*Updates are listed by date with the most recent listed first.
9/30/20: OBRA PDPM October 1, 2020 Assessment Information for Nebraska: If you were able to join us for the member call with DHHS this morning, you heard Dawn Sybrant discussing the anticipated changes related to MDS, effective October 1, 2020. Dawn indicated that there will be a few week period during which the transition will be allowed. DHHS - MLTC (Department of Health and Human Services - Medicaid and Long Term Care) will require the completion and submission of specific MDS item set fields associated with PDPM on all OBRA nursing home comprehensive, quarterly, significant change in status and significant correction to prior comprehensive or quarterly MDS assessment submissions. MLTC believes this is a necessary step to begin evaluating the PDPM classification system and its viability as an alternative for the Resource Utilization Group-III (RUG-III) classification system.
Nebraska will not be using the OSA (Optional State Assessment).
HERE is the OBRA PDPM document that contains additional detail provided by Dawn. Please share with your MDS Coordinators.
9/30/20: From Livanta QIO: FY 2021 Final Rule: CMS-1735-F: Federal regulations under FY 2021 Final Rule: CMS-1735-F now require ALL providers to transmit medical records and other documentation (like the Notices of Non-Coverage) to the Beneficiary and Family Centered Care - Quality Improvement Organizations (BFCC-QIOs) electronically using an electronic submission method determined by the QIO. Providers will now be reimbursed a flat rate of $3 per case for the electronic submission.
Beginning October 1, 2020, Livanta will accept medical records electronically in two ways. Providers may choose which method is best for them and submit medical records accordingly. For more information see HERE.
9/30/20: CMS Memo on Emergency Prep Guidance: CMS released a memo reiterating guidance around the emergency preparedness rule for all providers that was finalized in September 2019. This rule allowed an exemption from completing a full-scale or functional exercise if a provider had activated its emergency plan in response to an actual natural or man-made disaster. The memo clarifies that the COVID-19 PHE qualifies as a disaster and providers qualify for the exemption if they can demonstrate through written documentation that the emergency plan has been activated. LeadingAge has provided a summary of the new memo here, which will be available tomorrow. This applies to the following types of LeadingAge member providers: home health, inpatient hospice, ICF/IDD, nursing homes, and PACE.
9/30/20: CMS Press Release on Testing Frequency Data: CMS put out a press release describing updates to the methodology for determining testing frequency based on county positivity rates. As noted previously, the data had been adjusted to include 14 days of data, rather than the initial 7 days. Testing frequency color codes were adjusted for certain counties with low testing rates. LeadingAge has prepared additional information HERE, which will be available tomorrow.
During our member call today with DHHS the question came up as to whether the adjusted color codes should also be used for determining eligibility for indoor visitation. While it sounds as if CMS is endorsing this approach, we are awaiting specific direction from NE DHHS on this, as CMS has not yet provided that information in writing. Connie Vogt indicated that they would be raising this issue with CMS Region VII on a call this week. More to follow.
9/30/20: PPE Opportunity- GLOVES, anyone? We have been distributing PPE received from a number of generous donors. Most recently we have received items from our friends at DonatePPE. If you are in need of any of the following items, please email me (email@example.com). This PPE is intended to be prioritized for providers who are having challenges securing items through their regular distribution chain. Here is the PPE that is currently available.
- 49 containers of vinyl gloves, size small. Each container includes 10 boxes of 100 gloves.
9/28/20: NHSN Upgrades: In past COVID-19 updates, information has been included related to upgrading to NHSN enrollment to Level 3 security, which requires a SAMS grid card. Members are encouraged to pursue the enhanced security, as it it likely that this upgrade will allow nursing homes to report on patient-level data ("such as SARS-CoV-2 test results"), rather than simply reporting facility-level data as is done currently. This may provide some streamlining to reporting. The process to upgrade may take a few weeks. During that time providers will still be able to submit weekly reports using your level 1 enrollment while you complete the process of upgrading to level 3. Instructions on how to upgrade enrollment can be found here.
CDC will be updating NHSN to collect data on flu vaccines. CDC sent an email to NHSN users and will be hosting 2 webinars to go over these changes:
Webinar 1: Thursday, October 1 at 12:00pm CST. Register here.
Webinar 2: Tuesday, October 6 at 12:00pm CST. Register here.
9/28/20: BD Batching Guide: If you participated in the BD Veritor training offered by LeadingAge a week or so ago, there was a reference to a batching guide. BD has just released this batching guide for use with the Veritor machine.
9/28/20: Abbott BinaxNow Slides: Abbott partnered to offer a training on the Abbott BinaxNOW tests for home health and hospice organizations. The slides from the webinar can be found here. Distribution plans for the test kits are not yet known, however, remember that a CLIA CLIA certificate of waiver will be necessary to receive and administer these tests intended for staff of home health and hospice organizations.
9/28/20: Register NOW for Virtual Update on DOL Leave Rule: * FREE to LeadingAge Members* Please register and join LeadingAge for a Virtual Update on the Revised Regulation on COVID-19 Employee Leave on Tuesday, September 29 at 1pm CST. The virtual update will provide an overview of the revised regulation clarifying workers' rights and employers' responsibilities under the Families First Coronavirus Response Act paid leave provisions and hit on the following topics:
- Changes to the definition of which employees may be exempted from the paid sick leave and FMLA leave.
- Considerations for when your employees must provide notice, what documentation is expected, and if employees can take leave on an intermittent basis.
- Learn how to determine if an employee is "otherwise available to work", which employees are considered a "health care provider" and which are eligible for paid leave.
- Understand the records you must keep as an employer and how to be reimbursed for leave taken by your employees
9/28/20: Project ECHO: The formal roll out of the ECHO National Nursing Home COVID-19 Action Network will start next week. We have heard from Dr. Ashraf regarding this project on a number of our calls. The HHS Agency for Healthcare Research and Quality (AHRQ) is funding this initiative, in collaboration with CMS and CDC. Funds from the Provider Relief Fund will be used to pay the stipends to participating nursing homes. AHRQ has provided this flyer with information for nursing home members.
9/28/20: Updated Infection Control Tool: Since the new visitation guidance came out, LeadingAge has updated the Infection Control Survey Tool and Checklist to include a few additional considerations. CMS has not revised the CMS tool for visitation since September 2. Check out the updated LeadingAge tool here.
9/28/20: HUD COVID-19 Payment Update for Senior Housing Providers: HUD has completed reviews of all COVID-19 Supplemental Payment (CSP) requests received last month and has now obligated approved amounts to individual rental assistance contracts. HUD expects payments to begin flowing to properties next week and that most should receive funds by October 7. HUD will be providing email notifications to individual properties confirming request status. The payment mechanism is the same as standard rental assistance through LOCCs or via the contract administrator. More information about CSPs is available here.
9/28/20: Updated Heroes Act introduced in House: This evening, House Democrats released an updated version of the Heroes Act with a price tag of $2.2 trillion, down from the original $3 trillion. The bill retains funds for states to enhance wages for essential workers, including health care workers; Paycheck Protection Program improvements; housing assistance; and funding for states to establish and implement strike teams to deploy to nursing homes within 3 days of three residents or employees being diagnosed with or suspected of having COVID. Here is a press release and here is a section by section analysis.
9/28/20: Nursing Home Weekly Update: Here is the nursing home recap for last week.
9/28/20: Affordable Housing Weekly Update: Here is your affordable housing recap for last week.
9/28/20: PPE Opportunity: We have been distributing PPE received from a number of generous donors. Most recently we have received items from our friends at DonatePPE. If you are in need of any of the following items, please email me (firstname.lastname@example.org). This PPE is intended to be prioritized for providers who are having challenges securing items through their regular distribution chain. Here is the PPE that is currently available.
- 49 containers of vinyl gloves. Each container includes 10 boxes of 100 gloves.
- Currently enroute - 2500 medical grade masks. If you'd like to get on the list for medical grade masks let me know and I can add you to the list.
9/23/20: Nebraska DHHS Releases Testing Plan: If you were able to join our Wednesday Member Call with DHHS you heard that the Nursing Facility Testing Plan was that was being developed would be released today. This evening the Nursing Facility Testing Plan rolled out. This document applies specifically to Nursing Facilities, not to Assisted Living. More information will be forthcoming related to Assisted Living facilities.
The Nursing Facility Testing Plan outlines testing for both staff and residents, including prioritization of individuals for testing. The State is offering testing through Test Nebraska to all nursing homes, on a specifically timed basis. They will provide related test kits, PPE for those performing testing, and laboratory processing though CHI St. Elizabeth Lab. Use of Test Nebraska for testing may not satisfy the frequency requirements for testing depending on the positivity rate requirements for each location. Test Nebraska testing can be used to help facilitate necessary testing, especially in cases where POC equipment and tests are not yet available, have been exhausted, or other testing options are unavailable. There is a LTC Lab calendar attachment included that sets out specific days for testing for each Nebraska NF. Check the calendar to see when the Test Nebraska testing is available to your facility.
LeadingAge Nebraska was able to obtain the following information related to testing equipment:
- If a facility that has not yet received POC testing equipment, but has a CLIA Waiver, LeadingAge was able to confirm with CMS that additional equipment will begin shipping on October 1, 2020 for those facilities that did not have the CLIA Waiver in place in time to be on the earlier list of providers receiving equipment.
- If you have questions related to testing equipment, including receipt of equipment and testing you can email DNH_TriageTeam@cms.hhs.gov. Please provide your CLIA certificate number and CCN on the email.
LeadingAge (national) was able to get clarification from CMS on a number of issues, many of which arose on our Member Call today, including the following:
- General indoor visits are restricted in the midst of an outbreak/outbreak testing. Indoor compassionate care visits may continue in the midst of an outbreak/outbreak testing. Remember compassionate care visits should be exceptional, but are at the discretion of the nursing home.
- The most recently-released CMS data on county positivity rates were adjusted to account for low rates of testing. Approximately 350 counties with low rates of testing were placed in the lower testing frequency category than the positivity rate would otherwise indicate because the high positivity rate is determined to be a factor of low rates of testing rather than high rates of viral transmission. For example, a county may have a positivity rate of 23%, but be color-coded as yellow (medium). Nursing homes are to follow the color-code for testing frequency. CMS states that nursing homes may also follow the color-code for visitation. So in the above example, the nursing home may continue to offer indoor visitation if no other exclusionary criteria are met. We are awaiting confirmation from NE DHHS that they have received the same direction.
- The new guidance states that residents who are on transmission-based precautions should not have in-person visits (indoor or outdoor) except in compassionate care situations. We clarified that this includes residents who are on transmission-based precautions solely due to recent admission/readmission.
9/23/20: COVID-19 Testing Resources for Nursing Homes: If you are looking for guidance/resources related to testing. Here is a quick reference page from CDC that may help.
9/23/20: Updates to NHSN Reporting: CDC will soon be updating the COVID-19 module on NHSN to include data elements on flu vaccines. CMS confirmed that data elements on flu vaccines are not mandatory but are strongly encouraged. It would require regulatory action to make this reporting mandatory. Expect to see these new data elements in the next week or so. Providers should check out the Tables of Instructions located on the NHSN site under "Data Collection Forms and Instructions" to be sure that you are responding appropriately to these and other data elements. Providers can also find instructions for increasing their SAMS level access on this site under "Enhancing Data Security."
9/23/20: PPE Opportunity: We received a few hundred N95 masks from our friends at DonatePPE. If you are in need of N95s, size large, please email me (email@example.com) and let me know the number of masks that you need for immediate use. These supplies are intended to meet the needs of members who are unable to secure N95 masks otherwise.
9/21/20: MS Revises Visitation Guidance to Allow More Visitation Options: On September 17, 2020, the Centers for Medicare and Medicaid Services (CMS) released revised visitation guidance for nursing homes during the COVID-19 Public Health Emergency. The Nursing Home Visitation - COVID-19 QSO-20-39-NH provides guidelines, core principles and best practices for nursing home visitation both indoors and outdoors. As nursing homes prepare for either type of visitation, they must continue to adhere to screening protocols for all who enter, practice hand hygiene, wear face coverings or masks, maintain social distancing, wear appropriate PPE, clean and disinfect high touch surfaces and areas, create cohorting of COVID positive residents and comply with CMS regulations for staff and resident testing. In addition. For more information, see this LeadingAge article.
9/21/20: HHS Issues PRF Reporting Guidance with Limits on Lost Revenue: HHS issued its long-awaited Provider Relief Fund (PRF) Reporting Requirements Saturday, September 19, specifying the data that providers who received more than $10,000 in PRF payments will be required to submit as part of a post-payment reporting process. Providers should call their attention specifically to how HHS plans to calculate and limit the use of payments for lost revenues. For more information, see this LeadingAge article.
9/21/20: COVID-19 Testing Resources for Nursing Homes: If you are looking for guidance/resources related to testing. Here is a quick reference page from CDC that may help.
9/21/20: Abbott BinaxNOW Testing Webinar & Resources: A number of participants asked for the slides presented and you will find them HERE. Additionally, here are some useful links and critical contact information:
- To report shipping issues / order quality concerns (these should be sent to Abbott at: ARDxUSGovernmentSupport@abbott.com)
- For technical usage questions about the BinaxNOW™ test, contact Abbott directly at: Technical support: firstname.lastname@example.org or 1-800-257-9525
- For all other questions related to your distribution, please contact HHSBINAX@hhs.gov, this inbox was established to coordinate the distribution of government procured Abbott BinaxNOW™kits. This inbox should NOT be used to request kits for facilities not currently receiving these tests.
- For training videos & documentation and other important links, please refer the following information:
- For access to access training videos and documents, please visit the BinaxNOW COVID-19 Ag Card and NAVICA App Set-Up and Training portal.
- For CLIA FAQs and information, click here.
- For policy regarding performance of antigen tests authorized by the FDA under an Emergency Use Authorization (EUA) at the point of care or in patient care settings operating under a CLIA Certificate of Waiver, please refer to CMS's policy here and PREP Act guidance here.
- For FDA recommendations to health care providers who are ordering authorized tests outside their authorization (e.g., antigen tests for asymptomatic individuals), please see FDA's FAQ on Testing for SARS-CoV-2.
9/21/20: COVID-19 Hospice Respite Care Relief Act of 2020 Introduced in the House: Representatives Troy Balderson (R-OH) and Donna Shalala (D-FL) introduced a House companion to S. 4423, the COVID-19 Hospice Respite Care Relief Act of 2020, making this important legislation bicameral and bipartisan. The COVID-19 Hospice Respite Care Relief Act of 2020 would provide the Secretary of Health and Human Services (HHS) with the authority to make the hospice respite care benefit more flexible during any public health emergency, including the current COVID-19 pandemic. This legislation would allow the HHS Secretary to modify the existing benefit during a public health emergency by allowing respite care for up to 15 consecutive days and by allowing respite care to occur outside of the inpatient setting. LeadingAge thanks Rep Balderson and Rep Shalala for their work with us in getting this bill introduced in the House. A press release with more details can be found here and an article here.
9/18/20: *CLARIFICATION on the CMS Call TODAY* Per CMS, the CMS stakeholder call today will cover issues related to kidney disease and cancer, NOT specific Nursing Home issues or visitation.
There will be a call on Monday for nursing home stakeholders, which will include information related to nursing home issues.
This week, 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. LeadingAge has prepared the associated article. 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. This 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.
Please join CMS Chief Medical Officer Lee Fleisher, MD and agency officials for a National Stakeholder Call with Nursing Homes to discuss the announcement, Monday, September 21st from 2:00 - 2:30 PM Eastern (1-1:30 CST).
Toll Free Dial-In Number: (833) 614-0820, Conference ID: 7883929
Conference lines are limited, so we encourage you to join via webcast: https://protect2.fireeye.com/url?k=8777ef6c-db23c647-8777de53-0cc47a6d17cc-0bc7372546fd785c&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2592
- Press Release: https://www.cms.gov/newsroom/press-releases/independent-nursing-home-covid-19-commission-findings-validate-unprecedented-federal-response
- Full Independent Coronavirus Commission for Safety and Quality in Nursing Homes report: https://edit.cms.gov/files/document/covid-final-nh-commission-report.pdf
- Trump Administration Response to Commission Findings: https://edit.cms.gov/files/document/covid-independent-nursing-home-covid-19-federal-response.pdf
- COVID-19 Guidance and Updates for Nursing Homes during COVID-19: https://edit.cms.gov/files/document/covid-guidance-and-updates-nursing-homes-during-covid-19.pdf
9/17/20: *Supplemental COVID-19 Update* Big NEWS this evening: 1) CMS drops visitation and incentive payment guidelines with a call scheduled regarding visitation guidelines tomorrow; 2) Abbott sets BinaxNow test training for AL (NF can participate) tomorrow; 3) Reminder of LeadingAge exclusive training for members with BD tomorrow; 4) Quidel schedules testing training with LeadingAge members next week.
9/17/20: BD Veritor Training Session for LeadingAge Nursing Home Members: LeadingAge has invited BD to deliver a LeadingAge exclusive training on the BD Veritor System. The BD Veritor Training Session will be held Friday, September 18 at 2:00 CST. This free training will provide key information on: (1) Rapid antigen testing for COVID-19; (2) How the BD Veritor Plus System works; and (3) Key information on how to get support from BD on test results and accuracy. There will be a demonstration from BD staff and then a live Q and A session for members. The second part of the training will be with LeadingAge staff and cover Infection Control and other key topics. LeadingAge members may register for the training at: https://attendee.gotowebinar.com/register/8909746650265252622.
9/17/20: Abbott BinaxNow (cards) Webinar: Abbott has indicated that they have shipped about 1 million BinaxNow (card) tests to SNF operators and 540,000 to assisted living providers with CLIA waivers. Home health providers will be on a future distribution list. HHS has not issued a distribution plan in writing.
LeadingAge received notice this afternoon from the HHS Binax Team that they will offer a webinar tomorrow, September 18, from Noon - 1:00 Eastern, for assisted living facilities receiving Abbott BinaxNOW tests from HHS. Presumably this will help nursing homes as well. The webinar will "walk through the manufacturer's training, introduce the product, and discuss use in assisted living facilities. During the webinar, Abbott will demonstrate the training tools available and representatives from the U.S. government will be online to speak about the program. Use the following link to register for the training: click here to register. The webinar will accompany 10,000 registrants. The session will be recorded and available for review and shared. You can also access the Abbott BinaxNOW training portal here.
9/17/20: Save the date: Quidel Training: Training with Quidel Experts on Sofia COVID-19 Testing on Thursday, September 24 at 2:00 PM CST. LeadingAge will partner with Quidel to offer a LeadingAge exclusive training on the Quidel Sofia analyzers. As with the BD Veritor training, Quidel trainers will demonstrate how to use the machine, provide details on batch testing, and answer member questions. Jodi and Janine will be on hand to answer member questions about the CMS Interim Final Rule and other topics. You can register for the training here.
9/17/20: Visitation Memo & CMS Call: CMS dropped the revised Visitation Guidance this evening. The memo, effective immediately, will allow indoor visitation to begin. Visitation can be conducted through different means based on a facility's structure and residents' needs. The guidance requires screening of all who enter the community, but it does not require testing. Visitation is based on county positivity rates. The memo authorizes the use of CMP funds to help support in-person visits. A maximum of $3,000 per nursing home may be used for tents and clear dividers. LeadingAge will have a more detailed article available soon.
Presumably the Stakeholder Meeting scheduled by CMS tomorrow will cover the Visitation memo. It is scheduled for 12:30 PM CST. Please join Centers for Medicare and Medicaid Services Administrator Seema Verma and Innovation Center Director Brad Smith for a National Stakeholder Call on Friday, September 18th from 1:30 - 2:00 PM Eastern (12:30-1:00 CST).
Toll-Free Attendee Dial In: 833-614-0820, Conference ID: 7799256
Conference lines are limited, so we encourage you to join via webcast: https://protect2.fireeye.com/url?k=df2cc01e-8379c9ce-df2cf121-0cc47a6a52de-55b1add5b6c87a2d&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2582
9/17/20: HHS Announced the Nursing Home Incentive Payment Program Details: Today CMS released information on the incentive payment program on the CARES Act Provider Relief Fund website under General Information and Allocation for SNFs and Nursing Homes. LeadingAge has developed an article on the details that will be available soon.
Nursing homes will need to pass two key gateways before they are eligible for the funds: 1) their infection rate for non-admission related COVID needs to be less than the county rate; and 2) their mortality rate for non-admission COVID deaths must be less than a national benchmark set by HHS, which has not yet been defined. Modeling on these two factors showed that roughly 75% of nursing homes would qualify for some level of incentive payment. There are still some gaps related to the data points and formulas to be used. More to follow.
9/17/20: Admiral Giroir on LeadingAge National Member Call: Admiral Brett Giroir, MD, Administration testing lead will speak directly to LeadingAge members on the LeadingAge Coronavirus Update Call at 2:30 CST on Monday, September 21. Should we be using antigen testing for surveillance? What's your PCR testing experience lately, looking for shorter turnaround times? How long will you have to wait for BD test kits? If you offer assisted living services and do not have a CLIA waiver, how can you get Abbot BinaxNOW tests? Will home health providers or hospice providers receive Abbott cards? Join the LeadingAge Coronavirus Update Call at 3:30 Eastern on Monday, September 21 to hear answers to these and other questions related to testing. (Note: this is not a session on the CMS Interim Final Rule.) If you aren't already registered for these calls, you can register here.
9/16/20: Abbott Invoice Error: If you received invoices for Abbott BinaxNOW (Abbott card) tests disregard them. Abbott has indicated that the invoices are a mistake. Do not submit payment. These are the test cards that HHS is providing at no cost. Abbott has agreed to conduct a training for LeadingAge members on using the test kits; more information will be made available when details are known. Just a reminder, providers, including both assisted living and nursing home, must have a CLIA waiver to use these tests. The distribution plan for these tests has still not been made available.
9/16/20: CMS PACE FAQs: CMS issued new FAQs for PACE organizations on September 15. See the LeadingAge article on the FAQs here: https://www.leadingage.org/regulation/cms-issues-new-faqs-pace-organizations. CMS provided answers to questions in three areas: overnight care in a PACE center, COVID-19 case reporting requirements, and waivers from PACE regulations.
9/16/20: Voting Plan Toolkit Released by LeadingAge: This year is a major election year and the COVID1-19 pandemic has changed the way that voters can access the polls this year. LeadingAge has developed a "What's Your Voting Plan" toolkit that provides an easy to use self-assessment for both aging services providers and individuals to develop a plan to vote for this year's election. You can download the toolkit here.
LeadingAge has also developed an online Civic Action Center that will provide accurate and reliable information about voting and the upcoming election. By visiting www.leadingage.org/votingplan members of the public will be able to:
- Check their status as a registered voter
- Provide tools to register to vote in the voter's home state
- Give access to the forms and deadlines to request a mail-in (absentee) ballot to be submitted through the mail or dropped off at an election collection point
- Find out the location of their local polling station
- Learn about the candidates running for office in the upcoming election
Many states have started mail-in voting and early voting will be starting soon.
9/16/20: UNMC ID Nursing Home Project ECHO: You have likely heard on either the ICAP calls or through some of our member calls about the opportunity to learn about comprehensive COVID-19 prevention and containment program from some of the most experienced infection prevention and control experts in the state.
Preparations are underway for the launch of Nursing Home Project ECHO which will be focused on COVID-19 prevention and containment training. This will provide an opportunity for nursing homes to train their own COVID-19 prevention and containment experts. There will be many nursing home ECHO hubs across the country so nursing homes may be receive several recruitment offers. Each hub will be following the same core curriculum for training. However, each hub will have a different group of facilitators and subject matter experts who will conduct these training sessions. Under the leadership of Dr. Muhammad Salman Ashraf, the medical director for Nebraska ICAP, UNMC ID division is establishing one of the hubs in Nebraska. Nursing home team members enrolled in UNMC ID Project ECHO hub will be able to receive their training from infection control experts who are familiar to you.
Nursing Home Project ECHO is meant to provide nursing home healthcare workers access to subject matter experts for expanding their knowledge in the areas of infection prevention and control and quality improvement. It consists of 90-minutes weekly teleECHO training sessions using the Zoom platform for 16 weeks. Nursing homes will also have the option to participate in 60 minute optional weekly session for the rest of the year. Nursing homes will participate in these training as a cohort. Each cohort will consist of 33 to 34 nursing homes. Project ECHO participants will have a chance to work with their cohort peers to develop best practices and discuss particular issues within their facilities. Project ECHO HUB team will be available for questions and resources between the ECHO training sessions. Funding will also be made available to nursing homes to compensate for some of the healthcare worker time spent on the training. Each LTCF will nominate 3 to 4 healthcare workers to get trained (e.g. medical director, nurse/infection preventionist, quality team representative or other staff interested in getting involved in quality improvement process). They will also receive training certificates at the end of the training.
UNMC ID Nursing Home Project ECHO hub has reported that 150 nursing homes have already reserved their spot to participate. If a nursing home has not yet reserved a spot for project ECHO, they can use the following link to submit an application. https://unmcredcap.unmc.edu/redcap/surveys/?s=4RRCXDAJLM.
9/16/20: Slides for today's call:
- Nebraska Public Health Laboratory Point of Care Waived Testing for Long Term Care Facilities
- Sending a Secure Email with an Attachment Back to DHHS
- DHHS Implementation Guide
- Excel Template for Reporting Lab Data
9/14/20: Update and Feedback (SURVEY) Requested on Point of Care Antigen Testing: As we discussed in last week's Friday member call there have been some limited reports of false positives related to the BD POC testing. In an effort to better understand this, LeadingAge national and AHCA are coordinating efforts by asking nursing homes to complete a short survey on their BD and Quidel antigen POC testing. Please take the survey ASAP.
- Members should continue to use these POC tests but we encourage members to follow the CDC guidance and algorithm on when to conduct confirmation testing of positive antigen tests.
- Members may email BD at Technical_Services@bd.com with questions related to testing concerns.
- BD offers this microsite and these training webinars for members to review if you are having concerns with accuracy or want more information on instructions.
9/14/20: Is the COVID data that you are reporting to NHSN Correct? Today I heard from Dr. Ishrat Kamal-Ahmed with the DHHS Epidemiology Data group that while doing some random comparisons of information it appears that some facilities are submitting their COVID data incorrectly to NHSN. When this happens, the CMS website shows wrong data for the facility and the state receives inquiries from the public and the media. A few examples that she gave are reporting of staff deaths or rolling numbers in from a previous day. Dr. Kamal-Ahmed is asking that you take a look at the links below in an effort to make sure that you are reporting correctly:
Dr. Kamal-Ahmed notes that there is an 11-day delay between NHSN and CMS. Corrections made in NHSN will show up on CMS website after 11 days. She has shared the information related to the delay in corrected information to Connie Vogt as well.
9/14/20: CFO Hotline Report - Ziegler: Join the LeadingAge provider member national call on Wednesday, September 16 to hear special guest speaker, Lisa McCracken, give an insider's view of the just-released CFO Hotline Report. Lisa is the Director of Senior Living Research and Development for Ziegler, and she has kept her fingers on the financial pulse of senior living providers throughout the pandemic. This special report reviews data submitted by the CFOs of over 230 not-for-profit providers, and focuses on of-the-moment trends in occupancy, revenue shortfalls due to COVID, staff turnover, and marketing techniques to boost sales in a post-COVID world. Get the latest on these and other key market trends that directly concern you, our members, straight from the source! And take advantage of the time with Lisa to ask your own questions about the findings. If you're not already registered for Update Calls, you can register here.
9/14/20: Some Good News-MFAR Withdrawn: CMS announced this afternoon that it will not move forward with the proposed Medicaid Fiscal Accountability Regulation (MFAR). This was the proposed rule from earlier this year that had implications for nursing home bed taxes/tax exemptions for CCRCs, supplemental payment/UPL demonstrations and Medicaid IGT/CPEs. About 4,000 public comments were submitted in response to the proposal back in January and more than half mentioned nursing homes, CCRCs and/or LeadingAge. LeadingAge national was an amazing advocate for members on this issue. Nebraska joined in this effort as well. Thanks to each of you who gave of your time and shared your voice as well. You can read more here.
9/14/20: Provider Relief Fund for Private Pay Assisted Living and Nursing Home Providers EXTENDED: HHS has extended the deadline for applications from private pay (no Medicare and no Medicaid funds) assisted living and nursing home communities. The new deadline has not yet been provided, but will likely be Monday, September 21. If you fall in this category and have not yet started the process, you should work to get your TIN information submitted. Here is the link to the portal.
9/14/20: DOL Limits Definition of "Health Care" Employee: Based on the striking down of some of the provisions in the Department of Labor regulation related to the implementation of the paid sick leave and FMLA provisions, DOL will issue a revised rule on September 16, effective immediately.
Employees who are no longer exempt or excluded from paid leave are "Individuals who provide services that affect, but are not integrated into, the provision of patient care because they do not provide health care services, such as information technology (IT) professionals, building maintenance staff, human resources personnel, cooks, food service workers, records managers, consultants, and billers".
Employees who provide "diagnostic, preventive, treatment services, or other services that are integrated with and necessary to the provision of patient care are health care providers." This includes professionals like doctors, nurses, nursing assistants, but may also include non-professionals who provide "for example, bathing, dressing, hand feeding, taking vital signs, setting up medical equipment for procedures, and transporting patients and samples. These tasks must be integrated and necessary to the provision of patient care, which significantly limits this category."
LeadingAge is updating their FAQs on this, which means there will be more to follow. Remember, you should consult with your HR and legal departments to adapt to these changes.
9/14/20: CDC Releases COVID-19 Recommendations for Multifamily Housing Providers: The new CDC webpage covers COVID-19 safety issues in HUD-assisted senior housing. Read more HERE.
9/14/20: PPE Opportunity: We received a few hundred N95 masks from our friends at DonatePPE. If you are in need of N95s, please email me (email@example.com) and let me know the number of masks that you need for immediate use. These supplies are intended to meet the needs of members who are unable to secure N95 masks otherwise.
9/9/20: Grace Period for Lab Reporting & QSEP Training: If you were able to join the CMS call last evening or the LAN member call this morning with DHHS, you likely heard a reference to a potential three-week grace period for reporting. Based on feedback from the CMS Lab Excellence team today, it has been confirmed that laboratories have a one-time, three-week grace period to allow facilities to get their systems and processes in place prior to start reporting. This grace period is specific to reporting (not testing) and DOES apply to nursing facilities with CLIA Certificates of Waiver. The grace period started on September 2, 2020 and ends on September 23, 2020.
Here is the slide deck from last evening's CMS call. The three-week grace period is referenced on page 15.
This information has been brought to the attention of NE DHHS as well. More information to come.
During the call today, Becky Wisell referenced QSEP training that had just been made available. The links provided are links to the same training that we had shared with members previously for the modules related to Targeted COVID-19 Training for Frontline Nursing Home Staff and Management. Here is the link that Becky shared today: https://qsep.cms.gov/welcome.aspx.
9/9/20: HUD Staff on LeadingAge Call on Service Coordinator Payments: Today, LeadingAge hosted a call with HUD staff to address member concerns about the upcoming deadline for CARES Act payments for grant-funded Service Coordinators. Two key agency staff from HUD Headquarters joined nearly 100 LeadingAge members to discuss the timeline and eligible uses of the one-time supplemental COVID-19 payments to current grantees. The deadline to apply through GrantSolutions is this Friday, September 11th, at 11:59pm EST. More information is available here.
9/9/20: Updated COVID-19 Infection Control Survey Tool and Checklist: With the implementation of the new testing requirements, CMS updated the COVID-19 Infection Control Focused Survey tool. LeadingAge completed updates on the LA supplemental survey tool and checklist last week and it is still available as a great resource for your review. You can access the updated tool, which includes the updated CMS tool, here.
9/3/20: ICAP Call Today-Testing: If you were able to join the call sponsored by Nebraska ICAP today you had an opportunity to hear about testing from some facilities that have already done some testing. The call may have answered some of your questions and raised more, but the recording of the call is a good resource. If you are interested in listening to the call, here is the link to the recording. If you have questions about the information, Dr. Ashraf will join us for the LAN Member call at 11:00. Information below.
9/3/20: Assorted Testing Q&A from NE DHHS: How often is testing information required to be reported to NE DHHS?
- All tests must be reported as soon as possible; same day reporting is preferred.
- Submit test results once a day with a summary of all results obtained since the last time the report was submitted (the previous day).
- IF testing was done AFTER the daily report was submittedi, nclude those results on the next day's report.
Is the "Tests performed in a lab" tab the right place to report results from the Point of Care equipment?
- No, use the 'Test NOT Performed in a Lab' tab in the Excel spreadsheet.
- The 'Tests performed in a Lab' is only for laboratories use and contains additional data requirements specific to a Laboratory.
If the facility uses TestNebraska or contracts with a private lab, are these results reported on the "Tests performed in a lab" or "Tests performed NOT in a lab"?
- All tests sent to a private Laboratory are reported to DHHS by that Lab and do NOT need to be reported by the LTC facility.
If the facility uses one of the newer approved antigen tests that does not require equipment or a CLIA waiver, for example the Abbott test, where do these results get reported?
- Facilities are only required to report COVID-19 testing that their staff performs using a Point of Care testing device.
- Report these tests using the 'Test NOT Performed in a Lab' tab on the Excel spreadsheet.
- ALL tests done by LTC staff suing a Point of Care testing device must be reported.
- Report tests on both Staff AND Residents
- Report both Negative AND Positive tests
9/3/20: SNF Infection Control Distribution Incentive Payments Announced: The HHS announcement did not include specifics on how measures would be calculated, but to qualify:
- Must be a nursing home or skilled nursing facilities with active state certification
- Must receive reimbursement from CMS (Medicare/Medicaid)
- Must be in good standing (no revocation, terminations, expirations of certification or enrollment)
- Must report to at least one of these three data sources: CASPER, Nursing Home Compare or Provider of Services (POS)
The two measures will be:
- Ability to keep new COVID infection rates low among residents
- Ability to keep COVID mortality low among residents. (we are told this measure will be more lightly weighted than the prior measure and will be risk adjusted).
There will be four monthly performance periods in September, October, November, December. $500 million per performance period/month will be distributed in the form of incentive payments to eligible nursing homes in October, November, December of 2020 and January 2021.
HHS will compare CDC county-level data related to total confirmed/suspected COVID 19 infections and test positivity rates to nursing home NHSN LTCF COVID-19 reported data on COVID infection and mortality rates. There are no further details regarding the formulas or specific calculations to be used at this time.
9/3/20: NASEM Vaccine Allocation Comments: LeadingAge is submitting comments to NASEM on its draft framework for COVID-19 vaccine allocation. Key priorities include supporting phase 1 status for front line workers, including aging services and older adults in congregate settings. We are asking NASEM to define the second item broadly and specifically include people living in IL, affordable housing, and community-based services in the final framework. Comments are due tomorrow by midnight Eastern time. Comments can be submitted here: https://www.nap.edu/vaccine/. Note there is a 5,000 character limit including spaces.
9/3/20: New "Care Compare" Site: Many months ago CMS announced they were going to merge all of the "Compare" sites into one and LeadingAge participated in the stakeholder engagement sessions for this project. It was scheduled to launch in the spring. Today, CMS released this announcement about the new CMS Care Compare site. Access the new site here. The old compare sites (Nursing Home Compare, Home Health Compare, Hospice Compare) are all still live with a banner at the top of each one encouraging consumers to try the new site. There is no information about when the traditional sites will sunset. The information that is displayed on Care Compare has not changed from what was displayed on the previous compare sites. The information has been consolidated under one interface with an updated look. However, the press release (linked above) seems to indicate that additional information, like cost or new quality measures, may be included in the future.
9/3/20: Updated COVID-19 Infection Control Survey Tool and Checklist: With the implementation of the new testing requirements, CMS updated the COVID-19 Infection Control Focused Survey tool. LeadingAge has completed updates on the LA supplemental survey tool and checklist and it is again available on the COVID-19 nursing homes page. You can access the updated tool, which includes the updated CMS tool, here.
9/2/20: Provider Relief Funds Application Process NOW Open to Private Pay AL and Nursing Homes: We are pleased to be able to share this information for our Assisted Living and some additional Nursing Homes. Private pay members can now access some provider relief funds. Last night around 7 PM Eastern time, HHS announced that it was taking applications for assisted living facilities to receive Provider Relief Funds. The announcement detailed that HHS is inviting applications for provider relief funds that may have been previously ineligible for Phase 2 General Distribution funds. ALFs will receive 2% of their annual revenue from resident care. Additional details are available on the Provider Relief Website. Providers will have until September 13 to begin the process by entering their Tax Identification Number (TIN) for validation. More analysis coming tomorrow.
LeadingAge has outlined the details on the AL application process in an article posted today on the LeadingAge website. What isn't in the announcement but we have been told by HHS is that PRIVATE PAY NURSING HOMES can also apply through this same process. HHS staff indicate this is an option. In the event that a private pay nursing home applies but is told that their Tax Identification Number is not valid, please contact me so that I can share with LeadingAge national. If you are an AL connected to an NF with a separate Tax ID Number, you are likely eligible for these funds.
9/2/20: CMS Nursing Home Training: LeadingAge shared that on their call today with CDC that CMS has received a great deal of feedback on the new training that was released last week. Some of the information is being interpreted in a way that is not consistent with CDC guidance. For this reason, CMS is reviewing the training and may make revisions in the future. More to come on this. Keep in mind until then that any recommendations for infection control are intended to be consistent with CDC guidance.
9/2/20: SNF Infection Control Distribution and Training: During the LeadingAge member update call today, it was indicated that at this point the $2B in performance payments that will be distributed will not be tied to nursing homes completing infection control training. There was an indication that a minimal amount of compensation will be available for those who voluntarily participate in the AHRQ Project ECHO training program, as Dr. Ashraf had mentioned in last week's ICAP call. If you are interested in more information about the potential of Project ECHO being available in Nebraska, please feel free to contact Sarah Stream, Infection Preventionist with the ICAP team.
9/2/20: HUD Announces Service Coordinator COVID-19 Payments:
- Applications due to HUD by 9/11 Today, HUD announced that CARES Act awards for grant-funded Service Coordinators are now available. The supplemental payments will be approximately 9% of operating budgets, and applications for the payments are due to HUD by 9/11/20. LeadingAge will host a call with HUD staff next week to answer member questions. More information about the call and detailed instructions to apply for the payments, is available here: https://leadingage.org/regulation/hud-announces-service-coordinator-covid-19-payments
- Grant Awards: The supplemental awards will be equivalent to 9% of their SCMF/CHSP FY2020 program operating budget.
- Eligible Period of Increased Costs: March 27 - December 31, 2020
- Application Deadline: 9/11/2020
- Acceptance of Notice of Award: The authorizing official must access GrantSolutions and accept the award no later than 5 business days after receipt of notification. GrantSolutions is sending notification emails to eligible grantees.
- Spending Plan will be due: Grantees must submit a spending plan via Grant Notes/Application to the assigned grant specialist within 20 days after acceptance of the award.
- Availability of Funds: Once the spending plan is approved by the grants specialist, the funds will be available within 3 business days.Weekly Connection with Connie Vogt with LAN Members- Call from Today
- We heard a great deal of information on testing during our call with DHHS and through email communications related to testing throughout the day, but there are still many questions outstanding. I have included the handouts and PowerPoint from today's call below. These handouts are also available on the LeadingAge Nebraska website at leadingagene.org, COVID-19 resources.
- PowerPoint | QSO 20-28-NF Revised 7/9 | QSO 20-28-NH Revised 7/20 | QSO 20-38-NH | NH COVID DATA FAQ | COVID Testing FAQ SNF
- The main points from the call that are included in the PowerPoint address reopening to visitors, clarifications on communal dining and activities, testing and reporting. As was indicated last evening, the testing requirements DO NOT apply to Assisted Living yet. The requirements DO apply to Nursing Facilities, testing requirements and associated reporting went live today when the rule was published. Connie indicated that the key to addressing any challenges that you encounter while trying to comply is to document EVERYTHING. Please see the email from Becky Wisell that went to all NF providers around 4:00 this evening for more information on how to handle reporting at the State level.
9/2/20: Federal Eviction Moratorium: On September 1st, the CDC announced an "exceedingly rare" order to temporarily halt evictions for people impacted by COVID-19 through the end of the year. Housing providers, including HUD-assisted senior housing, are prohibited from evicting residents under a certain income threshold for non-payment of rent until December 31st; rent payments are still due, and housing providers can still charge late fees. LeadingAge will be working with federal agencies to provide accompanying relief for housing providers. For more information about the Agency Order and to read a recent LeadingAge letter to the CDC on evictions, click here.
9/2/20: Links for Connie Vogt Call Wednesday, 9/2/20:
- Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes
- Nursing Home COVID-19 Data Quality – Frequently Asked Questions
- Frequently Asked Questions (FAQs) on Nursing Home Visitation
- QSO-20-28, Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, Frequently Asked Questions, and Access to Ombudsman (REVISED)
- QSO-20-38, Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to ﾭ COVID-19 Focused Survey Tool
- PowerPoint Presentation for Connie Vogt call, 9/2/20
9/1/20: Clarifications for LeadingAge Member From HHS on Antigen Testing Machines: LeadingAge policy staff met with Rachel Kellogg, Deputy Chief of Staff to Assistant Secretary for Health Brett Giroir to discuss questions on antigen testing and the BD and Quidel machines. Here are some key take aways from the call:
- Providers that have not received an antigen testing machine (or an adequate supply of test kits) by the time the CMS interim final rule is published and takes effect should be documenting and informing local and state health officials.
- Test kits are specific to the BD and Quidel machines. BD test kits cannot be used on the Quidel machine and vice versa.
- Though BD machines are less accurate than Quidel's, BD is a larger company with more production capacity, so more of these are being distributed.
- Both companies have set up dedicated websites to respond to nursing home requests for test kits. The links are at https://www.bdveritor.com/ and https://togetheragain.quidel.com/.
- If machines arrive broken or damaged or with a clearly erroneous number of test kits, providers can contact the companies directly. If a provider doesn't receive a machine at all or there are other unusual issues, please let me know and I can pass them on to LeadingAge national to be shared with Assistant Secretary Giroir's office.
- HHS will soon issue its allocation plan for the 150 million rapid result Abbott tests. If nursing homes have these tests, they may use them in lieu of or in combination with the antigen machines and PCR tests. Recall, the interim final rule requires testing but it doesn't explicitly require use of the antigen machine.
9/1/20: Nursing Home Testing Rule: The LeadingAge analysis of the testing rule can be found here, it includes updates that have rolled out since the original analysis was posted.
Many of you have been asking about the effective date of the rule. The rule is scheduled to be published to the Federal Register on September 2. It will be effective on September 2.
CMS posted the county positivity rate data last Thursday. It can be accessed through a link here under "COVID-19 Testing". This website is generally updated on Thursdays. We will get more info from CMS to determine how often the county positivity rate file will be updated.
9/1/20: Point-of-Care Testing: We have been fielding a lot of questions about the point-of-care testing devices and the HHS initiative to send them out to nursing homes by September 30. LeadingAge has created this tool to act as a quick reference for the most common questions. The tool will continue to be updated as new questions arise and information changes.
9/1/20: NHSN updates: NHSN has updated the COVID-19 module for long-term care. Updates include 4 new data elements to collect information on point-of-care antigen testing. The Table of Instructions and CSV templates for group reporting have also been updated and can be accessed here under "Data Collection Forms & Instructions" and "Group Resources". CDC will host 2 webinars next week to review these changes: September 1 at 1:00pm ET and September 3 at 1:00pm ET. Register here under "Upcoming Trainings".
9/1/20: Change to Availability of Employee Test Results: Reminder...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.