• CDC: Asymptomatic/Presymptomatic COVID-19 Residents May Up Transmission Risk in Nursing Homes (3/20)

    Friday, March 27, 2020 | CDC

    Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

    Early Release / March 27, 2020 / 69

    Summary

    What is already known about this topic?

    Once SARS-CoV-2 is introduced in a long-term care skilled nursing facility (SNF), rapid transmission can occur.

    What is added by this report?

    Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.

    What are the implications for public health practice?

    Symptom-based screening of SNF residents might fail to identify all SARS-CoV-2 infections. Asymptomatic and presymptomatic SNF residents might contribute to SARS-CoV-2 transmission. Once a facility has confirmed a COVID-19 case, all residents should be cared for using CDC-recommended personal protective equipment (PPE), with considerations for extended use or reuse of PPE as needed.

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  • COVID-19: CMS Issues SNF QRP / SNF VBP Guidance Memo (3/20)

    Friday, March 27, 2020 | CMS

    DATE: March 27, 2020

    TO: MLN Connects Newsletter and Other Program-Specific Listserv Recipients

    FROM: [Program-Specific Listservs, Partner Listservs (e.g., NHSN), ESRD Networks, CMS Emergency web page]

    SUBJECT: Exceptions and Extensions for Quality Reporting Requirements for Acute Care Hospitals, PPS-Exempt Cancer Hospitals, Inpatient Psychiatric Facilities, Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, Ambulatory Surgical Centers, Renal Dialysis Facilities, and MIPS Eligible Clinicians Affected by COVID-19

     

    The Centers for Medicare & Medicaid Services (CMS) is granting exceptions1 under certain Medicare quality reporting and value-based purchasing programs for acute care hospitals, Prospective Payment System (PPS)-exempt cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, longterm care hospitals, ambulatory surgical centers, renal dialysis facilities, and Merit-based Incentive Payment System (MIPS) eligible clinicians for all providers and suppliers participating in the programs described below across the United States and its territories in response to the 2019 Novel Coronavirus (COVID-19) pandemic.

     

    On March 22, 2020, CMS announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to COVID-19.2 This memorandum supplements and provides additional guidance to health care providers with regard to the announcement. The scope and duration of the exceptions under each Medicare quality reporting program and value-based purchasing program are described below. CMS is granting exceptions and extensions for certain deadlines to assist these health care providers while they direct their resources toward caring for their patients and ensuring the health and safety of patients and staff. 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.

     

    Home Health Agencies (HHAs), Hospices, Inpatient Rehabilitation Facilities (IRFs), LongTerm Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs)

    CMS is granting an exception to the Quality Reporting Program (QRP) reporting requirements for all HHAs, Hospices, IRFs, LTCHs and SNFs. In accordance with 42 C.F.R. 412.560(c), 412.634(c), 413.360(c), 484.245(c), these providers are excepted from the reporting of data on measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, and standardized patient assessment data required under these programs for the post-acute care (PAC) quality reporting programs for calendar years (CYs) 2019 and 2020 for the following quarters specific to each program:

    • SNFs–Skilled Nursing Facility QRP
    • October 1, 2019–December 31, 2019 (Q4 2019)
    • January 1, 2020–March 31, 2020 (Q1 2020)
    • April 1, 2020–June 30, 2020 (Q2 2020)

     

    CMS finalized the SNF VBP Program’s Extraordinary Circumstances Exception (ECE) Policy in the FY 2019 SNF PPS final rule (83 FR 39280 through 39281). In accordance with § 413.338(d)(4)(iv) for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program, CMS will exclude qualifying claims from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for the following periods:

    • January 1, 2020–March 31, 2020 (Q1 2020)
    • April 1, 2020–June 30, 2020 (Q2 2020)

     

    PAC QRP Extraordinary Circumstances Exception Request Information For further information about exceptions, view the program-specific web pages:

    SNF Quality Reporting Reconsideration and Exception & Extension or email questions toSNFQRPReconsiderations@cms.hhs.gov

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  • CMS Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

    Friday, March 27, 2020 | CMS
    The Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19, are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.
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  • Focused COVID-19 Surveyor Training Course and Tools (3/20)

    Friday, March 27, 2020 | CMS

    Training Offering Overview

    Training Name: COVID-19 LTC-Surveyor Training (COVID19LTC)

    Activity Code: 0CMSCOVID19_LTC

    Training Description: A brief training related to a focused COVID-19 survey for Nursing Homes surveyors. This is not mandatory, but is recommended for LTC surveyors.

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  • COVID-19: 34 States Have Section 1135 Waivers as of 3/27/20

    Friday, March 27, 2020 | CMS

    CMS approved additional state Medicaid waiver requests under Section 1135 of the Social Security Act (Act), bringing the total number of approved Section 1135 waivers for states to 34. 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.

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  • LTCSP Survey Resources: Surveyor Tools (3/20)

    Friday, March 27, 2020 | CMS
    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).
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  • COVID-19 Not in Your Building? 10 Keys to Limiting Spread and Impact

    Wednesday, March 25, 2020 | Caralyn Davis, Staff Writer

    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (2019-nCoV or COVID-19), is spreading rapidly in nursing homes across the country. On March 23, the Centers for Medicare & Medicaid Services (CMS) announced that 147 nursing homes across 27 states have at least one resident with COVID-19, according to data from the Centers for Disease Control and Prevention (CDC). The number of providers with internal spread is increasing as well. For example, on March 25, news reports indicated that at least 16 residents and four staff members tested positive for COVID-19 in a West Virginia nursing home. Nursing homes that do not yet have COVID-19 in their facility should be actively working to mitigate the risk to residents and staff. Implementing the following strategies can assist in this effort:

     

    Constantly monitor key infection prevention practices

    Infection prevention auditing should highlight two areas:

     

    * Hand hygiene. “From a self-inoculation perspective, the hands are the key,” stresses Michael Bell, MD, deputy director of the Division of Healthcare Quality Promotion at the CDC. “If you were to touch a soiled surface, you could end up with infectious material on your hands. If you then touch your eyes, nose, or mouth without washing your hands first, then you could deliver the infectious materials to yourself. Hand hygiene either in the form of alcohol-based hand gel or soap and water is the key to breaking that transmission. Simply walking into a room that might have something on the surface is not associated with any recognized risk of transmission.”

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  • How to Properly Maintain Employee Medical and Personnel Files

    Wednesday, March 25, 2020 | AADNS

    On a day-to-day basis, the DNS can become so busy with staff and resident care that they completely lose track of employee files. However, the DNS is often either directly responsible for or works with human resources to manage employee files. Compiling and maintaining these files needs to be a priority in order to stay in compliance with survey requirements, avoid legal hurdles, and have a reference of past behavior when it’s time to evaluate or promote staff.

    To keep these important documents up to date, here’s what the DNS should know about employee files:

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  • CMS Finetunes Targeted Infection Control Inspections; Tells SNFs/NFs to Complete Voluntary Self-Assessment With COVID-19 Focused Survey Tool (3/20)

    Monday, March 23, 2020 | CMS

    Memorandum Summary

     

    • On Friday, March 13, 2020, the President declared a national emergency, which triggers the Secretary’s ability to authorize waivers or modifications of certain requirements pursuant to section 1135 of the Social Security Act (the Act). Under section 1135(b)(5) of the Act, CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks.
    • During this three-week time frame, only the following types of surveys will be prioritized and conducted:
    • Complaint/facility-reported incident surveys: State survey agencies (SSAs) will conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level. A streamlined Infection Control review tool will also be utilized during these surveys, regardless of the Immediate Jeopardy allegation.
    • Targeted Infection Control Surveys: Federal CMS and State surveyors will conduct targeted Infection Control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). They will use a streamlined review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.
    • Self-assessments: The Infection Control checklist referenced above will also be shared with all providers and suppliers to allow for voluntary self-assessment of their Infection Control plan and protections
    • During the prioritization period, the following surveys will not be authorized: Standard surveys for long term care facilities (nursing homes), hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices. This includes the life safety code and Emergency Preparedness elements of those standard surveys; and revisits that are not associated with IJ.
    • Furthermore, for Clinical Laboratory Improvement Amendments (CLIA), we intend to prioritize immediate jeopardy situations over recertification surveys, and generally intend to use enforcement discretion, unless immediate jeopardy situations arise.
    • Finally, initial certification surveys will continue to be authorized in accordance within current guidance and prioritization.

     Additional Instructions for Nursing Homes

    We are disseminating the Infection Control survey developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations. We expect facilities to use this new process, in conjunction with the latest guidance from CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19. This document may be requested by surveyors, if an onsite investigation takes place. We also encourage nursing homes to voluntarily share the results of this assessment with their state or local health department Healthcare-Associated Infections (HAI) Program. Contact information for each state’s health departments is identified on the Centers for Disease Control & Prevention’s (CDC’s) website at:https://www.cdc.gov/HAI/state-based/index.html.

    Furthermore, we remind facilities that they are required to have a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility, and when and to whom possible incidents of communicable disease or infections should be reported (42 CFR 483.80(a)(2)(i) and (ii)). CDC recommends that nursing homes notify their health department about residents with severe respiratory infection, or a cluster of respiratory illness (e.g., > or = 3 residents or HCP with new-onset respiratory symptoms within 72 hours). Local and state reporting guidelines or requirements may vary. Monitor the CDC website for information and resources to help prevent the introduction and spread of COVID-19 in nursing homes (CDC Preparing for COVID-19: Long-term Care Facilities, Nursing Homes:https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html ).

    We urge providers to review the tools and implement actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.

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  • CMS Relaxes SNF QRP Data Submission Requirement Changes, SNF VBP Data Changes Due to COVID-19 (3/20)

    Monday, March 23, 2020 | CMS

    CMS is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. These actions are part of CMS’s response to 2019 Novel Coronavirus (COVID-19).

     

    Specifically, CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming measure reporting and data submission deadlines that will impact both the SNF QRP and the SNF VBP.

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