Medicare Part D Payments During Covered Part A SNF Stay

Medicare Part A prospective payments to skilled nursing facilities (SNFs) cover most services, including drugs and biologicals furnished by the SNF for use in the facility for the care and treatment of beneficiaries. Accordingly, Medicare Part D drug plans should not pay for prescription drugs related to posthospital SNF care because these drugs are already included in the consolidated payment for Part A SNF stays. We will determine whether Medicare Part D paid for drugs that should have been paid under Part A SNF stays.

Background Checks for Nursing Home Employees

Federal regulation 42 CFR 483.12(a)(3) provides beneficiaries who rely on long-term care services with protection from abuse, neglect, and theft by preventing prospective employees with disqualifying offenses from being employed by these care providers and facilities. The National Background Check Program was enacted by legislation in 2010 to assist States in developing and improving systems for conducting Federal and State background checks. Prior OIG work has shown that not all States complied with the National Background Check Program for Long-Term Care Providers. We will determine whether Medicaid beneficiaries in nursing homes in selected States were adequately safeguarded from caregivers with a criminal history of abuse, neglect, exploitation, mistreatment of residents, or misappropriation of resident property, according to Federal requirements. 

Study 1: New findings from a study of thousands of healthcare workers in England show that those who got COVID-19 and produced antibodies against the virus are highly unlikely to become infected again, at least over the several months that the study was conducted. In the rare instances in which someone with acquired immunity for SARS-CoV-2 subsequently tested positive for the virus within a six month period, they never showed any signs of being ill. 

Study 2: Among 156 frontline health care personnel who had positive SARS-CoV-2 antibody test results in spring 2020, 94% experienced a decline in antibodies at repeat testing approximately 60 days later.

Testing Guidelines for Nursing Homes FRIDAY, OCTOBER 16, 2020

Revisions were made on October 16, 2020, to reflect the following:

Updated link to Testing Resources for Nursing Homes one-pager for nursing home personnel with link to Guidance for SARS-CoV-2 Point-of-Care Testing.

Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

Memo #QSO 20-34-NH

Posting Date 2020-06-25

Fiscal Year 2020

Summary

The Centers for Medicare & Medicaid Services (CMS) is committed to transparency about changes in publicly reported information on nursing homes during the COVID-19 public health emergency. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

• Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.

o Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.

• Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant.

The Occupational Safety and Health Administration (OSHA) is committed to protecting the health and safety of America’s workers and workplaces during these unprecedented times. The agency will be issuing a series of alerts designed to keep workers safe. In a nursing home or long-term care facility, the following tips can help reduce the risk of exposure to the coronavirus.

A revised version of the PBJ Data Specifications (Version 4.00.0) is available to Users. The new release of the Data Specifications reconciles changes to the file layout, fileSpecVersion 4.00.0. Census tags have been removed from the 4.00.0 version due to CMS no longer collecting Census data from PBJ as of April, 2018. No immediate changes are needed when using the current PBJ Submission File fileSpecVersions (2.00.0 and 2.00.3), however, Users are encouraged to begin using PBJ fileSpecVersion 4.00.0.  XML files submitted with versions other than 4.00.0 on or after June 2, 2020 will be rejected. Please note this does not apply to the PBJ Administration Submission File format. Users who use this file format for linking employees should continue to use fileSpecVersion 1.00.0. 

On April 21, CMS added an errata:

4.00.0 fileSpecVersion: CMS is delaying the previously communicated June 1, 2020 date for rejecting PBJ file Spec Versions 2.00.0 and 2.00.3. The PBJ system will continue to accept PBJ fileSpecVersions 2.00.0, 2.00.3 and 4.00.0 until further notice from CMS. Details can be found in the following document: Errata V4.00.1 for PBJ Data Submission Specifications (V4.00.0) 04-16-2020.