*Updates are listed by date with the most recent listed first.

8/28/20: Nursing Facilities Receive Deposits from HHS: Beginning yesterday, roughly $2.5 billion arrives in SNF Bank Accounts today.

Medicare and Medicaid certified nursing homes began receiving Provider Relief Fund payments August 27 that total roughly $2.5 billion.  This is the initial payment from the $5 billion distribution to nursing homes announced in late July. HHS issued its announcement on the funds around 10 a.m. CT, which also highlighted two voluntary training resources being made available to nursing homes in their fight against COVID-19.

The formula is that each nursing home with 6 beds or more received $10,000 base amount plus $1,450 for each bed. There is no indication that providers are required to participate in either of the two training programs it has made available and references in the announcement. However, providers who choose to participate in The AHRQ National Nursing Home COVID Action Network which is based on the Project ECHO pilot will be eligible for some compensation to cover staff training time.  Dr. Ashraf with Nebraska's ICAP is working to try to bring one of the Project ECHO learning hubs to Nebraska. If you are interested in receiving more information on this, please reach out to  Sarah Stream, Infection Preventionist with ICAP at sstream@nebraskamed.com

It remains unclear whether the use of the funds that have been distributed will be limited "to support facilities' COVID-19 infection control efforts, including by conducting appropriate testing, acquiring necessary personal protective equipment (PPE), investing in staff and establishing COVID-19 isolation facilities"  as noted in a communication that went directly to providers.  There was was no new information on the timing or details surrounding the $2 billion performance incentive payments except that more to come later this fall.

LeadingAge prepared the following article summarizing and analyzing this development.

8/28/20: CMS Guidance Explainer: LeadingAge has prepared this article explaining the CMS guidance about nursing home testing that came out Wednesday.

8/28/20: Change to Availability of Employee Test Results: The question had arisen over the past many months as to whether employee testing results from TestNE could be shared directly to facility emails versus having each staff having to check for results and report back from their individual emails. In a call with DHHS this morning, they shared that facilities CAN have employee testing reported directly to a facility email address, however, the facility must have a signed release from the employee indicating that they consent to sharing the testing with the facility AND the release must be kept on file.

8/26/20: Breaking News...CMS Releases Testing Memos: This afternoon, CMS released 2 new QSO memoranda related to COVID-19 testing for LTC providers. QSO-20-38-NH provides detailed guidance on the mandatory testing requirements for LTC providers for residents and staff and revises the COVID-19 Focused Infection Control Survey tool. The Interim Final Rule released yesterday provided the authority for CMS to mandate testing parameters for all Medicare and Medicaid certified SNF/NF providers across the country. CMS also released QSO-20-37-CLIA,NH, which sets the standards for reporting COVID-19 test results related to yesterday's Interim Final Rule.

LeadingAge analysis of the guidance will be available soon. The guidance relies heavily on CDC guidance, so certain parts of implementation may not be much different that what nursing homes are already doing.  The biggest requirement, testing staff according to county prevalence, will be challenging. This will include:

  • Monthly testing in counties with less than 5% positivity
  • Weekly testing in counties with 5-10% positivity
  • Bi-weekly testing in counties with greater than 10% positivity

Positivity rates should be monitored every other week here (the data will be available beginning August 28). Nursing homes have the flexibility to choose whether this testing is conducted via point-of-care antigen tests or nucleic tests processed in an off-site lab (PCR testing), provided test results are returned within 48 hours. The guidance also spells out how to respond to residents and staff who refuse testing, and exactly what documentation is required for many situations, such as outbreaks, symptoms, testing residents, testing staff, refusals, lack of access to testing, and more. The COVID-19 Focused Survey Tool has been updated to reflect these changes. 

8/26/20: COVID-19 Nursing Home Training: Check out this LeadingAge article related to the new COVID-19 training that CMS announced yesterday. There is no indication at this time that this training is linked to Provider Relief Funding, but we are waiting to hear more. The training is available online and has 15 modules targeted to front-line staff and nursing home management.  

8/26/20: 3-day Stay Waiver STILL IN EFFECT: Have you heard from a hospital that the 3-day stay waiver is no longer in effect or will be terminated soon?  WRONG.  LeadingAge has confirmed with CMS twice in the past week that the waiver is in fact still in effect.

8/26/20: NHSN Updates: NHSN updates are scheduled for tomorrow. Point-of-care antigen testing data will start being collected. CSV templates will be updated ahead of or along with the NHSN module. Those who are responsible for group reporting should check the NHSN site for updated templates. NHSN will also be working to transition all users to enhanced security levels within the next 2 months. This is optional and users will be contacted by NHSN in the coming weeks with information on how they can take part. Required reporting will not be interrupted while a user transitions to the upgraded enrollment.

Questions? You can always visit the LeadingAge national main coronavirus page, or contact your state association at jenifer.acierno@leadingagene.org.

8/26/20: Links for today's call with Connie Vogt:

8/25/20: *Special Update from CMS Call Today*

8/25/20: CMS Stakeholder Update Call: The CMS Stakeholder Update Call announced at 2:30 EST and held at 4:30 EST today was focused on the roll out of the interim final regulation on nursing home staff testing and CLIA reporting, but covered a range of other related topics of interest to nursing home providers. The call is summarized in this article

8/25/20: CMS releases Interim Final Rule with Comments on staff testing, CLIA reporting: This afternoon CMS issued the rule  it announced in July would be coming soon, mandating staff testing and CLIA reporting for nursing homes that test. Here is an article summarizing the highlights that will be important for LeadingAge members. Effective immediately, nursing homes that fail to comply with requirements to report COVID-19 data to CDC through NHSN will be subject to

  1. Citation at the scope of widespread and severity of no actual harm with potential for more than minimal harm that is not immediate jeopardy (level "F").
  2. Enforcement of a CMP of $1,000 per noncompliance, and
  3. Increasing increments of $500 per CMP for up to 12 instances of noncompliance.

As outlined previously in CMS guidance, nursing homes that fail to report on a weekly basis will receive a $1,000 CMP that increases incrementally by $500 for each subsequent missed week of reporting. This will cap at 12 weeks ($6,500) due to pre-existing statutory caps.

8/25/20: New Infection Control Training: CMS announced today a new infection control training available to nursing homes: "CMS Targeted COVID-19 Training for Frontline Nursing Home Staff and Management". Read the announcement here. This training is designed for both front-line staff and nursing home management, with separate training modules for each (5 for front-line staff, 10 for management). This self-paced training is available immediately on the CMS Quality, Safety & Education portal and certificates of completion will be available for each course completed. Additionally, subject matter experts from CMS and CDC will be available through bi-weekly webinars beginning this Thursday, August 27 and running through January 7. Members can register for these webinars here.

8/25/20: PPE Updates: The call today provided details on N95 mask production in the United States, which has increased from 30 million per month pre-Covid to 100 million per month now and projected to become 160 million per month. The federal government is going to ship 1.5 million N95 masks in the next week to nursing homes that indicated low supplies in the NHSN survey data. LeadingAge Nebraska has reached out to the Governor's office about who will be receiving the masks, as apparently Governors across the country received the list of providers who would receive shipments in their state.

During August and September, 14 million N95 masks will be deferred from the national stockpile, and sent to targeted markets in the commercial marketplace including hospitals, nursing homes, dentists, first responders in an attempt to provide additional commercial volume. It was noted that "we are fundamentally in a different place than we were back in March or April". The country now has 120,000 ventilators to deploy and states have 30-60 days of PPE supply on hand.

8/25/20: POC Testing: During the call today it was reported that 5593 nursing facilities have already received antigen testing machines and that by the end of September all nursing homes with CLIA waivers (about 14,800) will have the machines. He added that over two million test kits had also been shipped, enough to test each staff members at least twice and that nursing homes would be able to order additional tests (no details provided on that).

8/25/20: FDA recommendations for diagnostic tests for screening asymptomatic individuals for COVID-19: An FDA FAQ recommended that health care providers screening asymptomatic individuals should consider using a highly sensitive test, especially if rapid turnaround times are available. If highly sensitive tests aren't available or turnaround times are slow, providers should use less sensitive point-of-care tests, even if they aren't specifically authorized for this indication (commonly referred to as "off label"). "For congregate care settings, like nursing homes or similar settings, repeated use of rapid point-of-care testing may be superior for overall infection control compared with less frequent, highly sensitive tests with prolonged turnaround times." Negative tests results should be considered in the context of clinical observations, patient history and infection rates in the location or surrounding community and, if indicated, should be followed with a PCR test. "It is not necessary to perform confirmatory high-sensitivity tests on individuals with negative antigen test or other point-of-care test results if they are obtained during routine screening or surveillance."

8/25/20: Provider Relief: On today's call, Seema Verma said there would be $2.5 billion for "testing in nursing homes." She alluded to the possibility that the funds may start being distributed yet this week. The formula will include a base payment per facility plus additional funds based on the number of beds.

8/25/20: SNF VBP Performance Period Changes for FY2022: The SNF Value-Based Payment program for FY2022 would normally be based upon readmission measure performance between October 1, 2019 and September 30, 2020. However, under the public health emergency, CMS granted an Extraordinary Circumstances Exceptions to reduce reporting burden for the SNF VBP reporting requirements for January 1 through June 30, 2020. Therefore, under the interim final rule, CMS is changing the performance period for the SNF VBP program for FY2022 to include data from April 1, 2019 - December 31, 2019 plus July 1 through September 30, 2020. This provides a full 12 months of data for the calculations. Keep in mind, the SNF VBP program uses claims data so there is nothing new for SNFs to report.

8/26/20: LeadingAge 3:30 Coronavirus Update Call, Wednesday, August 26: Is in-person indoor visiting a possibility in your state or will it be sometime soon?  Join us for our Coronavirus Call on Wednesday, August 26, at 3:30pm Eastern time and hear from LeadingAge member Brian King, who leads the health and wellness programs at Deerfield retirement community in Asheville, North Carolina. Brian will provide great insight on how his community was able to overcome positive COVID-19 cases to work with the state to allow in-person visitation for residents. Through a vigorous testing program and working with staff to eliminate small risks, they have been able to safely open up and allow in-person visits even with positive cases in the community. Brian will also discuss his communities communication efforts with families and staff and how they are overcoming apathy and encouraging staff to stay vigilant outside of work to protect residents.  If you aren't already registered, sign up for calls here.

8/24/20: Nebraska Testing Equipment Assignment & Delivery Information: Here is the most recent information related to testing equipment and delivery timing. Look HERE for the listing of facilities in Nebraska, which testing equipment (Quidel or DB) that you they will be receiving, and the anticipated time frame for receipt. The delivery dates are somewhat dynamic, according to CDC, but will likely continue through the end of September.

We would encourage you to get ready and informed about reporting until then.  If you are a CLIA waived organization and you do COVID testing, you must report under HHS lab reporting guidelines in addition to NHSN reporting.  This reporting requirement is not new. CMS addresses it in this FAQ.  It is also included in this Q&A developed by LeadingAge.

From the CMS FAQs:

-Are nursing homes required to report results of any COVID-19 tests?

-Yes. All laboratories must have a CLIA Certificate and report the results of the COVID-19 tests that they conduct to the appropriate federal, state, or local public health agencies. Laboratories must report data for all testing completed, for each individual tested. This data must be reported within 24 hours of test completion, on a daily basis, to the appropriate state or local public health department, based on the individual's residence. Testing sites must report all diagnostic test data in accordance with the HHS Lab Data Reporting Guidance for COVID-19 issued June 4, 2020 and meet these reporting requirements by August 1, including providing your facility name and CLIA number when reporting results. For more information on reporting requirements, you can visit the CDC website.

8/24/20: Information on Training and Availability of Additional Testing Supplies from McKesson: Below is the link and the information on the BD analyzer training that will take place this week on Wednesday 8/26 and below that is a hyperlink to the training on the Quidel unit that was held a couple of weeks ago. We will make the recording of the BD analyzer training available after the webinar this week.

Are you ready for COVID-19 testing at your facility? Understanding the HHS program and the BD Veritorâ„¢ System

Date: August 26, 2020 | Time 2:00 PM CST

Save my seat!

View Playback Recording Quidel Analyzer training recording.

8/24/20: NHSN Security Enhancement: Remember how CDC had to stand up the NHSN COVID-19 reporting module for nursing homes extremely quickly, which left people scrambling to navigate an incredibly frustrating "expedited" enrollment process? Well, get ready. NHSN is hoping to upgrade all providers reporting through NHSN to the fully-secure enrollment, which requires the SAMS grid card within the next 2 months. NHSN has already launched a pilot initiative, working with 250 nursing homes over the past 2 weeks and successfully upgrading enrollment for 50 of them. The reason for this change is because currently, nursing homes are reporting only facility-level data but soon, nursing homes will begin reporting patient-level data, such as individual test results. Here's what you should be aware of:

  • At this time, this enrollment upgrade is OPTIONAL.
  • Even if providers want to upgrade, they do not need to proactively initiate an enrollment upgrade at this time.
  • NHSN (CDC) will send out guidance to all reporting providers with instructions on how to start the process. They plan to share this info with the QIOs and with LeadingAge to allow us to help members through this process.
  • Ability to report through NHSN will not be impacted during the upgrade process. Members will still be able to report according to CMS requirements even as they work to complete their enrollment upgrade. 

8/24/20: NHSN COVID-19 Module Update: The NHSN COVID-19 reporting module for long-term care is scheduled to be updated this coming Thursday. Updates will include new questions about access to and use of point-of-care antigen testing, as well as clarifications in the Tables of Instructions related to reinfection and false positives. Those "soft alerts" that pop up any time a provider reports more than once in a week will also go away. The CSV templates for group reporting will be updated on or before Thursday and they hope to send out an alert to group users ahead of Thursday's updates, but the ability to do this depends on how quickly that communication gets through internal clearance. A version 2 of the FAQs document is anticipated by the end of August. 

8/24/20: 3-Day Stay and Benefit Period Waiver: There have been a lot of questions about the qualifying hospital stay (3-day stay) and the benefit period waivers over the past few months. Both waivers are still in effect, both refer to skilled nursing facility services under your Medicare A benefits, but one requires direct impact from COVID-19 and for the other, the impact is assumed and applicable for all. LeadingAge has created this EXPLAINER to help.

8/24/20: Medicaid Information Bulletin from CMS: This afternoon CMS issued an Informational Bulletin on Medicaid Reimbursement Strategies to Prevent the Spread of COVID-19 in Nursing Facilities. The bulletin is a consolidation of already existing information. CMS reminds states that they have options to obtain an expedited State Plan Amendment under the Medicaid Disaster Relief SPAs. Once approved the state can increase payments to nursing homes or just certain nursing homes treating COVID diagnosed residents or in outbreak areas. There is no additional funding provided for this effort, however, we continue to advocate with DHHS for an increase in COVID-19 related nursing facility rates. 

8/24/20: HHS Telehealth for Community-Based Organizations: On August 26th, from 1-2 CST, HUD and HHS will host the next webinar of its  Telehealth for Community-Based Organizations series, titled Promising Practices: Accessibility and Language Access. The webinar will focus on telehealth accessibility for individuals with access and functional needs, as well as individuals with limited English proficiency. The program will highlights innovative strategies for ensuring access to older adults, people with disabilities, and addressing cultural and linguistic competency when providing telehealth services; there will also be an opportunity for questions and answers. Click HERE to register.

8/24/20: Rescheduled Member Connection with Connie Vogt: The August call with Connie Vogt was cancelled and the next call was not scheduled until September. Connie has kindly agreed to reschedule the August call to next Wednesday, August 26, 2020 from 10:00-11:00 CT.  Please join us then.

Join Zoom Meeting:  https://nehca-org.zoom.us/j/92253640474; Meeting ID:  922 5364 0474; Or call:  312-626-6799

8/19/20: Rescheduled Member Connection with Connie Vogt: The August call with Connie Vogt was cancelled and the next call was not scheduled until September. Connie has kindly agreed to reschedule the August call to next Wednesday, August 26, 2020 from 10:00-11:00 CT.  Please join us then.

Join Zoom Meeting:  https://nehca-org.zoom.us/j/92253640474 Meeting ID:  922 5364 0474, or call:  312-626-6799, Meeting ID:  922 5364 0474

8/19/20: CMS Resumes Survey Activity: As was included in Monday's update, CMS announced on August 17 that they will resume survey and enforcement activity, including standard surveys, revisits, and complaints triaged from non-IJ medium up through IJ. As a part of the announcement, CMS indicated that they will direct state survey agencies to resume routine inspections of all Medicare and Medicaid certified providers and suppliers and resolve enforcement cases that were suspended on March 23, 2020 in  QSO-20-20-ALL. CMS has expanded the ability for state agencies to clear plans of correction through desk review and instructs survey agencies to resume on-site activity as soon as they have adequate staff and PPE to do so. The details of the changes were published in QSO-20-35-ALL, which is effective immediately. See the LeadingAge analysis available here.  

8/19/20: CDC Released New Guidance on Antigen Testing: This week CDC issued new guidance on antigen testing that applies generally to providers using rapid antigen testing. There is an expectation that guidance specific to long-term care facilities will be released as well. The new guidance acknowledges that rapid antigen testing is not as accurate as PCR testing, but asserts that the testing is useful and proper interpretation of results is critical. Antigen tests are most helpful when viral load is highest, generally within the first five days of infection. CDC asserts that antigen tests are useful in cases of known exposure or high risk congregate settings when repeat testing can help to quickly identify infections and inform infection control procedures. Clinical presentation and prevalence of infection in the community will likely be used to determine the need for PCR testing.  More information to come as it is available. 

8/19/20: Need for Eviction Protection: Today LeadingAge sent a letter to several federal agencies urging quick action in support of low-income residents and housing providers impacted by the current crisis. The recent executive order did not include an extension of the eviction moratorium and left it up to federal agencies to determine the role of preventing evictions in containing COVID-19. LeadingAge sent a letter to the agencies addressed in the executive order asking for the CDC to urgently clarify the importance of housing stability during the pandemic.  The letter also asks HUD to immediately issue eviction protections and requests financial support for housing providers. The letter builds on the LeadingAge statement released yesterday, together with several other major housing organizations, asking Congress and the Administration to provide meaningful support for impacted housing communities.

8/19/20: ACTION ALERT: JOIN US! COVID-19 isn't taking a summer recess, neither should Congress. Tell them to finish the job and #Act4OlderAdults! https://actnow.io/ZjwIIVA

8/19/20: PPE Opportunity with Laguna Scientific: Still having difficulty ordering and securing PPE? Through our relationship with one of our PPE partners, you have the option to use the supplier, Laguna Scientific, to order PPE directly. Laguna Scientific is out of California and they have been really good to work with and quick with delivery. If you are interested in any of the Personal Protection items on their website you can email Subbarao at info@lagunascientific.org with information on what you would like to order and please cc: jenifer.acierno@leadingagene.org. In your email let Subbarao know that you are a LeadingAge Nebraska member.  He will use that information to facilitate getting our members as reduced of a cost as possible for the items needed. If you have questions about this feel free to contact Jenifer.

8/17/20: CMS Memo Expands Survey Activity: CMS released a memo this evening announcing expansion of survey and enforcements for all CMS-certified providers and suppliers. This builds on the survey activity as announced previously in the reopening guidance and in a June 1 memo.

Expanded activity now includes complaints assessed at non-IJ medium, annual recertification, and mandatory revisits for surveys on or after June 1. CMS has expanded the desk review policy and issued guidance on resolving enforcements that were previously suspended (Denials of Payment for New Admission and CMPs).  CMS directs that on-site survey activity resume as soon as resources permit (staff, PPE). More information will be provided as it becomes available. 

8/17/20: Nebraska Specific Survey Deficiency Information for NF & AL: Listed below are the top 10 deficiencies for nursing home E-tags and F-tags.  Following that are the top 10 deficiencies for ALFs.  This includes information for 2020.  As survey activity looks to increase in the future, these lists may provide some areas to focus on.

Top 10 E-tags and F-tags for Nursing Homes  

Emergency Preparedness (1.02)

  1. E0041 - Hospital CAH and LTC Emergency Power
  2. E0004 - Develop EP Plan, Review and Update Annually
  3. E0024 - Policies/Procedures-Volunteers and Staffing
  4. E0039 - EP Testing Requirements
  5. E0013 - Development of EP Policies and Procedures
  6. E0001 - Establishment of the Emergency Program (EP)
  7. E0006 - Plan Based on All Hazards Risk Assessment
  8. E0009 - Local, State, Tribal Collaboration Process
  9. E0015 - Subsistence Needs for Staff and Patients
  10. E0023 - Policies/Procedures for Medical Documentation

 F-Tags Long Term Care Facilities

  1. 0880 - Infection Prevention & Control
  2. 0689 - Free of Accident Hazards/Supervision/Devices
  3. 0884 - Reporting - National Health Safety Network
  4. 0812 - Food Procurement,Store/Prepare/Serve-Sanitary
  5. 0609 - Reporting of Alleged Violations
  6. 0657 - Care Plan Timing and Revision
  7. 0761 - Label/Store Drugs and Biologicals
  8. 0684 - Quality of Care
  9. 0656 - Develop/Implement Comprehensive Care Plan
  10. 0725 - Sufficient Nursing Staff

 Top ALF Deficiencies: N-Tags

  1. 0230 - Non Licensed Health Care Professional
  2. 0250 - Evidence Meeting Resident's Needs
  3. 0227 - Administration of Medication
  4. 0206 - Direct Care Staff Orientation
  5. 0239 - Storage
  6. 0248 - Food Safety
  7. 0278 - Environmental Safety
  8. 0201 - Administration
  9. 0207 - Ongoing Training
  10. 0222 - Provision of Medicine

8/17/20: LeadingAge Letter to Seema Verma: Following the information provided in last week's CMS Strike Team webinar, Katie Smith Sloan sent a letter to CMS Administrator, Seema Verma, outlining concerns and seeking an opportunity to discuss them. The letter stated that all members appreciate the review of infection control basics, but would hope to hear more complex discussion when strike teams present their findings.  There was also an ask for clarification about a few items that were contradictory to current policy, such as the comment that if nursing homes do not have an infection preventionist they should build relationships with one in the community (they are required to have one); and that staff need a negative test before returning to work (inconsistent with CDC guidance).  More information will be provided as it becomes available. 

8/17/20: Provider Relief Fund Reporting Information Delayed: HHS announced that it will not be providing additional details about the reporting process this week as was planned. HRSA is continuing to refine its data elements and will provide those additional details at a later date.  It is anticipated that the reporting instructions and data collection template will be provided in advance of when providers will need to submit their data into the reporting system. The current target date for submission is October 1, 2020.  

8/17/20: Medicare Care Compare Webinar: CMS is making changes to help people with Medicare find information about health care providers and services, as part of the eMedicare initiative to modernize and personalize experiences with Medicare information. Care Compare on Medicare.gov standardizes 8 existing compare sites to offer a more streamlined compare experience for users. 

There will be a webinar on August 24th from 2-2:45pm ET that will preview Care Compare to give partners an opportunity to learn about it before CMS launches it on Medicare.gov.  While this is a preview, CMS will continue to make improvements based on ongoing feedback. To register for this webinar, visit CMSnationaltrainingprogram.cms.gov/moodle/course/view.php?id=91. Space is limited. 

8/17/20: From McKnight's: Emergency funding, staffing have been key factors for provider's survival during COVID-19: Long-term care providers across the country have detailed numerous ways how the pandemic has drastically and negatively impacted their operations since the virus first emerged in early March. Read more HERE.

See this great infographic developed by LeadingAge that demonstrates the need for testing and related challenges.

8/17/20: Governor Ricketts signs LB 1053: On Saturday, Governor Ricketts signed LB 1053, which requires the nursing home Medicaid rate methodology be included in regulation.  The bill was a priority for the Health and Human Services Committee after DHHS removed the rate methodology from the regulations with an update this summer.  Thanks to each of you who took time to reach out the your elected officials to advocate for this bill and thanks to Kent Rogert for his work advocating on behalf of LeadingAge Nebraska members.   

8/17/20: PPE Opportunity with Laguna Scientific: Still having difficulty ordering and securing PPE?  Through our relationship with DonatePPE.org, we have an option to use one of their suppliers for our members to order PPE directly.  The name of the supplier is Laguna Scientific and they are out of California.  They have been really good to work with and quick with delivery.  If you are interested in any of the Personal Protection items on their website you can email Subbarao with information on what you would like to order and please cc: jenifer.acierno@leadingagene.org.  In your email to Subbarao (info@lagunascientific.com) let him know that you are a LeadingAge Nebraska member.  He will use that information to facilitate getting our members as reduced of a cost as possible for the items needed.  If you have questions about this feel free to contact Jenifer.

8/12/20: Provider Relief Fund Updates: As of today HHS has indicated that they have NOT finalized how they will be distributing these funds to nursing homes. In regard to the next $5B Nursing Home Distribution, $2.5 billion will go out as an initial payment, but HHS is unsure which factors will be used to determine how much a nursing home receives.  The same applies to the additional performance-based payment incentives. More information will be shared as it becomes available. 

The Provider Relief Fund Application Process is open for Medicaid and many Medicare providers.  HHS is referring to Phase I of General Distribution as the payments that went to Medicare providers in April. Phase II - General Distribution is what is happening right now through the application process. HHS updated their FAQs with new information including an expanded list of who is eligible to apply for the Phase II funds. As was indicated on Monday: 

  • Medicare providers who missed the June 3 deadline to apply for second payment by submitting their federal tax return and revenue loss information.
  • Medicare providers who've experienced a Change in Ownership in 2019 or 2020 under Medicare Part A & received no Medicare FFS in 2019.
  • Medicare providers whose total General Distribution payments are not equal to 2% of their annual patient service revenue. NEW
  • Medicare providers who previously rejected General Distribution payments and want to reapply. NEW

HHS noted in their FAQs that providers who are part of organizations that received a Phase I - General Distribution payment are no longer prohibited from applying for funds under Phase II, which opens the door for some Medicaid providers who have not yet seen provider relief fund dollars to apply. All providers who seek funds under Phase II must apply through the Provider Relief Fund Application and Attestation portal by August 28.

HHS is hosting another webinar this Thursday, August 13 at 3p ET on the application process for both Medicare and Medicaid providers. Providers must register.

8/12/20: REMINDER- PBJ Staffing Data Submissions: DUE by Friday, August 14

Important reminder for nursing home - PBJ staffing data submissions are due by this Friday, August 14. PBJ data submissions were suspended under an 1135 waiver, but the waiver was terminated on June 25. Data for calendar quarter 2 must be submitted by Friday and will be updated in Nursing Home Compare on the next regularly scheduled update in October 2020. CMS is encouraging providers to submit data for calendar quarter 1, but that data is not required. See this article by LeadingAge for more information. 

8/12/20: HHS Announces new Rural Health Model: HHS just announced something called the Community Health Access and Rural Transformation (CHART) model to build upon the President's Medicare Executive Order from last year and CMS's Rethinking Rural Health Initiative. For more information see this CHART fact sheet

8/12/20: Updates to NHSN COVID-19 module for LTCF: CDC has updated the testing data elements on the NHSN COVID-19 reporting module. For more information on these changes, please see this article by LeadingAge.  

8/12/20: National CMS/CDC Nursing Home COVID-19 Training Series Webcast: Coming next in the webcast series by CMS and CDC, and hosted by the QIO is Transparency: Resident and Family Notification, Department of Health and Other Notifications, is set for Thursday, August 13 from 4 to 5 pm ET.  Register for this webcast and others in this series.

During this session, learn about:

  • Guidance and policies on transparency during the COVID-19 public health emergency
  • Best practices to implement a comprehensive communication plan
  • Insight from a COVID-19 family member
  • Strategies to provide compassionate care and communication during the COVID-19 pandemic

View recordings, slides, and resources on QIOProgram.org. CMS does not provide continuing education credit for participation in this series. 

8/12/20: Nebraska Legislature Passes LB 1053: Yesterday the legislature passed LB 1053, which requires that the nursing home Medicaid rate methodology be included in regulation.  The bill has been presented to the Governor for signature.  DHHS removed the rate methodology from the regulations with an update this summer.    

8/10/20: More Providers Eligible to Apply for Relief Funds: Over the weekend information came out regarding additional possibilities for provider relief.  This afternoon some specifics have been made available. HHS has opened up the Provider Relief Funds application process to the following Medicare providers. Please note, there are some newly eligible providers:

  • Medicare providers who missed the June 3 deadline to apply for second payment by submitting their federal tax return and revenue loss information.
  • Medicare providers who've experienced a Change in Ownership in 2019 or 2020 under Medicare Part A & received no Medicare FFS in 2019.
  • Medicare providers whose total General Distribution payments are not equal to 2% of their annual patient service revenue. NEW
  • Medicare providers who previously rejected General Distribution payments and want to reapply. NEW

It should also be noted that providers who have low Medicare volumes and are predominantly Medicaid providers should also consider applying as they may not have received their full General Distribution payment (2% of annual patient service revenues) and they are not eligible to apply for the Medicaid Distribution. HHS has said that there should be parity between the Medicare General Distribution and Medicaid Distribution. In addition, we've learned that some members' cost reports  do not report revenue from all patient service categories and so they, too, may not have received the full 2% of patient service revenue payment. This is their chance to have their payments reflect all payer sources' patient revenues.

HHS is hosting another webinar this Thursday, August 13 at 3p ET on the application process for both Medicare and Medicaid providers. Providers must register.

Providers have a deadline to submit information for validation by August 28 whether they are applying for Medicare General Distribution (HHS is referring to this as Phase I) or the Medicaid General Distribution (Phase II).

For the latest information on the Provider Relief Fund Program, visit: hhs.gov/providerrelief.

For the full press release, visit: https://www.hhs.gov/about/news/2020/08/10/hhs-provider-relief-fund-phase-2-general-distribution-now-accepting-additional-applicants.html 

8/10/20: Updates to NHSN COVID-19 module for LTCF: CDC has updated the testing data elements on the NHSN COVID-19 reporting module. These data elements are contained within the "Resident Impact and Facility Capacity" pathway. Previously, the data elements asked about access to testing. The data elements have been updated to specify types of tests (nucleic acid and antigen), and ask about barriers to testing. The data elements also ask about turn-around time for test results, whether or not facility-wide testing has been conducted over the past 2 weeks, and if so, why testing was conducted (symptom onset, in response to an outbreak, as part of surveillance, etc.). CDC says that this information will help improve understanding of barriers to testing. We also note that the PPE module was updated over the past few weeks to clarify that when responding to data elements about PPE supply, providers should consider conventional capacity. If providers have only contingency or crisis capacity supplies, they should be responding "no" to indicate that they do not have any supply of the selected PPE. 

NHSN will be hosting another data quality webinar this Wednesday, August 12 at 1:00pm ET, to review these changes. Space is limited and registration is available on the NHSN COVID-19 LTCF module site.

8/10/20: HUD Announces Restart of Physical Inspections in October: On August 7th, HUD announced that the agency will resume Real Estate Assessment Center (REAC) inspections of HUD multifamily and public housing properties in early October.  HUD had halted physical inspections on March 13th due to health concerns; the agency said it will utilize strict safety protocols to restart operations. According to the HUD press release, standard 14-day physical inspection notifications to owners will resume no earlier than September 21st, 2020, with the first inspections resuming on or about Monday, October 5th. Inspections will be prioritized based on a state or locality's COVID-19 rates, as well as on the property's previous scores. More information will be available here.

8/10/20: Congressional Update and White House Executive Actions (Memoranda): The President then issued several "Executive Orders" (formally "memoranda") responding to provisions that had expired and adding a temporary benefit for workers:

  • Memorandum on Authorizing the Other Needs Assistance Program for Major Disaster Declarations Related to Coronavirus Disease 2019: This order replaces the $600 per week extended unemployment benefits with a $400 per week benefit, with $300 paid through FEMA's Disaster Relief Fund and $100 matched by the state (which can use unexpended coronavirus funds or its own funds). It is all voluntary, so it is not clear how long it will take to put in place or how many states will have the funds to participate. But by the White House signing this EO it has signaled willingness to continue expanded benefits of $400 per week for the rest of the year vs. the $200 in the Senate bill and the $600 in the House bill.
  • Memorandum on Deferring Payroll Tax Obligations in Light of the Ongoing COVID-19 Disaster: This order defers payment of employee payroll taxes for employees earning up to approximately $104,000 per year, beginning September 1. The deferral lasts through 12/31/2020 and appears to be discretionary, though the Treasury Secretary is directed to explore ways to make it permanent. It is unclear what is to happen to the deferred tax, though the intent was to add to the employees gross income.  If the deferral is not permanent the employee would have to repay beginning in January. LeadingAge will keep you informed on this EO and any regulations, guidance, etc.
  • Executive Order on Fighting the Spread of COVID-19 by Providing Assistance to Renters and Homeowners: This order replaces the moratorium on evictions that expired with a directive to CDC and the Secretary of HHS to "consider whether any measures temporarily halting evictions of tenants for failure to pay rent are reasonably necessary to prevent the spread of COVID-19 from one State to another." The Secs. of Treasury and HUD are directed to identify federal funds to provide temporary assistance to renters and may include providing assistance to landlords including affordable housing owners and public housing authorities. There is no timeline on implementing the order.

It is likely that these orders will bring continued discussion and will be superseded by legislation, which would be good since there is a question as to whether the President has the authority to issue these orders.

8/10/20: More on Testing: HHS Assistant Secretary for Health and White House testing coordinator Admiral Brett Giroir provided an update to LeadingAge about antigen testing and the machines that will be sent to all nursing homes in the country.  Admiral Giroir noted that the ideal would be to provide low cost, 100% accurate PCR tests for all residents and staff, however, recognizing that is not possible with current shortages and test delays the Quidel and BD machines are the plan.  Here is some additional information:

  • Concierge testing. Nursing homes are prioritized for antigen test kits. 
  • State antigen testing policy. HHS is talking to health directors in several states with the hope that they will be open to changing their policies concerning not accepting antigen test results from nursing homes.  
  • False negatives and double testing. Some research has shown that the tests are more accurate than originally thought (higher than the 85%) and FDA will change their labeling consistent with this research. Negative test results do not need to be repeated with a PCR test unless the person is highly symptomatic.

As always, more information will be shared as it becomes available. 

8/10/20: Nursing Home Weekly Recap: Here is your recap of LeadingAge nursing home updates.

8/10/20: Housing Weekly Recap: Here is your recap LeadingAge housing updates.

8/5/20: Survey Stories? Recent survey? Confused by any of the outcome?  We are trying to help. If you have a survey story, whether your story is one where ICAP instruction and your citations were conflicting, one where the findings just did not seem to include common sense, or one where you had a great result, please reach out and let us know.  We are working to try to help provide examples to educate DHHS on the challenges. Email jenifer.acierno@leadingagene.org or call me at (402) 440-3327.

8/5/20: CDC Guidance on Reporting Lab Data: Yesterday, CDC updated guidance on reporting COVID-19 lab data. The guidance may serve as another resource to help make sense of it all. Remember: all nursing homes that use a point-of-care testing device must have a CLIA certificate of waiver, must use the device in the location for which the waiver is issued, and must report testing data to the state/local health department according to the process outlined by the state.

The Department of Health and Human Services has published a list that now includes 2,400 nursing homes - an additional approximately 1,800 more than the 636 that have already received antigen testing machines.  The aim is to distribute the second tranche by mid-August.  If you would like to see the list, click HERE.  About ¼ of the way down the page, under "Supporting COVID-19 Testing", a link is embedded to access the list of facilities. When you click on this link, it opens a zip file containing the excel spreadsheet that lists the facilities. Separate tabs within the same excel file list the hot spot counties and the methodology for prioritizing facilities.

8/5/20: COVID-19 Supplemental Payment Requests due to HUD TODAY: Housing providers requesting reimbursement for COVID-19 expenses under the CARES Act have until midnight tonight, August 5th, to submit their request forms. More information from LeadingAge available HERE.

8/5/20: Action Alert: Join LeadingAge as we urge Congress to provide critical support to home and community-based services providers.

Leaders in Congress are negotiating the next major COVID-19 relief package. NOW is the time to make your voice heard to ensure that the critical needs home and community-based services providers are included in the final package. This includes support for adult day services providers, PACE organizations, and providers of in-home services (personal/home care, private duty nursing, and more). Send your message here: https://p2a.co/5DPDcKn

The House-passed Heroes Act recognizes the importance of home and community-based services in the continuum of care for older people. But the Senate package makes no mention of these important services. 

Tell Congress that the next COVID-19 relief package must include home and community-based services provisions. Act now by emailing your members of Congress. Contact Congress here: https://p2a.co/5DPDcKn

8/3/20: CMS Releases SNF PPS FY 2021 Final Rule: On the afternoon of July 31, CMS released the FY 2021 skilled nursing facilities (SNF) prospective payment system (PPS) final rule.  CMS largely limited the rule to required updates, which include a 2.2% market basket update, adoption of revised geographic delineations provided by OMB of urban/rural categories to calculate the wage index, and application of a 5 percent cap on any decreases in a provider's wage index from FY 2020 to FY 2021. CMS will not limit future decreases for FY 2022 which will lead to larger decreases in some geographic areas in the next rule making cycle. The rule finalizes some technical changes to ICD-10 mapping to selected PDPM categories as well as updates to the SNF VBP Program regulation text to reflect previously finalized policies.

8/3/20: FEMA PPE Update: LeadingAge has heard from some providers that they have still not received the second FEMA PPE shipment. FEMA official, Dave Sanford will join the LeadingAge national call on August 5 to discuss PPE. Those who have not previously signed up for calls can sign up here

In the mean time, he indicated that if nursing homes have not received their packages from FEMA, they are invited to contact Dave at  David.Sanford@dla.mil for assistance. Packages should include gloves, surgical masks, and gowns. If any items are not functional or usable Dave says first call the 1-800 number included in the package and then if you cannot resolve the issue, email Dave.

8/3/20: Changes to Provider Relief Funding Deadlines: On Friday night CMS/HHS released several changes to  Provider Relief Fund dates.  

  • Medicaid providers now have until August 28 to apply for funds.  (The date was originally July 20, then it was extended to August 3; now it has been extended again.)
  • Medicare providers who missed the opportunity to apply for additional funding from the Phase 1 Medicare General Distribution now have a second chance, starting August 10 and going until August 28.  These funds aim to offer providers financial relief up to 2 percent of their annual revenues. Some providers with low Medicare revenues did not complete this application.
  • Payments for providers who had a change of ownership. There is a window for them to apply from August 10 to August 28.

8/3/20: New Q & A Resource on Point of Care Testing: There have been, and likely will continue to be, many questions regarding point of care testing, antigen testing, and whether CMS will require staff testing related to the testing instruments that CMS is distributing to nursing homes.  This LeadingAge Q&A includes a great deal of information, including answers to many of these questions.  

For more information related to testing, see this MLN Matters article, specifically the section on Counseling and COVID-19 Testing that was updated on July 30.

8/3/20: HUD Updates Multifamily Q&A: On July 31, HUD issued its first update since May 21 of its Q&A for Multifamily Housing programs. HUD's July 31 Q&A document relays HUD's guidance on operational and procedural questions related to the safe administration of HUD-assisted programs during COVID-19. In the Q&A, HUD provides clarity on mask requirements for residents, testing requirements for residents, and Management and Occupancy Reviews.

8/3/20: HUD Tip Sheet for CSP Requests: Today HUD provided LeadingAge with a document titled "Tips for Completing HUD Form 52670-E." The document follows HUD's July 23rd announcement of COVID-19 Supplemental Payments (CSPs) for multifamily housing providers to request reimbursement for pandemic-related expenses. HUD staff answered additional questions related to reimbursement of COVID-19 related costs that are available here.

8/3/20: COVID-19 and Your Workforce: Legal Updates Webinar: Interested in legal updates related to COVID-19 and your workforce and need an opportunity to get up to speed? Check out this employment law webinar on the LeadingAge Learning Hub. 

8/3/20: Nursing Home Weekly Policy Recap: For the week ending July 31, 2020

8/3/20: Senior Housing Weekly Policy Recap: For the week ending July 31, 2020