Please note that both webinars are identical in content, so you may only need to attend once.

Topic: Reporting Results of Point of Care Testing for COVID-19: A New NHSN Pathway
When: Thursday, October 22, 2020
Time: 11:00 AM – 12:00 PM ET

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Meeting ID: 161 311 1399
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Topic: Reporting Results of Point of Care Testing for COVID-19: A New NHSN Pathway
When: Friday, October 23, 2020
Time: 2:00 – 3:00 PM ET

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Related Resources:

Point of Care Testing

• COVID-19 Ventilator Capacity and Supplies Pathway Form (57.155) pdf icon[PDF – 80 KB] (print-only) – October 16, 2020
• Table of Instructions (57.155) 

Oct. 23 Webinar, Strategies to Prevent the Spread of COVID-19

The first segment of this presentation will address key important and realistic approaches, consistent with current guidance, that health care workers can implement to mitigate the spread of COVID-19 for long-term care professionals.

The second segment will cover the multiple actions necessary for organizations to consider around PPE from planning, inventory, policies and procedures, types of PPE to use consistent with current guidelines, education, optimization, process surveillance, and follow up.

Friday, October 23, 2020

1:00-2:30 p.m. MT / 3 – 4:30 p.m. ET

Oct. 29 Webinar, COVID-19: Realistic and Quality Approach to Cohorting, Cleaning and Disinfection

The first segment of this presentation will discuss the guidance, planning, education, and prompt action approach to the very important mitigation step of cohorting during the COVID-19 pandemic. The second section will provide key strategies in both cleaning and disinfection to include the process, products, PPE, necessary and education of employees during the COVID-19 pandemic.

Thursday, October 29, 2020

10:30 a.m.-Noon MT / 12:30 p.m. – 2 p.m. ET

The Pharmacy Partnership for Long-Term Care Program provides complete management of the COVID-19 vaccination process. This means LTCF residents and staff across the country will be able to safely and efficiently get vaccinated once vaccines are available and recommended for them, if they have not been previously vaccinated. It will also minimize the burden on LTCF sites and jurisdictional health departments of vaccine handling, administration, and fulfilling reporting requirements.   

“Protecting the vulnerable has been the number one priority of the Trump Administration’s response to COVID-19, and that commitment will continue through distributing a safe and effective vaccine earliest to those who need it most,” said HHS Secretary Alex Azar. “Our unprecedented public-private partnership with CVS and Walgreens will provide convenient and free vaccination to residents of nursing homes across America, another historic achievement in our efforts to get a safe and effective vaccine to Americans as fast as possible.”

“Today’s historic pharmacy partnership will truly help jurisdictions solve a logistical hurdle and decrease the burden of distributing, administering, and reporting COVID-19 vaccination for both states and long-term care facilities,” said Centers for Disease Control and Prevention Director Dr. Robert Redfield. “CDC is proud to be a part of this public-private partnership that is advancing care for the Nation’s most vulnerable.”

“The pandemic has inflicted a devastating toll on America’s nursing home residents,” said Centers for Medicare and Medicaid Services Administrator Seema Verma. “That’s why the Trump Administration has taken unprecedented action to protect them in every possible way.  This effort will ensure they are at the front of the line for the COVID vaccine and will bring their grueling trial to a close as swiftly as possible.”

The program is:

• Free of charge to facilities.
• Available for residents in all long-term care settings, including skilled nursing facilities (SNF), nursing homes, assisted living facilities, residential care homes, and adult family homes.
• Available to all remaining LTCF staff members who have not been previously vaccinated for COVID-19 (e.g., through satellite, temporary, or off-site clinics).
• · Available in most rural areas that may not have an easily accessible pharmacy.

HHS is using multiple authorities to ensure appropriate reimbursement for these services and that no American being vaccinated for COVID-19 will have to pay out-of-pocket.

CVS and Walgreens will schedule and coordinate on-site clinic date(s) directly with each facility. It is anticipated that three total visits over approximately two months are likely to be needed to administer both doses of vaccine (if indicated) to residents and staff.  The pharmacies will also:

• Receive and manage vaccines and associated supplies (e.g., syringes, needles, and personal protective equipment).
• Ensure cold chain management for vaccine.
• Provide on-site administration of vaccine.
• Report required vaccination data (including who was vaccinated, with what vaccine, and where) to the state, local, or territorial, and federal public health authorities within 72 hours of administering each dose.
• Adhere to all applicable Centers for Medicare & Medicaid Services (CMS) requirements for COVID-19 testing for LTCF staff.

“Ensuring access to COVID-19 vaccines, particularly among our most vulnerable populations, will be critical to saving lives and helping our nation recover from the pandemic,” said John Standley, Walgreens president. “Since the onset of the pandemic, Walgreens has worked closely with the CDC, HHS and the Administration to help accelerate the availability of COVID tests, ensure access to essential medicines and products and serve as a safe and trusted source of information in our communities. We are proud of how our pharmacists have continued to serve our patients and look forward to leveraging our nationwide footprint, community presence and pharmacist expertise to help administer COVID-19 vaccines, once they become available.”

“CVS Health has been on the frontlines of the fight against COVID-19, working across the health care spectrum in all the communities we serve and that will continue to be the case when we have a vaccine to dispense,” said Troy Brennan, Chief Medical Officer, CVS Health.

Starting October 19, 2020, LTCFs will be able to opt in and indicate which pharmacy partner their facility prefers to have on-site. LTCFs are not mandated to participate in this program and can request to use their current pharmacy contracts to support COVID-19 vaccination. Nursing homes can sign up via the National Healthcare Safety Network and assisted living facilities can sign up via an online survey they will receive.  An alert has been incorporated into the NHSN LTC COVID-19 module to guide users to the form.

When completing the form, facilities will need to indicate participation in the Pharmacy Partnership for Long-term Care Program and their preferred retail provider (CVS or Walgreens).  If opting to not participate in the program, facilities must indicate their alternate plan for securing vaccine supply and vaccinating residents. 

The form will remain open for two weeks, this decision is not binding and can be changed during these two weeks. Once the forms close, a facility must coordinate directly with the selected pharmacy provider to change any requested vaccination supplies and services.  

The Department of Health and Human Services, Office of the Assistant Secretary for Health (OASH), recently announced plans to provide nursing homes with a Point of Care (POC) rapid response testing instrument to bolster each facility’s ability to prevent the spread of COVID-19. The data collected through the NHSN system directly supports this initiative by helping to prioritize the nursing homes with testing needs and an increasing number of cases. 

CMS offers:

• A toolkit for nursing homes using point of care devices for SARS-CoV-2 testing as a quick reference guide to important information about testing.
• The methodology describing how facilities are prioritized, and a listing of the facilities. 
• A list of frequently asked questions (FAQs) and a recorded webinar. 

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.

CDC’s NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), with a customized system to track infections and prevention process measures in a systematic way. Tracking this information allows facilities to identify problems, improve care, and determine progress toward national healthcare-associated infection goals.

The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response through the COVID-19 Module for LTCFs. Facilities eligible to report into the COVID-19 Module include nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities.

The COVID-19 Module for LTCFs consists of four pathways within NHSN’s Long-term Care Facility Component:

• Resident Impact and Facility Capacity
• Staff and Personnel Impact
• Supplies and Personal Protective Equipment
• Ventilator Capacity and Supplies

Data submitted into the Module pathways enables an assessment of the impact of COVID-19 through facility reported information, including: 1) counts of residents and facility personnel with newly suspected and laboratory positive COVID-19; 2) death counts among residents and facility personnel with suspected and laboratory positive COVID-19; 3) staffing shortages; 4) availability of personal protective equipment (PPE) and supplies; and 5) ventilator capacity and supplies for facilities with ventilator dependent units.

In addition to the reporting pathways, the Point-of-Care (POC) Test Reporting Tool has been added to enable LTCFs to enter POC SARS-CoV-2 test results into the NHSN application.  NHSN will route the POC laboratory test data to the public health agency at the local or state level that has jurisdictional authority and responsibility to receive those data.  Health agencies, in turn, will use the data to fulfill their public health functions, which include reporting to the US Department of Health and Human Services, where the data will be used in the COVID-19 response. Participation in this pathway requires users to have secure access through Secure Access Management Services (SAMS), which includes having a SAMS grid card.

LTCF data submission options include manual entry and/or CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities. Note: CSV file submission is not currently available for the Point-of-Care (POC) Test Reporting Tool.

The Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care.

“Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well. This revolutionary method of improving access to care is transforming healthcare delivery in America. President Trump will not let the genie go back into the bottle.”  

Expanding Medicare Telehealth Services

For the first time using a new expedited process, CMS is adding 11 new services to the Medicare telehealth services list since the publication of the May 1, 2020, COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately, and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth services list builds on the efforts CMS has already taken to increase Medicare beneficiaries’ access to telehealth services during the COVID-19 PHE.

Since the beginning of the PHE, CMS has added over 135 services to the Medicare telehealth services list – such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services. With today’s action, Medicare will pay for 144 services performed via telehealth. Between mid-March and mid-August 2020, over 12.1 million Medicare beneficiaries – over 36 percent – of people with Medicare Fee-For-Service have received a telemedicine service.

Preliminary Medicaid and CHIP Data Snapshot on Telehealth Utilization and Medicaid & CHIP Telehealth Toolkit Supplement

In an effort to provide greater transparency on telehealth access in Medicaid and CHIP, CMS is releasing, for the first time, a preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE. This snapshot shows, among other things, that there have been more than 34.5 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June of this year, representing an increase of more than 2,600% when compared to the same period from the prior year. The data also shows that adults ages 19-64 received the most services delivered via telehealth, although there was substantial variance across both age groups and states.  

To further drive telehealth, CMS is releasing a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that have implemented telehealth changes. The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires.

The toolkit includes approaches and tools states can use to communicate with providers on utilizing telehealth for patient care. It updates and consolidates in one place the Frequently Asked Questions (FAQs) and resources for states to consider as they begin planning beyond the temporary flexibilities provided in response to the pandemic.

To view the Medicaid and CHIP data snapshot on telehealth utilization during the PHE, please visit: https://www.medicaid.gov/resources-for-states/downloads/medicaid-chip-beneficiaries-COVID-19-snapshot-data-through-20200630.pdf.

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Press Release Date: September 29, 2020

The Agency for Healthcare Research and Quality (AHRQ) is partnering with the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston to establish a National Nursing Home COVID Action Network. The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff.

Nursing home residents are especially vulnerable to SARS-COV-2 (COVID-19) due to their age, their underlying frailty, and their communal living conditions. And nursing home staff who care for them are among the most needed and most at-risk essential workers. It is estimated that almost 56,000 nursing home residents and staff have died from COVID-19, representing more than one-quarter of the nation’s known COVID-19 deaths.

"Protecting vulnerable older Americans in nursing homes is a central part of our fight against COVID-19, and we’ve learned that improving infection control in many nursing homes is not a matter of will but of skill," said HHS Secretary Alex Azar. "AHRQ is deploying its unique expertise in partnership with Project ECHO and IHI to help nursing homes protect both their residents and staff from the virus, slowing the spread and saving lives."

"Expanding the use of proven safety practices will directly benefit nursing home residents and staff members and help save lives," said AHRQ Director Gopal Khanna, M.B.A. "AHRQ has a proven track record of producing science and research to address critical needs such as responding to COVID-19 and achieving 21st century care for all Americans. We are pleased to be working with the ECHO Institute and IHI on this new initiative."

The new network is being created under an AHRQ contract worth up to $237 million that is part of the nearly $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. While $2.5 billion has already been distributed to help fund testing, personal protective equipment, and other supplies, another $2 billion is available for Medicare and Medicaid-certified nursing homes that show improvement in infection control.

The ECHO Institute is recruiting academic medical centers and large health centers across the country to serve as training centers for local nursing homes. Over 15,000 nursing homes that are certified to participate in the Medicare and Medicaid programs will be able to participate in a 16-week training program using a standardized curriculum developed by the IHI. Nursing homes that actively participate are eligible to receive $6,000 in compensation to cover staff training time.

While the curriculum will continue to be refined as new evidence emerges and the pandemic evolves, topics to be covered in the early weeks include:

• Best Practices in the Use of Personal Protective Equipment for COVID-19.
• Making the Environment Safe during COVID-19 through Infection Control Practices.
• Minimizing the Spread of COVID-19.
• COVID-19 Testing.
• Clinical Management of Asymptomatic and Mild Cases of COVID-19.
• Managing Social Isolation during COVID.

Weekly virtual training sessions will be facilitated by small multidisciplinary teams of subject matter and quality improvement experts. Sessions will combine short lectures that provide immediately usable best practices with case-based group learning. Between sessions, a robust community of practice will foster peer-to-peer learning supported by additional expert consultation.

"Collaborative education and shared learning is critical for our nonprofit nursing home members on the front line of this pandemic, under often challenging conditions," said Katie Smith Sloan, president and CEO of LeadingAge. "Access to mentors, local experts, community peers, and resources, with a focus on continuous improvement, will go a long way to help mitigate the virus’ spread and ensure the health and safety of older adults."

Sanjeev Arora, M.D., Project ECHO’s director and founder, said he looks forward to leading the initiative in partnership with AHRQ. "At a time when the dissemination of best practices in health care is more critical than ever, we are honored to help address this urgent need for nursing homes," he said.

Project ECHO (Extension for Community Healthcare Outcomes) was established to provide training and telementoring for health care professionals and staff across the nation and around the world. It includes over 250 training partners across the United States. AHRQ funded the initial establishment and evaluation of Project ECHO beginning in 2004. The new network’s training program will use the evidence-based process pioneered by Project ECHO and referred to as the ECHO Model, which is an interactive, case-based approach based on adult learning principles.

"The ECHO model is a proven approach that brings experts and providers together to learn and solve clinical and operational challenges," said Mark Parkinson, President and CEO for the American Health Care Association/National Center for Assisted Living. "We strongly encourage providers to participate in the COVID Action Network to get access to experts and learn the latest best practices to prevent the spread of COVID-19."

The Confidential Dry Run Reports for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations Measure are now Available

The Centers for Medicare & Medicaid Services (CMS) would like to announce the Confidential Dry Run Reports containing FY 2018 and FY 2019 performance scores for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations measure (SNF HAI measure) are now available. Performance scores are based on the draft measure specifications posted on CMS Measure Management Public Comment page. Providers can view these reports in their Certification and Survey Provider Enhanced Reports (CASPER) provider shared folders. These reports are accompanied by a Data Dictionary defining key measure terms.

The purpose of these Confidential Dry Run Reports is to allow SNFs to become familiar with this measure and to inform them of their performance in comparison to their peers. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs and to statistically distinguish between SNFs that are either better than or worse than their peers in infection prevention and in infection management. SNFs may choose to incorporate this measure into their internal quality assurance activities to improve patient outcomes. Review and use of this measure information is strictly voluntary.

Please send any questions or feedback on this measure via email to: SNFQualityQuestions@cms.hhs.gov.  

Note: The updated methodology is inside the updated spreadsheet for weekly county positivity rates: Rates of county positivity are posted here. 

The Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence. Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.” This information is critical to nursing homes, which are required to test their staff for COVID-19 at a frequency based on the positivity rate of their respective counties.

Under guidance CMS issued on August 26, 2020, nursing homes must test staff at a frequency of once monthly if the facility’s county positivity rate is less than five percent. Staff testing frequency increases to once weekly if the county positivity rate is between five and 10 percent. Finally, testing frequency increases to twice weekly if the county positivity rate exceeds 10 percent.

CMS heard concerns from some governors of rural states that the frequency guidelines did not work well for some rural areas. They were concerned that some rural counties had seemingly high comparative positivity rates as a result of low amounts of testing, rather than actual positivity in the community. This resulted in a significant burden for nursing homes being required to conduct staff testing at a higher frequency than necessary. In response to these concerns, the Trump Administration acted swiftly and decisively, and implemented the change to the positivity rate calculation in order to accommodate rural counties.  The new, resulting methodology reduces burden while still requiring facilities to conduct testing to at a frequency that can detect COVID-19 early to keep nursing home residents safe.

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Memorandum Summary

• CMS is committed to continuing to take critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

• Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE. The guidance below provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.

• Use of Civil Money Penalty (CMP) Funds: CMS will now approve the use of CMP funds to purchase tents for outdoor visitation and/or clear dividers (e.g., Plexiglas or similar products) to create physical barriers to reduce the risk of transmission during in-person visits.

Summary

What is already known about this topic?

Nursing homes are high-risk settings for COVID-19 outbreaks. The Centers for Medicare & Medicaid Services (CMS) publishes star quality ratings of all CMS-certified nursing homes.

What is added by this report?

During March–June 2020, 14 (11%) of 123 West Virginia nursing homes experienced COVID-19 outbreaks. Compared with 1-star–rated (lowest rating) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star–rated facilities and 94% lower among 4- to 5-star–rated facilities.

What are the implications for public health practice?

CMS star ratings can serve as proxy indicators for COVID-19 outbreak risk; health departments could use them to identify priority nursing homes and inform the allocation of infection prevention and control resources.

Serial Testing for SARS-CoV-2 and Virus Whole Genome Sequencing Inform Infection Risk at Two Skilled Nursing Facilities with COVID-19 Outbreaks — Minnesota, April–June 2020

Summary

What is already known about this topic?

Facility-wide, serial testing in skilled nursing facilities (SNFs) can identify asymptomatic SARS-CoV-2 infections among health care personnel (HCP) and residents to inform mitigation efforts.

What is added by this report?

Serial facility-wide testing at two Minnesota SNFs identified COVID-19 cases among 64% of residents and 33% of HCP. Genetic sequencing found facility-specific clustering of viral genomes from HCP and residents’ specimens, suggesting intrafacility transmission.

What are the implications for public health practice?

HCP working in SNFs are at risk for infection during COVID-19 outbreaks. To protect residents and prevent SARS-CoV-2 infection among HCP, SNFs need enhanced infection prevention and control practices, assured availability of personal protective equipment, improved HCP testing participation, flexible medical leave, and timely result reporting.

Preventing COVID-19 Outbreaks in Long-term Care Facilities Through Preemptive Testing of Residents and Staff Members — Fulton County, Georgia, March–May 2020

Summary

What is already known about this topic?

Residents of long-term care facilities (LTCFs) are at risk for severe COVID-19. Facility-wide testing, even in the absence of a reported COVID-19 case, can identify asymptomatic and presymptomatic infection in LTCFs.

What is added by this report?

LTCFs in which testing was conducted after a confirmed case of COVID-19 were found to have significantly higher proportions of infected residents and staff members at initial testing and after 4 weeks of follow-up compared with those testing as a preventive measure. The majority of LTCFs testing as a preventive measure identified an infection, although initial prevalence was significantly lower and fewer cases occurred during follow-up.

What are the implications for public health practice?

Proactive testing of LTCF residents and staff members might prevent large COVID-19 outbreaks in LTCFs through early identification and timely infection prevention and control response.