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

5/25/21: Nebraska DHHS Provider Feedback- HCBS Funding: On Thursday, May 27, NE Medicaid will be hosting two meetings for Medicaid providers to give updates on new funds available for home and community based services. More information is available at http://dhhs.ne.gov/Pages/Medicaid-Providers.aspx.

5/25/21: CMS Administrator Confirmed by Senate: Today, the Senate confirmed Chiquita Brooks-LaSure by a bipartisan vote of 55-44 to be CMS Adminstrator. Brooks-LaSure was nominated in the early days of the Biden administration and had a relatively uncontentious confirmation hearing, but confirmation was held up by concern over a Medicaid issue that was unrelated to Brooks-LaSure. Brooks-LaSure previously served HHS and CMS during the Obama Administration and was instrumental in implementation of the Affordable Care Act. One priority identified for CMS at the outset is to permanently adopt some of the telehealth flexibilities employed through emergency waiver during the public health emergency.

5/25/21: Governor Ricketts Discontinues DHMs & Cancels Some COVID-19 EOs, Withdraws State from Enhanced Unemployment Benefits: Answering a question at his news conference yesterday, the Governor said he believes the extra unemployment benefit acts as "a disincentive for some people to go back to work."

Ricketts canceled a number of previous COVID-19 executive orders and all directed health measures while urging Nebraskans to make their own personal decisions about whether to continue to wear a mask. Here is an article from the Journal Star.  

5/25/21: Resources to Assist with QSO 21-19-NH Compliance: CMS has recommended a number of helpful resources to assist providers in compliance with the requirements for vaccine education, administration and vaccine and therapeutics reporting.  LeadingAge has compiled them for you HERE.

5/25/21: Updates from CMS:

  • Requirements for educating residents and staff who decline vaccination: As reported by Holly Norelli of CMS on the LeadingAge national member call Thursday, May 20, the new rule does not require multiple refusals from residents and staff who decline vaccination. CMS encourages providers to work with residents and staff to address vaccine hesitancy, which may involve multiple conversations, but a provider is in compliance with the requirement if they have documented at least one episode of educating and offering vaccination. Remember, however, the rule also requires providers to educate on ongoing opportunities for vaccination. 
  • NHSN reporting: The effective date of the rule vs. the date of enforcement is creating a great deal of confusion. CMS states, "The rule is effective now," and indicates that providers should begin reporting now to avoid any last minute issues ahead of the June 13 / 11:59pm enforcement date. However, we note that CMS states in QSO-29-21-NH, "Facilities must begin including vaccination and therapeutic data reporting in facility NHSN submissions by 11:59 p.m. Sunday, June 13, 2021." Additionally, as with previous NHSN reporting requirements, providers must submit data at least once per week, but may choose the day they submit data.

For more information on reporting you can listen to last week's Nebraska ICAP call and see the slides.  A TMF representative provides details on reporting. 

5/25/21: Final Opportunity to Provide Feedback on Hospice Payment Rule: LeadingAge will provide an opportunity on Thursday May 27th at 12pm CT to obtain feedback focused on the changes to hospice quality reporting program and changes to the labor portion of the hospice wage index, but look forward to all contributions to LeadingAge's comments.  The rule comments are due on June 7. No registration is necessary, please just bring yourselves and your feedback. Please reach out to Mollie ( mgurian@leadingage.org) if you have questions or would like to provide feedback on the rule but are unable to attend the session. Zoom Link for May 27th session: https://us02web.zoom.us/j/81460236913?pwd=eVVaNDJIZHRrZWtYMjVlek05ZEhoUT09i

5/25/21: NGA COVID-19 Vaccine Incentives: The National Governors Association released a memo to provide an update on the current COVID-19 vaccine incentives being utilized across the country. This memo includes information on state- and city-led incentives. Please note that vaccination incentives is a relatively novel topic in public policy and it is not known to what extent incentives like this drive increases in vaccinations, but there are some early indications that the right incentive can help.

5/25/21: Emergency Rental Assistance Portal of Local Programs: The Department of Housing and Urban Development released information on the Emergency Rental Assistance (ERA) Portal of local programs. The ERA program, funded through the Department of the Treasury, makes funding available to assist households that are unable to pay rent or utilities. Two separate programs have been established: ERA1 provides up to $25 billion and ERA2 provides up to $21.55 billion. The funds are provided directly to states, U.S. territories, local governments, and for ERA1, Indian tribes. Grantees may use the funds to provide assistance to eligible households through existing or newly created rental assistance programs. Learn more about the ERA program in the Frequently Asked Questions.

5/25/21: Guidance for Adult Day Services Centers: CDC updated their guidance for adult day services centers (ADSCs). ADSCs provide social or health services to community-dwelling adults aged 65 and over and adults of any age living with disability. Older adults and persons with disabilities are at highest risk for severe illness from COVID-19 including hospitalization, intensive care, and death. ADSC administrators and staff can help protect themselves and program participants (that is, adults attending ADSCs) from COVID-19 by promoting and engaging in preventive behaviors that reduce spread and maintain healthy operations and environments at ADSC facilities.

5/25/21: REGISTRATION OPEN - The HQRP - Understanding the Composite Quality Measure Webinar: The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar on Wednesday, June 2, 2021 from 1:00 to 2:30 p.m. CT. The purpose of this training is to provide a general overview of the Hospice Quality Composite Measure and how it differs from individual quality measures. Specific topics include:

  • What is a Composite Measure?
  • Current HQRP Composite Measure.
  • Calculation of a Composite Measure.
  • Interpreting and Using Composite Measure Results.

Please register only if you know you will be able to attend the webinar, as space is limited. If you would like your name placed on a list to receive an email notification when the recorded version of the webinar is available, please CLICK HERE to be placed on an email notification list.

CLICK HERE to register for The HQRP - Understanding the Composite Quality Measure Webinar.

5/25/21: State and Local Funding Guidance Released *Repost from last week: Treasury rolled out the guidance for how states and local governments can use the American Rescue Plan relief money allocated to those entities. Links follow, but in short the recipients of these funds have considerable flexibility with respect to how to spend them down, and the guidance sets the stage for all levels of government affected to support aging services. 

 PDFs linked here contain the amounts how much funding states will receive, in addition to countiescities, and other municipal governments.

5/18/21: Member call on Wednesday, May 19, 2021 is CANCELLED. We were informed this morning that Becky Wisell and Dan Taylor have a conflict with the member call tomorrow at 10:00 CT.  The call for tomorrow has been cancelled. We look forward to visiting with you on Wednesday, May 26th.  

Again- the Weekly Connection with DHHS hosted jointly by LAN & NHCA is CANCELLED for May 19. If you have questions between now and the May 26 call, please feel free to contact Jenifer.

5/13/21: HCBS FMAP Guidance: CMS published its guidance for state Medicaid agencies today. Brendan has an article in the link at the end of this item. In short, states will receive an extra ten points of FMAP for all Medicaid HCBS. States have until March 2024 to spend the funds down and must use them for HCBS purposes. Provider rate increases and supplemental payments, among others, are specifically allowed uses of the dollars. To demonstrate compliance with program rules, states receiving the dollars cannot restrict eligibility, eliminate or narrow services, or cut provider rates across HCBS programs until the dollars are spent. The guidance also requires states to submit initial reports to CMS by mid-June...definitely continue to monitor activity from your state Medicaid agencies. Here is a LeadingAge article on the guidance and here is the guidance document itself.

5/13/21: New CDC Guidance: CDC issued revised guidance today on what people can do "When You've Been Fully Vaccinated."  They state that people who have been fully vaccinated can "start to do some things that they had stopped doing because of the pandemic." Fully vaccinated people can resume indoor and outdoor activities without wearing a mask or staying 6 feet apart, except where federal, state, local, tribal, or territorial laws, rules or regulations or local business or workplace guidance is different.  No testing is required for travel within the US, unless required by the destination.  International travelers are advised to get tested 3-5 days after finishing the travel.  Vaccinated people exposed to those with COVID do not need to quarantine or be tested unless they have symptoms. Healthcare, correctional, and homelessness organizations are expressly NOT included in this guidance.  LeadingAge members, particularly those who serve people in independent living settings, will likely face many questions and new requests from residents.  

5/13/21: CMS National Nursing Home Stakeholder Call: CMS hosted a national stakeholder call this afternoon to review the newly released interim final rule on COVID-19 reporting. As CMS outlined, the rule has 3 major requirements: providers are required to education residents and staff on the benefits and potential side effects of COVID-19 vaccination; offer the vaccine to residents and staff who have not previously been vaccinated and for whom no contraindications to vaccination exist; and report vaccination rates on numbers of residents and staff who have lived or worked in the nursing home in the past week. During the stakeholder call, CMS provided the following clarifications:

  • While the rule for educating and offering vaccination applies to both long-term care and ICF/IID settings, reporting vaccination rates will be voluntary for ICF/IID. Reporting is required for nursing homes.  *LeadingAge NE note* Reporting is voluntary for AL, but Becky Wisell shared in the Wednesday member call that ALs should employ best practices.
  • Reporting will be enforced under F884 Reporting to NHSN. CMS will survey for compliance through a weekly data pull and audit conducted off-site by CMS. The educating and offering aspects of the requirements will be surveyed under new F887. Surveyors will look at sample education materials provided to residents/staff, rosters of individuals attending group trainings and education sessions, and will sample residents and staff to determine if they have been educated/offered the vaccine.
  • If the nursing home is not available to offer the vaccine, they must provide alternatives for where the resident/staff can access the vaccine. Providers should document the information provided to residents/staff for accessing the vaccine, as well as all attempts made by the provider to obtain the vaccine.
  • Reporting into NHSN is aggregate data that includes cumulative numbers. Providers should begin reporting immediately but do not need to include residents and staff who were vaccinated previously but are not currently living/working in the nursing home. To obtain the accurate numbers for reporting, the nursing home should identify all residents who were in the nursing home at least one day over the reporting week, and all staff who worked in the nursing home at least one day during the reporting week, then identify vaccination rates from these samples.
  • Nursing homes must report on residents and staff regardless of where they were vaccinated. For example, a resident who has stayed in the facility at least one day over the reporting week and was vaccinated at the hospital or another off-site location would be calculated in the vaccination rate for reporting.
  • If an individual is unwilling to disclose vaccination status or if the vaccination status cannot be determined, the individual should be considered "unvaccinated" and the provider should attempt to provide education and offer the vaccine, while reporting the individual as "unvaccinated" until vaccination is provided or confirmed.

This rule is effective May 21, 2021. CMS states that providers should begin to implement these requirements immediately. Reports should be entered by 11:59pm on June 13, 2021. Providers who fail to comply with reporting requirements will be assessed citations and associated penalties beginning June 14, 2021.  View CMS QSO 21-19-NH.

During the Nebraska ICAP call today, TMF and ICAP provided additional information. You can see the call recording here.  Powerpoint here.

5/13/21: LTC Providers: The New 21st Century Cures Act Rules Apply to You! If you are a nursing home, home health or other LTC provider, don't miss LeadingAge's next virtual event on the implications of regulations stemming from the 21st Century Cures Act on long-term post-acute care (LTPAC) providers. The webinar on Tuesday, May 25 from 12:00-2:00 p.m. CT will walk through how the recently released rules support the seamless and secure access, exchange and use of electronic health information.  Speakers from the Centers for Medicare & Medicaid Service (CMS) and Office of the National Coordinator (ONC) include:

  • Kianna Banks, Nurse Consultant,  CMS
  • Scott Cooper,  Center for Clinical Standards & Quality,  CMS
  • Johnalyn Lyles, Division Deputy Director, Regulatory & Policy Affairs, ONC
  • Alex Mugge, Deputy Chief Health Informatics Officer,  CMS

They will talk about the applicability to LTPAC of the CMS Interoperability Rule, ONC Information Blocking Rule, and other quality/reporting regulations and requirements. This virtual event is free, but registration is required. Save your spot now.

5/13/21: White House Issues Guidance for New Emergency Rental Assistance Funds: As eviction moratoria and rent backlogs continue across the country, the Biden-Harris Administration announced the allocation of additional funds for Emergency Rental Assistance (ERA). The additional $21.6 billion in emergency rent relief funds were approved under the American Rescue Plan in March and complement the initial $25 billion approved by Congress in December to assist impacted renters with back rent, future rent, and utility payments. Nearly 7 million Americans reported being behind on rent in the second half of April, and more than 40% of those renters reported concerns that they could be evicted in the next two months. The new guidance allows assistance to reach renters more quickly, including by cutting down wait time, offering assistance to renters directly instead of the housing providers first, and by clearing the path for federally-subsidized renters to receive assistance. More info on the new guidance here.

5/13/21: LeadingAge Featured in Service Coordinator Podcast as Emergency Broadband Benefit Goes Live: Today, LeadingAge was featured in National Church Resident's Service Coordinator podcast. The episode discusses the new Emergency Broadband Benefit (EBB) program, which provides a monthly discount on internet services and opened for enrollment today. More info on the EBB is available here, and the podcast episode is available here.

5/13/21: HUD Publishes Physical Inspection Resident Flyer in 19 Languages: Today, HUD published the translated versions of the resident flyer for HUD's new physical inspection approach. The flyer, which explains resident rights and options related to restarting inspections during the pandemic, is available in 19 different languages

5/13/21: Living in or Visiting Retirement Communities: CDC updated their guidance for residents of and visitors to retirement communities and independent facilities on taking preventative actions to help keep their communities safe from COVID-19. Cleaning with products containing soap or detergent reduces germs on surfaces and objects by removing contaminants and may also weaken or damage some of the virus particles, which decreases risk of infection from surfaces. Cleaning high touch surfaces and shared objects once a day is usually enough to sufficiently remove virus that may be on surfaces unless someone with confirmed or suspected COVID-19 has been in your facility.

5/10/21: KEPRO Update Today: On Monday morning, May 10th, KEPRO added an admission and discharge workflow in Atrezzo for Nebraska nursing homes. Please see attached for instructions and feel free to email or call KEPRO with any questions.  

Nebraska Phone:  833.840.9945, Email: eolsen@kepro.com

5/10/21: State and Local Funding Guidance Released: Treasury rolled out the guidance for how states and local governments can use the American Rescue Plan relief money allocated to those entities. Links follow, but in short the recipients of these funds have considerable flexibility with respect to how to spend them down, and the guidance sets the stage for all levels of government affected to support aging services. We are going to schedule time for state partners (execs and staff) to talk about next steps and strategize. If you want to be part of that discussion, please reach out to Brendan. 

5/10/21: HUD Announces COVID-19 Vaccine Partnership Webinars: Following last week's HUD and HHS announcement of a joint effort to increase vaccine access at HUD-assisted communities, the department today announced it is hosting COVID-19 webinars focusing on housing and health partnerships, the COVID-19 vaccine, and community health workers.

  • Health Center 101: Building Housing/Health Partnerships
    • Wednesday, May 12, 2021 | 1:00 - 2:30 pm (CT) Want to bring more health resources to your community? Whether you've been working with your community health partner for a day or a decade, learn the tricks of the trade for more effective health/housing partnerships. Registration link.
  • COVID-19 Vaccine Challenge: Tools and Resources
    • Wednesday, May 19, 2021 | 1:00 - 2:30 pm (CT) Building on the joint HUD-HHS Partnership, presenters will highlight ways you can further your COVID-19 vaccination effort, including mapping tools, transportation opportunities, and examples of successful COVID-19 vaccination partnerships. Registration link.

5/10/21: The Missing Link: Community Health Workers

Wednesday, May 26, 2021 | 1:00 - 2:30 pm (CT)

Looking for trusted messengers in your community? They've been there all along! Resident champions bridge the gap between health and housing: see how Community Health Workers can boost your vaccine efforts! Registration link.

HUD also announced a COVID-19 Vaccine Challenge and is co-hosting virtual "vaccine confidence boot camps" with the CDC.  

5/10/21: CMS National Nursing Home Stakeholder Call: CMS has announced the next national nursing homes stakeholder call for this Thursday, May 13 at 3pm CT. The agenda has not yet been announced. Register  here for this call.

5/10/21: FDA Approves Pfizer Vaccine for Kids 12-15: FDA made this decision today, and it could lead to most middle and high school-aged kids being vaccinated before the next school year - and being able to follow the CDC guidance for fully vaccinated people, as soon as they are fully vaccinated. News article here. FDA announcement here.  The FDA also announced today that its vaccine advisory committee will meet on June 10 to discuss the agency's approach to vaccinating children for COVID-19.  The committee will focus on the data that will be needed to support permitting shots to be administered to children under the age of 12.  The panel will not discuss specific vaccine products in this regard.

5/10/21: Grants Available to Assist Family Caregivers: Today the HHS Administration on Community Living (ACL) released a Request for Proposals (RFP) for Community Care Corps grants to organizations with innovative models in which local volunteers assist family caregivers, older adults, or people with disabilities with non-medical care in their own homes in order to maintain independence. Details are here on the program and how to respond to the RFP.  Successful applicants will receive grants between $30,000 and $150,000 for new applicants. Current grantees may apply for a second year of funding. Grant applications may be submitted from June 14 through July 9.

5/10/21: Multifamily Housing: CDC updated their considerations for owners and operators of multifamily housing, including populations at increased risk for complications from COVID-19. The guidance is provided to help owners, administrators, and operators of multifamily housing work together with residents, staff, and public health officials to create a safe living environment and prevent the spread of COVID-19. Public health actions needed to reduce the spread of COVID-19, such as social distancing, can lead some people to feel isolated and lonely or can increase stress and anxiety. This page provides guidance in assessing and reducing exposure risks and resources for coping with stress in healthy ways.

5/5/21: Member Call with DHHS and ICAP Today: During our weekly member call today there was a good deal of confusion regarding CMS's directives via QSO 20-39-NH Revised regarding masking and social distancing related to an unvaccinated staff member. All confusion aside...or at least a little bit...here is the clarification that I can offer after speaking with our LeadingAge National nursing facility experts (Janine and Jodi). CMS and CDC did verbally state during at least 3 different calls last week that IF an unvaccinated staff member provides care or participates in a congregate activity that everyone, regardless of vaccination status, should be masked and socially distanced. Of course, that staff member would be wearing appropriate PPE. The recent revisions to the QSO only addresses vaccination status of residents, not staff.  Absent the information being included in the QSO, some  states are proceeding with implementing the masking and social distancing only in relation to the participation of unvaccinated residents. Both Nebraska DHHS and ICAP support that approach at this time. This has been a BIG question from providers that has been posed to CMS. The belief is that CMS may address the issue by revising the QSO to include staff in some way, but that is yet to be seen. 

At this point, you can move forward with considering resident vaccination status based on the direction of the NE Survey Agency, which has ICAP support.  As more information becomes available it will be shared.  

A few other questions that came up:

  • It was confirmed that CMS stated that residents can be separated or cohorted for dining and activities based on their vaccination status.  However, whatever approach is taken must comply with Resident Rights Requirements.
  • When you are doing screening, include a question on vaccination status.  This will provide a record that you are requesting vaccination status for survey purposes and also for the purposes of contact tracing (if necessary).  Keep your screening documents for staff and visitors until you have an annual survey.  You can keep hard copies or scan them to be saved electronically, so long as the information can be made available to surveyors when requested.  Becky indicated that once survey is complete, the screening documents from the past would no longer have to be maintained.  
  • You should ask visitors about their vaccination status, but you cannot ask them to verify the status.  If a visitor refuses to provide his/her status their status should be marked as "unknown".  The individual can proceed with the visit, but will have to follow the requirements of an unvaccinated individual (mask, social distancing).
  • Including the link to the CDC infographic that I shared during today's member call.  It is an easy reference guide to Choosing Safer Activities and the differences to be considered for Unvaccinated vs. Fully Vaccinated People. 

5/5/21: OAA Funds Disbursed: The White House announced that the $1.4 billion for OAA programs were disbursed to states and grantees this week. Read more here: https://www.whitehouse.gov/briefing-room/statements-releases/2021/05/03/fact-sheet-biden-harris-administration-delivers-funds-to-support-the-health-of-older-americans/. Today ACL released state OAA title allocations for the American Rescue Plan funding for Older Americans Act programs.

5/5/21: HUD and HHS Announce Federal Partnership to Increase Vaccine Access: During a joint news conference, HUD Secretary Fudge and HHS Secretary Becerra today announced a joint agency effort to increase access to COVID-19 vaccinations for HUD-assisted residents. Leveraging the Health Center Vaccine Program, which is sending vaccine doses directly to Federally-Qualified Health Centers, HUD and HHS have directed their agencies to build partnerships between community health centers and thousands of HUD communities. To help build these partnerships, HUD has also developed a mapping tool that shows the locations of Multifamily Housing properties, Public Housing developments, and Continuum of Care (CoC) grantees in relation to Federally-Qualified Health Centers (FQHCs). LeadingAge welcomes the effort by HUD and HHS to connect affordable housing communities to health resources and encourages housing providers to utilize HUD's new mapping tool to reach out directly to your community health centers. More info will be available here.

5/5/21: Changes Coming to COVID-19 Vaccine Reporting Module on NHSN: CDC shared on Monday that they will be making a few changes to the COVID-19 vaccine reporting module on NHSN. Changes are being made on a few data elements to streamline reporting and provide greater clarification around requested data. The changes will be related to adverse event reports (will direct this reporting to VAERS), remove history of previous positive, provide additional information on which hcps are vaccine eligible and more. Based on CMS "strongly encouraging" reporting through this module and the recently proposed FY 2022 SNF PPS rule that includes a proposed SNF QRP measure on COVID-19 vaccination rates among staff, LeadingAge is watching this for a switch from optional to mandatory reporting. Updated Tables of Instructions and FAQs on this reporting module will be released next week and NHSN will hold a training on Tuesday, May 11 at 2:30pm CT. Registration has not yet opened but will be posted here, along with the above-mentioned documents. A recording of the May 11 training will be available at the same link following the training.