights—and what these changes mean for nurse assessment coordinators (NACs) and their ever-growing to-do lists, according to Jessie McGill, RN, RAC-MTA, RAC-MT, curriculum development specialist at AANAC:

     

    SNF QRP Oct. 1 – Dec. 31, 2019 MDS data collection

    Read more
Previous 3 of 26 Next