AADNS News Feed

Sorting through all that is happening in LTC and then figuring out just what you need to know can be a daunting task. Luckily, we’re here to help. Our nursing experts scour through mountains of information to identify the breaking news and important updates and changes that you need to know today. Find the latest on important topics with links to resources, websites, and tools to keep you up-to date.

  • SNF QRP Comorbidity HCC Groups ICD-10 Codes Updated (7/20)

    By CMS - July 06, 2020

    These charts provide an update to the Comorbidity HCC groups used for the SNF QRP as covariates for the Change in Self-Care score, Change in Mobility score, Discharge Self-Care sore, and Discharge Mobility score.

    They appear to be an update/crosswalk to the ICD-10 codes listed in table A-5 of the SNF QRP Measure Calculations and Reporting User’s Manual.

    It's worth noting that, in the user guide, there are only 24 HCC Groups, but this updated crosswalk lists 190 groups.

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  • FY 2021 ICD-10-CM Code Update (7/20)

    By CDC - July 02, 2020

    The 2021 ICD-10-CM codes are to be used from October 1, 2020 through September 30, 2021.

    Note: This replaces the FY 2020 release. These files listed below represent the FY 2021 ICD-10-CM. The FY 2021 ICD-10-CM is available in both PDF (Adobe) and XML file formats. Most files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to nchsicd10cm@cdc.gov .

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  • COVID-19 Testing: CDC Says Repeated Point Prevalence Surveys Can ID Asymptomatic Cases in SNFs (7/20)

    By CDC - July 01, 2020

    Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

    Early Release / July 1, 2020 / 69

    Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

    What is added by this report?

    Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

    What are the implications for public health practice?

    Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

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  • CDC 2020 On-Demand Video Schedule for Vaccination Series that Runs July 1 - October 14

    By CDC - July 01, 2020
    Pink Book Series

    CDC is offering a series of weekly one-hour web-on-demand videos that will provide an overview of vaccination principles, general best practices, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each video will include updated information from recent Advisory Committee on Immunization Practices (ACIP) meetings and votes.

    Audience

    Immunization providers: Physicians, nurses, nurse practitioners, pharmacists, physician assistants, DoD paraprofessionals, medical students, state and local immunization programs, etc.

    Continuing Education

    Continuing education will be available for each event.

    2020 Videos

    This year, because of limited staff availability during the ongoing COVID-19 response, the series will be prerecorded rather than live events. There is no registration process to view the sessions. The link to each course can be accessed on/after the indicated date. Questions about the material presented can be submitted to nipinfo@cdc.gov.

    2020 Release Schedule

    2018 webinar schedule with presentation information

    Date

    Topic

    July 1

    Principles of Vaccination

    July 8

    General Best Practice Guidelines, Part 1

    July 15

    General Best Practice Guidelines, Part 2, and Vaccine Safety

    July 22

    Immunization Strategies

    July 29

    Vaccine Storage and Handling and Vaccine Administration

    August 5

    DTaP/Tdap

    August 12

    Rotavirus and Hepatitis A

    August 19

    Meningococcal Vaccines

    August 26

    Measles, Mumps, Rubella

    September 2

    Polio and Hib

    September 9

    Varicella and Zoster

    September 16

    Hepatitis B

    September 23

    HPV

    September 30

    Pneumococcal Vaccines

    October 14

    Influenza

     


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

    By CMS - June 30, 2020

    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 6/29/20) 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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  • COVID-19 Waivers: CMS Article Answers Q's About 3-Day Hospital Stay & Benefit Period Ending/Renewal (6/20)

    By CMS - June 29, 2020

    3-day inpatient qualifying hospital stay waiver

    Benefit period ending/renewal waiver

    New MLN Matters article reviews in detail which residents each waiver applies to, including some useful examples for the benefit period waiver. Also provides extensive billing instructions.

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  • SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 (Calendar 2020) SNF QRP APU - REVISED (6/20)

    By CMS - June 26, 2020

    On January 30, 2020, CMS published the FY 2022 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Annual Payment Update (APU) Table for Reporting Assessment-Based Measures and Standardized Patient Assessment Data Elements (SPADES).

    Since that time, CMS has delayed the release of the SNF Minimum Data Set (MDS) Version 1.18.0 needed to support the Transfer of Health (TOH) Information Quality Measures and the new or revised SPADEs due to the COVID-19 Public Health Emergency.

    CMS has revised the SNF QRP APU table to reflect the updated Data Collection periods and applicable version number.  The table has also been updated with new footers to provide additional clarity on the use of the dash (-) for specific items. The revised table can be found in the Downloads section below with the title SNF QRP Table for Reporting Assessment-Based Measures for the FY 2022 SNF QRP APU.

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  • Final MDS 3.0 Item Sets and Data Specifications, Plus New Specs Erratata, for Oct. 1, 2020 (7/20)

    By CMS - June 26, 2020

    In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications.  These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1.  This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.

    The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.4 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.4) Final 04-30-2020 in the Downloads section below. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file:  MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip also posted in the Downloads section below.

    Please confirm with your State Medicaid Agency if your State will be requiring the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment.

    June 25, 2020 update:  An updated errata (V3.00.5) was posted for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications, currently in production.  Two issues were identified.  These changes will go into production on October 1, 2020.  As a result, two edits will be revised.  These changes will facilitate calculation of PDPM HIPPS codes on OBRA assessments for states that wish to have this calculation performed. 

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  • Calendar Q2 2020 PBJ Staffing Data Due Aug. 14, 2020 and Five-Star/Nursing Home Compare Updates From CMS (6/20)

    By CMS - June 26, 2020

    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.

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  • AAPACN Advocacy Agenda Supports the LTPAC Nursing Profession During the COVID-19 Crisis

    By Tracey Moorhead - June 25, 2020

    Without a doubt, COVID-19 has been the nearly singular focus for AAPACN and our members over the last few months. We have closely communicated with members to understand the needs and challenges of long-term and post-acute care professionals during this time and developed a lengthy roster of tools, tips, and alerts for you. AAPACN has also maintained a strong advocacy and policy presence at the federal level in support of our members and the nursing profession. You might be surprised to know that many federal policy issues continued to move forward and, in many cases, garnered more attention and action during the COVID-19 pandemic.

    AAPACN actively advocates at the federal level for policy priorities important to our members.  Even before COVID-19, these priorities included building and maintaining a strong LTPAC workforce; ensuring educational opportunities for LTPAC nurses; supporting nursing research initiatives; and advocating for common-sense regulatory compliance policies. Each of these issues is impacted and underscored by the challenges of COVID-19.

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  • CMS COVID-19 Emergency Declarations and Specific SNF/NF Flexibilities UPDATED (6/20)

    By CMS - June 25, 2020

    COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (6/25/20)

    Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities) (PDF) UPDATED (6/15/20)
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  • SNF QRP Data Reporting Requirements Back in Full Force July 1, 2020

    By CMS - June 25, 2020

    Reminder

    ·         Quality Reporting Programs are expected to report their quality data to meet requirements starting Quarter 3, which begins July 1, 2020. 

    The March 27, 2020 Medicare Learning Network Newsletter (MLN) Exceptions and Extensions for Quality Reporting Program (QRP) Requirements that includes Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals (hereafter referred to as post-acute care (PAC) programs) applies only to Quarter 4 of 2019 (October 1-December 31, 2019) and Quarters 1 and 2 of 2020 (January 1-June 30, 2020).  Providers are expected to report data and meet the QRP requirements beginning with Quarter 3, 2020 that starts July 1, 2020.

     As stated in that March 27, 2020 MLN Newsletter, “In some instances, these exceptions and extensions are granted because the data collected may be greatly impacted by the response to COVID-19 and therefore should not be considered in the quality reporting program. CMS is closely monitoring the situation for potential adjustments and will update exception lists, exempted reporting periods, and submission deadlines accordingly as events occur.”

    Starting with Quarter 3 that begins July 1, 2020, CMS expects providers to report their quality data.  CMS will analyze the data for each program recognizing that the COVID-19 public health emergency (PHE) remains in effect and could impact the quality data submitted.  CMS will closely monitor the situation for public reporting of the data and provide any updates.

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

    By CMS - June 25, 2020

    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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  • CDC Recommends Full-Time Infection Preventionist for Many SNFs/NFs

    By Caralyn Davis, Staff Writer - June 23, 2020

    The Centers for Disease Control and Prevention (CDC) has replaced the Interim Additional Guidance for Infection Prevention and Control for Patients With Suspected or Confirmed COVID-19 in Nursing Homes with a new set of core practices, as well as tiered recommendations to nursing homes in different phases of COVID-19 response. Note: The tiered recommendations are consistent with the Centers for Medicare & Medicaid Services’ (CMS) recently released recommendations for a phased-in approach for reopening nursing homes.

     

    One of the new core practices focuses on ensuring the facility’s infection preventionist has enough hours to do the job:

    Assign One or More Individuals With Training in Infection Control to Provide On-Site Management of the IPC Program.

     

    “We would really encourage facilities to assign and dedicate one individual with infection prevention and control training to be the onsite manager of their COVID-19 prevention and response activities full-time,” says Nimalie Stone, MD, medical epidemiologist for long-term care in the Division of Healthcare Quality Promotion at the CDC.

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  • Advance Care Planning Basics: What Is It, and Why Does It Matter?

    By Caralyn Davis, Staff Writer - June 23, 2020

    Editor’s note: This is the first article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes.

     

    The surveyor guidance under F578 (Request/Refuse/Discontinue Treatment; Formulate Advance Directives) in Appendix PP of the State Operations Manual defines and discusses advance care planning as follows:

     

    “Advance care planning” is a process of communication between individuals and their healthcare agents to understand, reflect on, discuss, and plan for future healthcare decisions for a time when individuals are not able to make their own healthcare decisions. …

     

    The ability of a dying person to control decisions about medical care and daily routines has been identified as one of the key elements of quality care at the end of life. The process of advance care planning is ongoing and affords the resident, family, and others on the resident’s interdisciplinary health care team an opportunity to reassess the resident’s goals and wishes as the resident’s medical condition changes. Advance care planning is an integral aspect of the facility’s comprehensive care planning process and assures re-evaluation of the resident’s desires on a routine basis and when there is a significant change in the resident’s condition. The process can help the resident, family and interdisciplinary team prepare for the time when a resident becomes unable to make decisions or is actively dying.

     

    But what exactly does that mean? “The commonly used definition of advance care planning is that it is a process to support a person in understanding and ensuring their values, goals, and preferences regarding future medical care,” says Shigeko (Seiko) Izumi, PhD, RN, FPCN, associate professor in the School of Nursing at Oregon Health & Science University in Portland, OR; presenter of the April 22 webinar “COVID Conversations: Team Approach To Assisting Patients With Advance Care Planning” from the Coalition for Compassionate Care of California; and co-author of “A Model to Promote Clinicians' Understanding of the Continuum of Advance Care Planning” in the Journal of Palliative Medicine (2017; 20(3):220-22).

     

    “It’s very important to know the resident’s values, goals, and preferences of future care and then to share that information with families and other healthcare providers so they understand what kinds of care the resident wants when that resident is unable to make their own decisions or cannot express their wishes,” she explains.

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