• FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    Monday, August 10, 2020 | CMS

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

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

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (7/20)

    Monday, July 20, 2020 | CMS

    New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

    CMS has released a new toolkit (updated 7/15/20) developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

    “The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

    The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

    Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

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  • CMS Will Increase Use of QIOs to Fight COVID-19 Hot Spots (7/20)

    Monday, July 13, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

    Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

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  • CMS FAQs Detail Recommendations for Allowing Nursing Home Visits (6/20)

    Thursday, June 25, 2020 | CMS

    CMS has issued seven Frequently Asked Questions to supplement existing guidance about the rules for nursing home visitations during the COVID-19 pandemic, starting with No. 1:

    1. What steps should nursing homes take before reopening to visitors? 

    Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19, and follow state and local direction. Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when: 

    • There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two) 

    • The nursing home is not experiencing staff shortages 

    • The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents 

    • The nursing home has adequate access to testing for COVID-19 

    • Referral hospital(s) have bed capacity on wards and intensive care units

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  • CMS COVID-19 Stakeholder Engagement Calls – Week of 5/18/20

    Monday, May 18, 2020 | CMS

    CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

    Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. 

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  • Coronavirus Commission for Safety and Quality in Nursing Homes to Focus on Identifying Best Practices, Strengthening Regulations and Enforcement (4/20)

    Thursday, April 30, 2020 | CMS

    On April 30, the Centers for Medicare & Medicaid Services (CMS) announced that an independent Commission will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will be convened and lead by a CMS contractor and will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. 

    The convening of the Commission is the next step in improving quality and safety within nursing homes. The Commission will help inform efforts to safeguard the health and quality of life of vulnerable Americans as CMS continues to battle COVID-19. The Commission will include residents, families, resident/patient advocates, leading industry experts, clinicians, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other experts selected through a nomination process.

    It is expected to convene in May and develop recommendations on three key tasks: 

    • Putting nursing home residents first by ensuring they are protected from COVID-19 and improving the responsiveness of care delivery to meet the needs of all residents to maximize quality of life for residents.

    • Strengthen regulations to enable rapid and effective identification and mitigation of COVID-19 transmission in nursing homes; and 

    • Enhance federal and state enforcement strategies to improve compliance with infection control policies in response to COVID-19. 

    Additionally, the Commission will focus on identifying potentially innovative approaches for using existing and newly available nursing home (and other) data to enable better coordination between federal surveyors and state and local entities to address the current spread of COVID-19 within nursing homes as well as to analyze the impact of efforts to stop or contain the virus within these facilities. 

    Participants will help to identify best practices to address COVID-19, which CMS or states may incorporate into a larger regulatory framework for effective oversight to better inform federal and state officials as well as nursing homes across the country, to better achieve compliance through improved enforcement solutions, and to improve the quality of life and overall health status of nursing home residents during the pandemic. 

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  • April 8 CMS Call: COVID-19 in Nursing Homes

    Tuesday, April 7, 2020 | CMS

    Please join the Centers for Medicare and Medicaid Services (CMS) for a call on COVID-19 with Nursing Homes tomorrow, Wednesday, April 8th at 4:30 PM EST. CMS leadership will provide updates on the agency’s latest guidance and we will be joined by leaders in the field interested in sharing best practices with their peers. The call will be recorded if you are unable to join us.

    Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

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  • COVID-19 Prevention / Management in Long-Term Care: CMS Issues New CDC-Based Recommendations (4-2-20)

    Thursday, April 2, 2020 | CMS

    The new recommendations include:

    ·  Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.

    ·  As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.

    ·  Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.

    ·  Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.

    ·  To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.

    “The Trump Administration is calling on the nursing home industry and state and local leaders to join us by taking action now to ensure the safety of their residents, who are among our most vulnerable citizens. The Administration urges them to carefully review our recommendations, and implement them immediately,” said CMS Administrator Seema Verma.

    Today’s recommendations will help State and local governments, and nursing homes, as they consider creative ways to stop the spread of the virus, such as designating units within facilities – or entire facilities – solely for residents with confirmed COVID-19. An example of such an arrangement is in Wilmington, Massachusetts, in which a 142-bed facility has been designated as a solely COVID-19-positive facility. Residents across the region who are infected with COVID-19 can be moved to this facility to receive appropriate care and avoid transmitting the virus within their facilities. This approach also eases the challenges of preventing transmission, like extensive PPE usage and isolation practices, for individual facilities. The Massachusetts arrangement, developed in coordination with the state’s government, is a prime example of the arrangements envisioned in the recommendations announced today.

    The recommendations also speak to enhanced screening and transmission prevention practices. Previous CMS guidance, developed with CDC and issued in mid-March, advised nursing homes to restrict all but the most urgent visitors and staff. Today’s guidance builds on this by recommending temperature screenings for all visitors and that all staff utilize adequate PPE when interacting with patients, to the extent PPE is available.

    Nursing homes are unique in the healthcare system because, unlike other healthcare facilities, they are full-time homes as well as settings of care. Importantly, nursing home residents, given their advanced age and corresponding health issues, are at particular risk of complications arising from COVID-19. Because they are large concentrations of particularly vulnerable individuals, nursing homes have been a major focus for the Trump Administration in its aggressive efforts to combat the virus.

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  • CMS Adds New COVID-19 Waivers to Address Nurse Aide Training, Other Issues (4/20)

    Wednesday, April 1, 2020 | CMS

    Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19

    CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration. For general information about waivers, see Attachment A to this document. These waivers DO NOT require a request to be sent to the 1135waiver@cms.hhs.gov mailbox or that notification be made to any of CMS’s regional offices.

    Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs)

    • 3-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).

    • Reporting Minimum Data Set. CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.

    • Staffing Data Submission. CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system.

    • Waive Pre-Admission Screening and Annual Resident Review (PASARR). CMS is waiving 42 CFR 483.20(k) allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available.

    • Physical Environment.

    CMS is waiving requirements related at 42 CFR 483.90, specifically the following:

    • Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under § 483.90 to allow for a non-SNF building to be temporarily certified and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults. CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care. CMS will waive certain conditions of participation and certification requirements for opening a NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
    • CMS is also waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met. This can be done so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department.

    • Resident Groups. CMS is waiving the requirements at 42 CFR 483.10(f)(5), which ensure residents can participate in-person in resident groups. This waiver would only permit the facility to restrict in-person meetings during the national emergency given the recommendations of social distancing and limiting gatherings of more than ten people. Refraining from in-person gatherings will help prevent the spread of COVID-19.

    • Training and Certification of Nurse Aides. CMS is waiving the requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under § 483.35(d). CMS is waiving these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. To ensure the health and safety of nursing home residents, CMS is not waiving 42 CFR § 483.35(d)(1)(i), which requires facilities to not use any individual working as a nurse aide for more than four months, on a full-time basis, unless that individual is competent to provide nursing and nursing related services. We further note that we are not waiving § 483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.

    • Physician Visits in Skilled Nursing Facilities/Nursing Facilities. CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform inperson visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.

    • Resident roommates and grouping. CMS is waiving the requirements in 42 CFR 483.10(e) (5), (6), and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19, and separating them from residents who are asymptomatic or tested negative for COVID-19. This action waives a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room, and to provide for a resident’s refusal a transfer to another room in the facility. This aligns with CDC guidance to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission of COVID-19 to other residents.

    • Resident Transfer and Discharge. CMS is waiving requirements in 42 CFR 483.10(c)(5); 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), (c)(9), and (d); and § 483.21(a)(1)(i), (a)(2)(i), and (b) (2)(i) (with some exceptions) to allow a long term care (LTC) facility to transfer or discharge residents to another LTC facility solely for the following cohorting purposes:

    1. Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents;
    2. Transferring residents without symptoms of a respiratory infection or confirmed to not have COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents to prevent them from acquiring COVID-19; or
    3. Transferring residents without symptoms of a respiratory infection to another facility that agrees to accept each specific resident to observe for any signs or symptoms of a respiratory infection over 14 days.

     Exceptions:

    • These requirements are only waived in cases where the transferring facility receives confirmation that the receiving facility agrees to accept the resident to be transferred or discharged. Confirmation may be in writing or verbal. If verbal, the transferring facility needs to document the date, time and person that the receiving facility communicated agreement.

    • In § 483.10, we are only waiving the requirement, under § 483.10(c)(5), that a facility provide advance notification of options relating to the transfer or discharge to another facility. Otherwise, all requirements related to § 483.10 are not waived. Similarly, in § 483.15, we are only waiving the requirement, under § 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), and (d), for the written notice of transfer or discharge to be provided before the transfer or discharge. This notice must be provided as soon as practicable.

    • In § 483.21, we are only waiving the timeframes for certain care planning requirements for residents who are transferred or discharged for the purposes explained in 1–3 above. Receiving facilities should complete the required care plans as soon as practicable, and we expect receiving facilities to review and use the care plans for residents from the transferring facility, and adjust as necessary to protect the health and safety of the residents the apply to.

    • These requirements are also waived when the transferring residents to another facility, such as a COVID-19 isolation and treatment location, with the provision of services “under arrangements,” as long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department. In these cases, the transferring LTC facility need not issue a formal discharge, as it is still considered the provider and should bill Medicare normally for each day of care. The transferring LTC facility is then responsible for reimbursing the other provider that accepted its resident(s) during the emergency period.

    • If the LTC facility does not intend to provide services under arrangement, the COVID-19 isolation and treatment facility is the responsible entity for Medicare billing purposes. The LTC facility should follow the procedures described in 40.3.4 of the Medicare Claims Processing Manual (https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/clm104c06.pdf) to submit a discharge bill to Medicare. The COVID-19 isolation and treatment facility should then bill Medicare appropriately for the type of care it is providing for the beneficiary. If the COVID-19 isolation and treatment facility is not yet an enrolled provider, the facility should enroll through the provider enrollment hotline for the Medicare Administrative Contractor that services their geographic area to establish temporary Medicare billing privileges.

    We remind LTC facilities that they are responsible for ensuring that any transfers (either within a facility, or to another facility) are conducted in a safe and orderly manner, and that each resident’s health and safety is protected. We also remind states that under 42 CFR 488.426(a)(1), in an emergency, the State has the authority to transfer Medicaid and Medicare residents to another facility.


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  • CMS Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

    Friday, March 27, 2020 | CMS
    The Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19, are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.
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