CMS will be transitioning to a new data source for a provider’s demographic data for all five Post-Acute Care (PAC) provider types (Skilled Nursing Facilities / Nursing Facilities (SNF/NFs), Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Hospices).  These demographic data include such items as the provider name, provider-mailing address, provider physical address, State, ZIP Code, etc.  These provider demographic data are displayed on the Provider and Quality Measure reports generated from the Quality Improvement and Evaluation System (QIES) Certification and Survey Provider Enhanced Reports (CASPER) Reporting application for SNF/NF and Hospice providers and reports generated from Internet Quality Improvement and Evaluation System (iQIES) for HHA, IRF, and LTCH providers.  Additionally these same demographic data are displayed on the public reporting websites such as the Provider Data Catalog (PDC).

Historically provider demographic data have been maintained in the Automated Survey Processing Environment or ASPEN software; however, CMS will be transitioning to use the demographic information from Provider Enrollment, Chain and Ownership System (PECOS).  While this transition is underway, a final date when all demographic data will be obtained from PECOS has not been identified.  During this transition, all PAC providers will be responsible to ensure their latest demographic data are updated and available in both the ASPEN and PECOS systems. 

• SNF Beneficiary Protection Notification Review
• Dining Observation
• Infection Prevention, Control & Immunizations.  Note: 12/10/2020 update for this pathway.
• Kitchen Observation
• Medication Administration Observation
• Resident Council Interview
• Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement (QAPI) Plan Review
• Abuse Critical Element Pathway
• Environmental Observations
• Sufficient and Competent Nurse Staffing Review
• Personal Funds Review
• Activities Critical Element Pathway
• Activities of Daily Living (ADL) Critical Element Pathway
• Behavioral and Emotional Status Critical Element Pathway
• Urinary Catheter or Urinary Tract Infection Critical Element Pathway
• Communication and Sensory Problems (Includes Hearing and Vision) Critical Element Pathway
• Dental Status and Services Critical Element Pathway
• Dialysis Critical Element Pathway
• General Critical Element Pathway
• Hospice and End of Life Care and Services Critical Element Pathway
• Death Critical Element Pathway
• Nutrition Critical Element Pathway
• Pain Recognition and Management Critical Element Pathway
• Physical Restraints Critical Element Pathway
• Pressure Ulcer/Injury Critical Element Pathway
• Specialized Rehabilitative or Restorative Services Critical Element Pathway
• Respiratory Care Critical Element Pathway
• Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review Critical Element Pathway
• Medication Storage and Labeling
• Preadmission Screening and Resident Review Critical Element Pathway
• Extended Survey
• Hydration Critical Element Pathway
• Tube Feeding Status Critical Element Pathway
• Positioning, Mobility & Range of Motion (ROMADL) Critical Element Pathway
• Hospitalization Critical Element Pathway
• Bladder or Bowel Incontinence Critical Element Pathway
• Accidents Critical Element Pathway
• Neglect Critical Element Pathway
• Resident Assessment Critical Element Pathway
• Discharge Critical Element Pathway
• Dementia Care Critical Element Pathway

These Frequently Asked Questions cover the following topics:

1.      Q: CMS posts county positivity rates for staff testing. What if my state or county also posts rates of COVID-19 positivity for each county?

2.      Q: Should nursing homes use the percent positivity rate or the color-coded positivity classification to determine their frequency for routine testing (i.e., twice a week, weekly, or monthly)?

3.      Q: Given CMS’ modifications to the methodology for test positivity to include two weeks of data, do I still have to wait two weeks to reduce testing frequency?

4.      Q: Should facilities always perform outbreak testing for all residents and staff when a new COVID-19 infection is identified

5.      Q: Can staff be tested by a different entity than the nursing home?

6.      Q: Some staff or care providers do not come into the facility each week; do I have to test them at the same frequency as all staff? For example, do they need to come into the facility just to be tested?

7.      Q: What is a false positive Point of Care antigen test result and what should we do if we potentially have one?

8.      Q: What steps can be taken to reduce the potential for false-positive antigen tests?

9.      Q: What if a facility is trying to comply with the testing requirements, but is unable due to factors outside of its control?

10.  Q: Do individuals providing emergency medical services (EMS) need to be tested?

11.  Q: What does the 48-hour turn-around time mean?

12.  Q: When a facility admits a new resident with COVID-19, does that trigger outbreak testing?

Agency thanks nursing homes whose staff have completed free CMS training, but urges remaining homes to take advantage of this resource

The Centers for Medicare & Medicaid Services (CMS) is publicly recognizing the 1,092 nursing homes at which 50% or more of their staff have completed CMS training designed to help staff combat the spread of coronavirus disease 2019 (COVID-19) in nursing homes. CMS applauds these facilities for taking this critical step to equip their staff with the latest information regarding infection control, vaccine distribution, and other topics.

There are 125,506 individuals from 7,313 nursing homes who have completed the training. This represents approximately 12.5% of the approximately one million nursing home staff in the country. With today’s announcement, CMS is calling on nursing homes to take action, urging them to require their staff to take this free training, as part of the Trump Administration’s continued efforts to keep nursing home residents safe.

“We’ve provided nursing homes with $20 billion in federal funding, millions of pieces of PPE, free testing machines and supplies, and significant technical assistance and on-the-ground support,” said CMS Administrator Seema Verma. “Ultimately, the ownership and management of every nursing must take it on themselves to ensure their staff is fully equipped to keep residents safe. With coronavirus cases increasing across the country and infection control identified as a major issue, we encourage all nursing homes to take advantage of this no-cost opportunity to train their staff.”

The training includes multiple modules, with emphases on topics such as infection control, screening and surveillance, personal protective equipment (PPE) usage, disinfection of the nursing home, cohorting and caring for individuals with dementia during a pandemic. CMS developed this training in consultation with the Centers for Disease Control and Prevention (CDC) and expert stakeholders, and announced the training on August 25, 2020. For anyone interested, the training is free to access on a public CMS website; instructions on how to create an account and take the training are available at qsep.cms.gov/welcome.aspx.

Skilled Nursing Facilities (SNFs) must issue a notice to Original Medicare (fee for service - FFS) beneficiaries in order to transfer potential financial liability before the SNF provides:

• an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or
• custodial care.

For Part A items and services: SNFs use the SNF ABN as the liability notice.

For Part B items and services: SNFs use the Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. The ABN and information on this notice can be found at /Medicare/Medicare-General-Information/BNI/ABN.

Note: The SNFABN process is separate from the expedited determination process. So the SNFABN does not replace the Notice of Medicare Noncoverage (NOMNC). Each notice is used to meet the requirements of the separate processes.

CMS approved additional state Medicaid waiver requests under Section 1135 of the Social Security Act (Act). The waivers were approved within days of states’ submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states. The waivers were approved within days of states' submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states.

SUBJECT: State Operations Manual (SOM) Chapter 2, The Certification Process

I. SUMMARY OF CHANGES: The SOM Chapter 2 sections that provide instructions on voluntary termination work is revised. The revisions are part of an effort to streamline the enrollment process for certified providers/suppliers. Certain certification functions performed by the CMS regional locations are transitioning to CMS’ Center for Program Integrity (CPI) Provider Enrollment Oversight Group (PEOG) and the Medicare Administrative Contractors (MACs). The voluntary termination work is the first phase of the certification work to transition. The MAC will process and finalize voluntary termination actions and will coordinate with the State Survey Agency directly as needed. The approval recommendation made to the CMS regional locations by the MAC has been removed. The MAC will notify the provider or supplier of approval of voluntary termination and send copies of the letter to the State Survey Agency, CMS regional locations and Accrediting Organizations. Additionally, Community Mental Health Center (CMHC) sections 2252A through 2252F are being deleted since they were mistakenly omitted from Transmittal 197.

SUBJECT: State Operations Manual (SOM) Chapter 3, Additional Program Activities

I. SUMMARY OF CHANGES: The SOM Chapter 3 sections that provide instructions on voluntary termination work is revised. The revisions are part of an effort to streamline the enrollment process for certified providers/suppliers. Certain certification functions performed by the CMS regional locations are transitioning to CMS’ Center for Program Integrity (CPI) Provider Enrollment Oversight Group (PEOG) and the Medicare Administrative Contractors (MACs). The voluntary termination work is the first phase of the certification work to transition. The MAC will process and finalize voluntary termination actions and will coordinate with the State Survey Agency directly as needed. The approval recommendation made to the CMS regional locations by the MAC has been removed. The MAC will notify the provider or supplier of approval of voluntary termination and send copies of the letter to the State Survey Agency, CMS regional locations and Accrediting Organizations.

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.