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Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).
This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:
This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.
Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating
The Centers for Medicare & Medicaid Services (CMS) is releasing the first episode in a series of short podcasts for frontline nursing home staff “CMS Beyond the Policy”.
This edition is titled “Nursing Home Series for Front Line Clinicians and Staff.” Dr. Shari Ling, Deputy Chief Medical Office for The Centers for Medicare and Medicaid Services and geriatrician is joined by David Wright, Director of the Quality Safety & Oversight Group to discuss training and infection control practices in nursing homes to help combat the spread of coronavirus disease 2019 (COVID-19).
The following CDC infection control training courses are part of the new States Targeting Reduction in Infections via Engagement (STRIVE) curriculum intended for the infection prevention team, hospital leaders, clinical educators, nurse and physician managers, environmental services managers, all patient care staff, and patient/family advisors.
These training courses were developed by national infection prevention experts led by the Health Research & Educational Trust (HRET) for the Centers for Disease Control and Prevention (CDC).
All courses are free and offer continuing education (CE).
The STRIVE curriculum will include over forty individual training modules grouped into 11 courses that focus on Foundational and Targeted infection prevention strategies.
Foundational Infection Prevention Strategies
· Competency-Based Training
· Hand Hygiene
· Strategies for Preventing HAIs
· Environmental Cleaning
· Personal Protective Equipment
· Patient and Family Engagement – WB4226
· Building a Business Case for Infection Prevention – WB4227
Targeted Infection Prevention Strategies
Writing a plan of correction that will be accepted by the state survey agency is the first half of the battle to deal with any citations that the survey team hands out on the statement of deficiencies (form CMS-2567) in situations that don’t involve immediate jeopardy (IJ), says Janet Feldkamp, RN, BSN, LNHA, CHC, JD, a partner in the Benesch Healthcare+ Practice Group at Benesch, Friedlander, Coplan & Aronoff in Columbus, OH. Note: Learn more about how to write a plan of correction that reduces negative impacts from survey in the AADNS Navigator article, “Writing a Plan of Correction: Keys to Success.”
The second half of the battle is successful, ongoing implementation of the plan of correction—and the stakes can be high. “While the plan of correction serves as the facility’s allegation of compliance in non-immediate jeopardy cases, substantial compliance cannot be certified and any remedies imposed cannot be lifted until facility compliance has been verified,” states the Centers for Medicare & Medicaid Services (CMS) in section 7317.1, Verifying Facility Compliance, of Chapter 7, “Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities,” of the State Operations Manual (SOM).
Note: Section 7317.2, Revisits, in chapter 7 of the SOM includes a chart that explains how surveyors certify compliance, the role of onsite revisits, and required remedies, up to and including the provider’s termination from the Medicare and Medicaid programs. In addition, section 7600, Continuation of Payments During Correction, addresses payment scenarios where states pursue alternative remedies to termination, and facilities do or don’t take corrective action according to the approved plan of correction and do or don’t achieve substantial compliance. Further, the August 17 Quality, Safety, & Oversight (QSO) memo QSO-20-35-ALL reviews changes to the revisit policy during the COVID-19 public health emergency.
Once again, the holiday season is upon us. However, due to the pandemic, the way people celebrate will be different this year. Holiday traditions that normally call for large gatherings of people—such as family dinners, religious ceremonies, and company holiday parties—will be planned keeping in mind the Centers for Disease Control and Prevention’s (CDC) recommendations for reducing disease transmission. Social distancing is critical because anytime people gather, especially those who do not live together, the risk of spreading the COVID-19 infection increases for everyone. The higher the level of community transmission in the area where the gathering is held, the higher the risk of spreading COVID-19 at the gathering. The frail elderly living in skilled nursing facilities (SNFs) are particularly susceptible to the spread of COVID-19, and it has been found that as the spread of the virus increases in the community, the risk for an outbreak in an SNF increases dramatically (AHCA, 2020).
Facility leaders, in addition to making personal holiday decisions, also need to be proactive and start making plans for how their facility will approach the holidays. This plan should not only include procedures for residents and staff but also address physical plant issues that may occur.
Getting the Facility Prepared
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.
The scope and duration of the exception under each Medicare quality reporting program is described below; however, all of the exceptions are being granted to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities.
Also see: Guidance for SARS-CoV-2 Point-of-Care Testing
The rules provide greater flexibility for healthcare providers to participate in value-based arrangements and to provide coordinated care for patients. The final rules also ease unnecessary compliance burden for healthcare providers and other stakeholders across the industry, while maintaining strong safeguards to protect patients and programs from fraud and abuse.
The HHS Office of Inspector General (OIG) issued the final rule “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements,” and the Centers for Medicare and Medicaid Services (CMS) issued the final rule “Modernizing and Clarifying the Physician Self-Referral Regulations.” These rules are part of HHS’s Regulatory Sprint to Coordinated Care, which has examined federal regulations that potentially impede healthcare providers’ efforts that otherwise would advance the transition to value-based care and improve the coordination of patient care across care settings in Federal healthcare programs and the commercial sector. In addition to advancing value-based care, the CMS final rule clarifies and modifies existing policies to ease unnecessary regulatory burden on physicians and other healthcare providers while reinforcing the physician self-referral law’s (often called the “Stark Law”) goal of protecting patients from unnecessary services and being steered to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest.
The new and amended regulations related to the federal Anti-Kickback statute and the civil monetary penalties law issued by OIG address stakeholder concerns that these laws unnecessarily limit the ways in which healthcare providers can coordinate care with and for federal healthcare program beneficiaries. OIG’s final rule modifies and clarifies the agency’s proposed rule in response to comments, as explained in the preamble to the final rule.
For example, OIG’s final rule clarifies how medical device manufacturers and durable medical equipment companies may participate in protected care coordination arrangements that involve digital health technology, and the final rule lowers the level of “downside” financial risk parties must assume to qualify under the new safe harbor for value-based arrangements that involve substantial downside financial risk. In recognition of the urgent problem of cyber threats to the healthcare industry, the rule also broadens the new safe harbor for cybersecurity technology and services to protect cybersecurity-related hardware.
OIG’s final rule, and the CMS final rule to the extent the Stark Law is applicable, would facilitate a range of arrangements to improve the coordination and management of patient care and the engagement of patients in their treatment if all applicable regulatory conditions are met, including the following examples:
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