• CDC Strategies for Optimizing the Supply of PPE and Other Equipment (12/20)

    By CDC - February 15, 2021

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

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  • CMS Section N: Medications – Drug Regimen Review Web-Based Training (2/21)

    By CMS - February 14, 2021

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of the Drug Regimen Review standardized patient assessment data elements (SPADEs) found in the Medications Section of the guidance manuals.

    This 45-minute course is intended for providers in Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs), and is designed to be used on demand anywhere you can access a browser.

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  • CMS QSO Memo: Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results (2/21)

    By CMS - February 08, 2021

    DATE: June 1, 2020

    REVISED 01/04/2021

    TO: State Survey Agency Directors FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes

    CMS is committed to taking critical steps to protect vulnerable Americans to ensure America’s health care facilities are prepared to respond to the CoronavirusDisease2019(COVID-19) Public Health Emergency (PHE).

    • CMS has implemented a new COVID-19 reporting requirement for nursing homes, and is partnering with CDC’s robust federal disease surveillance system to quickly identify problem areas and inform future infection control actions.

    • Following the March 6, 2020 survey prioritization, CMS has relied on State Survey Agencies to perform Focused Infection Control surveys of nursing homes across the country. We are now initiating a performance-based funding requirement tied to the Coronavirus Aid, Relief and Economic Security (CARES) Act supplemental grants for State Survey Agencies. Further, we are providing guidance for the limited resumption of routine survey activities. CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care.

    • CMS is providing Frequently Asked Questions related to health, emergency preparedness and lifesafety code surveys

    • CMS is also enhancing the penalties for noncompliance with infection control to provide greater accountability and consequence for failures to meet these basic requirements. This action follows the agency’s prior focus on equipping facilities with the tools they needed to ensure compliance, including 12 nursing home guidance documents, technical assistance webinars, weekly calls with nursing homes, and many other outreach efforts. The enhanced enforcement actions are more significant for nursing homes with a history of past infection control deficiencies, or that cause actual harm to residents or Immediate Jeopardy.

    • Quality Improvement Organizations have been strategically refocused to assist nursing homes in combating COVID-19 through such efforts as education and training, creating action plans based on infection control problem areas and recommending steps to establish a strong infection control and surveillance program.

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  • LTCSP Survey Resources: Surveyor Tools Updated (2/21)

    By CMS - February 07, 2021

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

     

     

    02/05/2021 Survey Resource folder update: 

     

    LTCSP Procedure Guide

    • Expansion of complaints/FRIs in LTCSP during recertification survey

    LTCSP 11.9.5 User Guide

    • Expansion of complaints/FRIs in LTCSP during recertification survey

     

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  • LTCSP Procedure Guide - Updated (2/21)

    By CMS - February 07, 2021

    The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the Long-term Care Survey Process. Surveyors use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually participating. The LTCSP steps are organized into seven parts: 1) offsite preparation; 2) facility entrance; 3) initial pool process; 4) sample selection; 5) investigation; 6) ongoing and other survey activities; and 7) potential citations.

    2/5 update

    1. LTCSP Procedure Guide: Expansion of complaints/FRIs in LTCSP during recertification survey

     

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  • Check Your Data: Updated Data Process Will Impact CASPER/SNF QRP Provider Demographic Data (2/21)

    By QTSO - February 06, 2021

    CMS will be transitioning to a new data source for a provider’s demographic data for all five Post-Acute Care (PAC) provider types (Skilled Nursing Facilities / Nursing Facilities (SNF/NFs), Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Hospices).  These demographic data include such items as the provider name, provider-mailing address, provider physical address, State, ZIP Code, etc.  These provider demographic data are displayed on the Provider and Quality Measure reports generated from the Quality Improvement and Evaluation System (QIES) Certification and Survey Provider Enhanced Reports (CASPER) Reporting application for SNF/NF and Hospice providers and reports generated from Internet Quality Improvement and Evaluation System (iQIES) for HHA, IRF, and LTCH providers.  Additionally these same demographic data are displayed on the public reporting websites such as the Provider Data Catalog (PDC).

    Historically provider demographic data have been maintained in the Automated Survey Processing Environment or ASPEN software; however, CMS will be transitioning to use the demographic information from Provider Enrollment, Chain and Ownership System (PECOS).  While this transition is underway, a final date when all demographic data will be obtained from PECOS has not been identified.  During this transition, all PAC providers will be responsible to ensure their latest demographic data are updated and available in both the ASPEN and PECOS systems. 

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  • Final PDPM Grouper DLL V1.0009 (Supporting Info Updated) Effective Oct. 1, 2020

    By CMS - February 04, 2021

    February 4, 2021

    An update to the PDPM Grouper DLL package was posted.  This is NOT a change to the previously posted DLL file itself, just supporting information.  The documentation file was updated, as there were NTA mapping changes not previously documented.  Also, one file in the source code zip from the previous package, mdsgrouper,h, was not the latest version.  The correct version is included in this updated package.  NOTE: the DLL was compiled with the latest version of mdsgrouper.h in the previous package.  Therefore, there is no change to the DLL file itself.

    An updated errata (V3.00.7) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  The resolution to issue 17 in the previous errata was flawed, as the addition of edit -3963d prevented submission of IPA inactivations.  Therefore, edit -3963d has been suspended for now, and will be revised in a future release.

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  • FY 2021 MDS 3.0 Data Specs -- New Errata Issued (2/21)

    By CMS - February 03, 2021

    February 4, 2021

     An updated errata (V3.00.7) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  The resolution to issue 17 in the previous errata was flawed, as the addition of edit -3963d prevented submission of IPA inactivations.  Therefore, edit -3963d has been suspended for now, and will be revised in a future release.

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  • NACs, Need More Time? Four Areas to Gain Efficiencies

    By Caralyn Davis, Staff Writer - February 02, 2021

    Amid the national staffing shortage, nurse assessment coordinators (NACs) may continue to face clinical demands on their time—making a fine-tuned Resident Assessment Instrument (RAI)/MDS process more critical than ever.

    Read this article for potential time sinks NACs can review, according to Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC, to find ways to gain efficiencies in the RAI process.


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  • Section G Coding Still Matters: Keep It Accurate

    By Caralyn Davis, Staff Writer - February 02, 2021

    "Despite its limited use related to Medicare Part A, section G currently remains a vital part of the MDS—and it’s worth some attention from both the nurse assessment coordinator (NAC) and the interdisciplinary team,” says Jillian Martin, RN, BS, DNS-CT, RAC-MT, RAC-CTA.

     

    Read this article to learn more about section G's impact on Quality Measures, care planning, and Medicaid payment rates, and gain tips that NACs can implement to boost section G coding accuracy.

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  • How to Triage the RAI/MDS Process

    By Caralyn Davis, Staff Writer - January 26, 2021

    Early 2021 could be challenging for the nation’s nursing homes. Recent trends in infection rates combined with the slow rollout of the COVID-19 vaccine have the potential to make the coming months “the deadliest of the pandemic for long-term care residents and staff,” says the Kaiser Family Foundation in the Jan. 14 issue brief, Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020.

     

    “Providers have a number of months yet to get through,” agrees Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA. “Getting vaccines in nursing homes is absolutely great, but COVID-19 will still be in the local communities. Nursing homes, especially facilities with high turnover, will have new residents coming in from their communities, increasing the risk of an outbreak.”

     

    To prepare, nurse assessment coordinators (NACs) should triage the Resident Assessment Instrument (RAI)/MDS process much the same way that healthcare providers triage personal protective equipment (PPE) supplies, suggests Maher. “There are three core modes: conventional, contingency, and crisis,” she notes. “Conventional mode is business as usual; COVID-19 is not in your facility. Contingency mode means that you have challenges, but you are still managing the RAI process. Crisis mode means that you face catastrophic challenges that could stop the RAI process in its tracks.”

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  • Top 5 Facts NACs Need to Know About the CY 2021 Medicare Physician Fee Schedule Final Rule

    By AAPACN - January 26, 2021

    On Dec. 2, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule. However, on Dec. 21, 2020, Congress passed the Consolidated Appropriations Act, 2021 and it was signed into law by the President on Dec. 27, 2020, which modified the previously released final rule. To help dissect this lengthy final rule, AAPACN asked Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, AVP of Clinical Innovation for Paragon Rehabilitation, a contract therapy provider, to share her insights on the most important facts nurse assessment coordinators (NACs) need to know.

     

    Decrease in payments for CPT codes

    “In the December 2 release of the final rule, there were changes to Current Procedural Terminology (CPT) codes. Because therapy for Medicare Part B services is paid for by CPT codes, that was the biggest change for skilled nursing facilities (SNFs) in the final rule. The rule caused a big decrease in payment for the way we bill Part B. Originally, it was going to be a cut of about 9%. While there were some CPT codes that received an increase, like PT evaluation codes, most of them received a decrease,” says Barlow, explaining the impact of the early December version of the final rule.

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  • AHRQ: Treatments for Acute Pain: A Systematic Review (1/21)

    By AHRQ - January 24, 2021

    Main Points

    • Opioids are probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stone pain and might be similarly effective to NSAIDs for low back pain.
    • Opioids might be and NSAIDs are probably more effective than acetaminophen for surgical dental pain, but opioids are probably less effective than acetaminophen for kidney stone pain.
    • An opioid might be more effective than gabapentin for acute neuropathic pain.
    • Opioids are probably associated with increased risk of short-term adverse events versus nonopioid pharmacologic therapy for acute pain, including any adverse event, study withdrawal due to adverse events, nausea, dizziness, and somnolence, but serious adverse events are uncommon in randomized trials.
    • Being prescribed an opioid for acute low back pain or postoperative pain might be associated with increased likelihood of use of opioids at long-term followup versus not being prescribed.
    • Heat therapy is probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, massage might be effective for postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy.
    • Research is very limited on the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge.

    Structured Abstract

    Objectives. To evaluate the effectiveness and comparative effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic therapy in patients with specific types of acute pain, including effects on pain, function, quality of life, adverse events, and long-term use of opioids.

    Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to August 2020, reference lists, and a Federal Register notice.

    Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) of outpatient therapies for eight acute pain conditions: low back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain following discharge, dental pain (surgical or nonsurgical), pain due to kidney stones, and pain due to sickle cell disease. Meta-analyses were conducted on pharmacologic therapy for dental pain and kidney stone pain, and likelihood of repeat or rescue medication use and adverse events. The magnitude of effects was classified as small, moderate, or large using previously defined criteria, and strength of evidence was assessed.

    Results. One hundred eighty-three RCTs on the comparative effectiveness of therapies for acute pain were included. Opioid therapy was probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stones, and might be similarly effective as NSAIDs for low back pain. Opioids and NSAIDs were more effective than acetaminophen for surgical dental pain, but opioids were less effective than acetaminophen for kidney stone pain. For postoperative pain, opioids were associated with increased likelihood of repeat or rescue analgesic use, but effects on pain intensity were inconsistent. Being prescribed an opioid for acute low back pain or postoperative pain was associated with increased likelihood of use of opioids at long-term followup versus not being prescribed, based on observational studies. Heat therapy was probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, acupressure might be effective for acute musculoskeletal pain, an opioid might be effective for acute neuropathic pain, massage might be effective for some types of postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy. Most studies had methodological limitations. Effect sizes were primarily small to moderate for pain, the most commonly evaluated outcome. Opioids were associated with increased risk of short-term adverse events versus NSAIDs or acetaminophen, including any adverse event, nausea, dizziness, and somnolence. Serious adverse events were uncommon for all interventions, but studies were not designed to assess risk of overdose, opioid use disorder, or long-term harms. Evidence on how benefits or harms varied in subgroups was lacking.

    Conclusions. Opioid therapy was associated with decreased or similar effectiveness as an NSAID for some acute pain conditions, but with increased risk of short-term adverse events. Evidence on nonpharmacological therapies was limited, but heat therapy, spinal manipulation, massage, acupuncture, acupressure, a cervical collar, and exercise were effective for specific acute pain conditions. Research is needed to determine the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge; effects of therapies for acute pain on non-pain outcomes; effects of therapies on long-term outcomes, including long-term opioid use; and how benefits and harms of therapies vary in subgroups.

    Citation

    Chou R, Wagner J, Ahmed AY, Blazina I, Brodt E, Buckley DI, Cheney TP, Choo E, Dana T, Gordon D, Khandelwal S, Kantner S, McDonagh MS, Sedgley C, Skelly AC. Treatments for Acute Pain: A Systematic Review. Comparative Effectiveness Review No. 240. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 20(21)-EHC006. Rockville, MD: Agency for Healthcare Research and Quality; December 2020. 

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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (1/21)

    By CMS - January 18, 2021

    CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. This manual provides in-depth descriptions of the ratings and the methods used to calculate them. 

    On December 1, 2020 the Nursing Home Compare website was retired. It has been replaced by the new Care Compare website. Care Compare can be accessed at: (https://www.medicare.gov/care-compare/). The Provider Data Catalog (PDC) located at https://data.cms.gov/provider-data/ allows users to search and download the publicly reported data. While this Technical Users’ Guide has been revised to refer to Care Compare, there may be previously published materials or documents that refer to Nursing Home Compare and all prior references to Nursing Home Compare will now apply to Care Compare.

     

    January 2021 Revisions

     

    Health Inspection Rating Changes:

    Beginning with the January 2021 refresh, CMS resumed calculating the health inspection rating domain and began to use results from surveys that occurred after March 3, 2020. Additionally, focused infection control surveys are included in the rating calculation, with citations from these surveys counting towards the total weighted health inspection score (similar to how complaint survey citations are counted).

    These changes resulted in updates to the Special Focus Facility (SFF) program, including updates to SFF candidates, and facilities’ status for receiving an icon for noncompliance related to abuse. Specifically, updates to the health inspection data due to the incorporation of surveys occurring after March 3, 2020 and the updating of the complaint periods means that the abuse icon will be removed for facilities that no longer meet the abuse icon criteria based on more recent survey findings. Once facilities no longer meet criteria for the abuse icon, their health inspection rating will no longer be capped at two stars. More information on the abuse icon is found in the Health Inspection section of this document.


    Staffing Rating Changes:

    Beginning with the January 2021 refresh, facilities that did not report staffing for the November 14, 2020 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available” with the January, February, and March refreshes. Starting with the April 2021 refresh of Care Compare, when staffing data submitted by the February 14, 2021 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for October – December 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star.

     

    Quality Measure Rating Changes:

    Quarterly updates of most of the quality measures (QMs) posted on Care Compare and used in the FiveStar Quality Rating System resumed with the January 2021 refresh. For the January 2021 update, CMS used data for July 2019- June 2020 for all of the measures that were updated. The two QMs that are part of the Skilled Nursing Facility Quality Reporting Program (Percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened and Rate of successful return to home and community from a SNF) will not be updated in January 2021.


    January 2020 addition: Technical specifications for claims-based measures


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  • Patterns in COVID-19 Cases and Deaths in Long-Term Care Facilities in 2020: Kaiser Family Foundation Review (1/21)

    By Kaiser Family Foundation - January 18, 2021

    For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority group. A second, related analysis synthesizes the findings of 30 studies that examined potential factors associated with COVID-19 cases and deaths in long-term care facilities.

    KFF held a web briefing yesterday to review this latest data on COVID-19 cases and deaths in long-term care facilities and examine how the effort to vaccinate residents and staff in long-term care settings is going, challenges experienced so far, and opportunities for improvement. 

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