• AHRQ Establishes National Nursing Home COVID Action Network, Seeks Participants (9/20)

    By AHRQ - September 29, 2020

    Press Release Date: September 29, 2020

    The Agency for Healthcare Research and Quality (AHRQ) is partnering with the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston to establish a National Nursing Home COVID Action Network. The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff.

    Nursing home residents are especially vulnerable to SARS-COV-2 (COVID-19) due to their age, their underlying frailty, and their communal living conditions. And nursing home staff who care for them are among the most needed and most at-risk essential workers. It is estimated that almost 56,000 nursing home residents and staff have died from COVID-19, representing more than one-quarter of the nation’s known COVID-19 deaths.

    "Protecting vulnerable older Americans in nursing homes is a central part of our fight against COVID-19, and we’ve learned that improving infection control in many nursing homes is not a matter of will but of skill," said HHS Secretary Alex Azar. "AHRQ is deploying its unique expertise in partnership with Project ECHO and IHI to help nursing homes protect both their residents and staff from the virus, slowing the spread and saving lives."

    "Expanding the use of proven safety practices will directly benefit nursing home residents and staff members and help save lives," said AHRQ Director Gopal Khanna, M.B.A. "AHRQ has a proven track record of producing science and research to address critical needs such as responding to COVID-19 and achieving 21st century care for all Americans. We are pleased to be working with the ECHO Institute and IHI on this new initiative."

    The new network is being created under an AHRQ contract worth up to $237 million that is part of the nearly $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. While $2.5 billion has already been distributed to help fund testing, personal protective equipment, and other supplies, another $2 billion is available for Medicare and Medicaid-certified nursing homes that show improvement in infection control.

    The ECHO Institute is recruiting academic medical centers and large health centers across the country to serve as training centers for local nursing homes. Over 15,000 nursing homes that are certified to participate in the Medicare and Medicaid programs will be able to participate in a 16-week training program using a standardized curriculum developed by the IHI. Nursing homes that actively participate are eligible to receive $6,000 in compensation to cover staff training time.

    While the curriculum will continue to be refined as new evidence emerges and the pandemic evolves, topics to be covered in the early weeks include:

    • Best Practices in the Use of Personal Protective Equipment for COVID-19.
    • Making the Environment Safe during COVID-19 through Infection Control Practices.
    • Minimizing the Spread of COVID-19.
    • COVID-19 Testing.
    • Clinical Management of Asymptomatic and Mild Cases of COVID-19.
    • Managing Social Isolation during COVID.

    Weekly virtual training sessions will be facilitated by small multidisciplinary teams of subject matter and quality improvement experts. Sessions will combine short lectures that provide immediately usable best practices with case-based group learning. Between sessions, a robust community of practice will foster peer-to-peer learning supported by additional expert consultation.

    "Collaborative education and shared learning is critical for our nonprofit nursing home members on the front line of this pandemic, under often challenging conditions," said Katie Smith Sloan, president and CEO of LeadingAge. "Access to mentors, local experts, community peers, and resources, with a focus on continuous improvement, will go a long way to help mitigate the virus’ spread and ensure the health and safety of older adults."

    Sanjeev Arora, M.D., Project ECHO’s director and founder, said he looks forward to leading the initiative in partnership with AHRQ. "At a time when the dissemination of best practices in health care is more critical than ever, we are honored to help address this urgent need for nursing homes," he said.

    Project ECHO (Extension for Community Healthcare Outcomes) was established to provide training and telementoring for health care professionals and staff across the nation and around the world. It includes over 250 training partners across the United States. AHRQ funded the initial establishment and evaluation of Project ECHO beginning in 2004. The new network’s training program will use the evidence-based process pioneered by Project ECHO and referred to as the ECHO Model, which is an interactive, case-based approach based on adult learning principles.

    "The ECHO model is a proven approach that brings experts and providers together to learn and solve clinical and operational challenges," said Mark Parkinson, President and CEO for the American Health Care Association/National Center for Assisted Living. "We strongly encourage providers to participate in the COVID Action Network to get access to experts and learn the latest best practices to prevent the spread of COVID-19."

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  • Proposed Healthcare-Associated Infections QM: Confidential Dry Run Reports Available in CASPER (9/20)

    By CMS - September 29, 2020

    The Confidential Dry Run Reports for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations Measure are now Available

    The Centers for Medicare & Medicaid Services (CMS) would like to announce the Confidential Dry Run Reports containing FY 2018 and FY 2019 performance scores for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations measure (SNF HAI measure) are now available. Performance scores are based on the draft measure specifications posted on CMS Measure Management Public Comment page. Providers can view these reports in their Certification and Survey Provider Enhanced Reports (CASPER) provider shared folders. These reports are accompanied by a Data Dictionary defining key measure terms.

    The purpose of these Confidential Dry Run Reports is to allow SNFs to become familiar with this measure and to inform them of their performance in comparison to their peers. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs and to statistically distinguish between SNFs that are either better than or worse than their peers in infection prevention and in infection management. SNFs may choose to incorporate this measure into their internal quality assurance activities to improve patient outcomes. Review and use of this measure information is strictly voluntary.

    Please send any questions or feedback on this measure via email to: SNFQualityQuestions@cms.hhs.gov.  

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  • MDS 3.0 Provider User's Guide Updated, Including Validation Rpt Error Messages (9/20)

    By QTSO - September 29, 2020
    Key information about how to submit MDS files and how to obtain and understand error messages on initial and final validation reports. 
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (9/20)

    By QTSO - September 29, 2020
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • CMS COVID-19 Guidance: Emergency Preparedness Testing Exercise Requirements (9/20)

    By CMS - September 28, 2020

    CMS QSO Memo: Guidance related to the Emergency Preparedness Testing Exercise Requirements- Coronavirus Disease 2019 (COVID-19)

    Memo # QSO-20-41-ALL

    Posting Date 2020-09-28

    Fiscal Year 2020


    • Emergency Preparedness Testing Exemption and Guidance - CMS regulations for Emergency Preparedness require specific testing exercises be conducted to validate the facility’s emergency program. During or after an actual emergency, the regulations allow for an exemption to the testing requirements based on real world actions taken by providers and suppliers.

    • This worksheet presents guidance for surveyors, as well as providers and suppliers, with relevant scenarios on meeting the testing requirements in light of many of the response activities associated with the COVID-19 Public Health Emergency (PHE).

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  • CMS QSO Life Safety Code Memo: Categorical Waiver – Corrugated Medical Tubing (9/20)

    By CMS - September 28, 2020
    Memo # QSO-20-40-LSC

    Posting Date 2020-09-24

    Fiscal Year 2020


    • CMS regulation requires compliance with the 2012 edition of the NFPA Health Care Facilities Code (NFPA 99) for Ambulatory Surgical Centers, Critical Access Hospitals, End-Stage Renal Disease, Hospitals, Inpatient Hospice, Intermediate Care Facilities for Intellectuals with Disabilities, Long-term Care, Programs for All-Inclusive Care of the Elderly, and Religious Nonmedical Health Care Institutions facilities.

    • The 2012 NFPA 99 requires medical gas and vacuum system tubing to be rigid copper tubing and does not allow for the use of corrugated medical tubing (CMT).

    • In certain applications, the inability to use CMT may be considered an unreasonable hardship as the installation of CMT may be more efficient and economical.

    • CMS is issuing a categorical waiver to allow the use of CMT in new and existing health care facilities based on provisions provided in the 2018 NFPA 99.

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  • CMS COVID-19 Emergency Declarations and Specific SNF/NF Flexibilities UPDATED (9/20)

    By CMS - September 24, 2020

    COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (9/30/20)

    Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities) (PDF) UPDATED (7/09/20)
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  • COVID-19 Medicare FAQs Updated (9/20)

    By CMS - September 24, 2020
    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.

    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. 

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  • CMS QSO Memo Offers New Guidance for Nursing Home Visitations During COVID-19 Public Health Emergency (9/20)

    By CMS - September 19, 2020

    Memorandum Summary

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

    • Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE. The guidance below provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.

    • Use of Civil Money Penalty (CMP) Funds: CMS will now approve the use of CMP funds to purchase tents for outdoor visitation and/or clear dividers (e.g., Plexiglas or similar products) to create physical barriers to reduce the risk of transmission during in-person visits.

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  • CMS Five-Star Ratings and COVID-19 Outbreaks: CDC Finds Associations (9/20)

    By CDC - September 18, 2020


    What is already known about this topic?

    Nursing homes are high-risk settings for COVID-19 outbreaks. The Centers for Medicare & Medicaid Services (CMS) publishes star quality ratings of all CMS-certified nursing homes.

    What is added by this report?

    During March–June 2020, 14 (11%) of 123 West Virginia nursing homes experienced COVID-19 outbreaks. Compared with 1-star–rated (lowest rating) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star–rated facilities and 94% lower among 4- to 5-star–rated facilities.

    What are the implications for public health practice?

    CMS star ratings can serve as proxy indicators for COVID-19 outbreak risk; health departments could use them to identify priority nursing homes and inform the allocation of infection prevention and control resources.

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  • FY 2021 ICD-10 Code Lookup File for MDS Item I0020B

    By CMS - September 17, 2020
    The lookup files containing the allowable ICD codes for item I0020B have been updated for FY2021, and is posted as a ZIP file. 
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  • Independent Nursing Home COVID-19 Commission Findings (9/20)

    By CMS - September 16, 2020
    The Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE.  CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the coronavirus disease 2019 (COVID-19) in nursing homes. The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. Today’s announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.

    Nursing homes and other shared or congregate living facilities have been severely affected by COVID-19, as these facilities often house older individuals who suffer from multiple medical conditions, making them particularly susceptible to complications from the virus. To help CMS inform immediate and future actions as well as identify opportunities for improvement, the Commission was created to conduct an independent review and comprehensive assessments of confronting COVID-19. The Commission’s report contains best practices that emphasize and reinforce CMS strategies and initiatives to ensure nursing home residents are protected from COVID-19.

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  • Don’t Delay Using Health Literacy in Your Care Planning and Discharge Planning Process

    By Jessie McGill, RN, RAC-MT, RAC-MTA - September 15, 2020

    Mrs. Elderberry is ready to go home. It’s been five long weeks of rehabilitation following a broken hip from that clumsy slip on a rug. Home. She’s wondering if her son actually watered her house plants that she proudly kept vibrant for years. Home. The nurse called her attention back to the medication list they were reviewing and asked which pharmacy she preferred. Mrs. Elderberry recited the name of the drugstore down the street and silently thought about enjoying coffee with the neighbor ladies. Maybe she could host this Sunday? Home. The nurse asked if she had any questions regarding her medications. She smiled and said no, thinking her son could explain it more clearly once she was home.


    Discharge planning is an essential piece of a successful return to the community. However, assessing the resident’s health literacy is another critical piece that is necessary for effective planning. The U.S. Department of Health and Human Services (HHS) defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make an appropriate health decision. While the assessment of health literacy is not yet a required part of the resident assessment process in skilled nursing facilities (SNFs), it should still be incorporated into the care planning and discharge planning process.


    In the SNF Prospective Payment System (PPS) Fiscal Year (FY) 2020 Final Rule, the Centers of Medicare and Medicaid Services (CMS) finalized health literacy as a Standardized Patient Assessment Data Element (SPADE). It stated, “low health literacy can interfere with communication between the provider and resident or patient and the ability for residents and patients or their caregivers to understand and follow treatment plans, including medication management. Poor health literacy is linked to lower levels of knowledge about health, worse health outcomes, and the receipt of fewer preventive services, but higher medical costs and rates of emergency department use.”

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  • FY 2021 ICD-10 Coding Updates: How to Prepare

    By Caralyn Davis, Staff Writer - September 15, 2020

    On Oct. 1, the revised fiscal year (FY) 2021 ICD-10-CM code sets and FY 2021 ICD-10-CM Official Guidelines for Coding and Reporting go into effect. Understanding these annual updates is crucial. ICD-10 coding accuracy has always been key to submitting clean claims and sharing relevant diagnoses with other healthcare providers to ensure quality of care. However, it has grown even more important since the implementation of the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment System (SNF PPS), which uses ICD-10 codes in MDS items I0020B (ICD Code/Resident’s Primary Medical Condition) and I8000 (Additional Active Diagnoses) to classify residents into case-mix groups—not to mention the ICD-10 codes that risk-adjust certain quality measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP).


    Here’s what nurse assessment coordinators (NACs) and other coders should know to be ready to implement the FY 2021 ICD-10 codes:


    COVID-19 guideline revisions

    “The biggest change to the Coding Guidelines is that there is a whole section on COVID-19 coding guidelines,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding and compliance at AHIMA in Chicago. “This section duplicates some of the interim COVID-19 coding guidelines that were released in April. However, it also expands and clarifies some of those interim guidelines.”


    Changes to the COVID-19 guidelines from April include the following:

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  • SNF Healthcare-Associated Infections (HAI) Measure: Public Comments Due by Oct. 14

    By CMS - September 14, 2020

    The Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is seeking input from the public as part of the measure development process. CMS has posted Draft Measure Specifications: SNF Healthcare-Associated Infections Requiring Hospitalizations for the SNF QRP (SNF HAI measure).  This document contains conceptual and technical measure information and provides a link to the Final Technical Expert Panel Summary Report: Development of a Healthcare-Associated Infections Quality Measure for the SNF QRP for the public’s review.  Please review both of these documents and give us your feedback via the email:  SNFQualityQuestions@cms.hhs.gov.  

    CMS would also like to announce the SNF HAI measure will be a part of the Measures Under Consideration list later this year and it is our intention to present this measure for pre-rulemaking review at the Measure Applications Partnership Post-Acute Care/Long-Term Care Workgroup meeting in December.  CMS will be providing Confidential Dry Run Reports to alert each SNF of their SNF HAI performance score based on these draft measure specifications later this summer.

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