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.

  • PBJ Data Specs Versions 2.00.0, 2.00.3 and 4.00.0 Will Be Accepted Until Further Notice (5/20)

    By CMS - May 03, 2020

    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.


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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (4/20)

    By CMS - April 30, 2020

    CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated twice in October 2019.

    April 2020 Revisions: Temporary Changes due to COVID-I9 

    On March 23, CMS announced a new, targeted inspection plan designed to help keep nursing home residents safe in the face of the COVID-19 pandemic. The plan called for focused inspections on urgent patient safety threats (called “immediate jeopardy”) and infection control. These targeted inspections allow CMS to focus inspections on the most urgent situations, so the agency can get the information it needs to ensure safety, while not getting in the way of patient care. Due to this action, there is a great shift in the number of nursing homes inspected, and how the inspections are conducted. Without action, this would disrupt the inspection domain of the Five Star Quality Rating System because many nursing homes that would normally be inspected, will not, thereby over-weighting and impacting the ratings of those facilities that are inspected. This could then potentially mislead consumers. Therefore, we will temporarily maintain and hold constant the health inspection domain of the rating system. Specifically, health inspections conducted on or after March 4, 2020, will be posted publicly, but not be used to calculate a nursing home’s health inspection star ratings. This action will start with the scheduled update to the Nursing Home Compare website on April 29, 2020. The surveys will be posted through a link on the front page of the Nursing Home Compare website in the upcoming months (as the survey data is finalized and uploaded).


    January 2020 addition: Technical specifications for claims-based measures

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  • Coronavirus Commission for Safety and Quality in Nursing Homes to Focus on Identifying Best Practices, Strengthening Regulations and Enforcement (4/20)

    By CMS - April 30, 2020

    On April 30, the Centers for Medicare & Medicaid Services (CMS) announced that an independent Commission will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will be convened and lead by a CMS contractor and will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. 

    The convening of the Commission is the next step in improving quality and safety within nursing homes. The Commission will help inform efforts to safeguard the health and quality of life of vulnerable Americans as CMS continues to battle COVID-19. The Commission will include residents, families, resident/patient advocates, leading industry experts, clinicians, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other experts selected through a nomination process.

    It is expected to convene in May and develop recommendations on three key tasks: 

    • Putting nursing home residents first by ensuring they are protected from COVID-19 and improving the responsiveness of care delivery to meet the needs of all residents to maximize quality of life for residents.

    • Strengthen regulations to enable rapid and effective identification and mitigation of COVID-19 transmission in nursing homes; and 

    • Enhance federal and state enforcement strategies to improve compliance with infection control policies in response to COVID-19. 

    Additionally, the Commission will focus on identifying potentially innovative approaches for using existing and newly available nursing home (and other) data to enable better coordination between federal surveyors and state and local entities to address the current spread of COVID-19 within nursing homes as well as to analyze the impact of efforts to stop or contain the virus within these facilities. 

    Participants will help to identify best practices to address COVID-19, which CMS or states may incorporate into a larger regulatory framework for effective oversight to better inform federal and state officials as well as nursing homes across the country, to better achieve compliance through improved enforcement solutions, and to improve the quality of life and overall health status of nursing home residents during the pandemic. 

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  • COVID-19 Infection Prevention and Wandering: Can the Two Co-Exist?

    By Caralyn Davis, Staff Writer - April 28, 2020

    In the March 13 revised Quality, Safety, and Oversight (QSO) memo QSO-20-14-NH, the Centers for Medicare & Medicaid Services (CMS) advised nursing homes to restrict all visitors except for compassionate-care situations and to “cancel communal dining and all group activities, such as internal and external group activities.” Adjusting to these changes has been difficult for every nursing home resident, but social distancing is especially hard for residents with dementia who wander and are eased by group activities.


    “That’s not who these people are,” acknowledges Teepa Snow, MS, OTR/L, FAOTA, founder and CEO of Positive Approach to Care, a global dementia care services and products company based in Efland, NC. “Nurses are being asked to do the impossible with the inadequate.”


    While physicians and physician extenders may be willing to prescribe an antipsychotic medication as an emergency measure in an acute or emergency situation as allowed under F758 (Free From Unnecessary Psychotropic Meds/PRN Use) in Appendix PP of the State Operations Manual, giving residents with dementia antipsychotics to make them immobile not only increases their risk of adverse events, such as cerebrovascular accidents (CVA) and even death, it also increases their risk of respiratory symptoms, including shortness of breath—one of the primary symptoms of COVID-19, points out Snow. “Providers may also consider taking away wheelchairs and other mobility aids. However, doing that puts residents with dementia at greater risk for falls and fall-related injuries, potentially resulting in a trip to the emergency department where they may be exposed to SARS-CoV-2, the virus that causes COVID-19.”


    Instead, the goal should be to come up with strategies that make sense, balancing safety and resident needs, says Snow. “Keeping these residents in a small room is highly improbable, so you want to be ready to move forward with some element of safety. You will put residents at risk if you aren’t prepared for the reality that they will come out of their rooms.”

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  • CMS Expands Telehealth Services during the COVID-19 Pandemic: What the DNS Needs to Know

    By AADNS - April 28, 2020

    Telehealth has existed for quite a while, and as its use has expanded in recent years, some healthcare groups have even provided the services to their entire network of facilities. These networks often paid for telehealth access out of their own pockets, as accessibility and financial assistance for Medicare beneficiaries has previously been very limited, with coverage only available to facilities in designated rural areas and only for patients who had a previously-established relationship with their doctor. However, on March 6, the $8.3 billion dollar Coronavirus Preparedness and Response Supplemental Appropriations Act was passed, which allowed the Department of Health and Human Services (HHS) “to temporarily waive certain Medicare restrictions and requirements regarding telehealth services during the coronavirus public health emergency.”

    Then, on March 13, President Trump declared the COVID-19 outbreak a national emergency. And thus, we received the 1135 waiver, which expanded telehealth services:

    Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

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  • AHRQ COVID-19 Articles: Peer Support/Crisis Communications and Helping LTC Settings Deal With the Pandemic (4/20)

    By AHRQ - April 28, 2020

    COVID-19: Peer support and crisis communication strategies to promote institutional resilience.

    Wu AW, Connors C, Everly Jr GS. Ann Intern Med. 2020

    To address the negative psychological impacts faced by healthcare workers during the COVID-19 crisis, the authors of this commentary recommend three strategic principles for healthcare institutions responding to the pandemic:

    ·  Encourage leadership to focus on resilience

    ·  Ensure that crisis communication provides both information and empowerment

    ·  Create a continuum of staff support within the organization to address a surge in mental health concerns among healthcare workers.


    Unprecedented solutions for extraordinary times: helping long-term care settings deal with the COVID-19 pandemic.

    Gaur S, Dumyati G, Nace DA, et al.  Infect Control Hosp Epidemiol. 2020

    This commentary discusses the provision of safe care in long-term care settings during the COVID-19 pandemic. The authors propose the following measures to ensure the safety of long-term care patients:

    ·  facilities should only accept patients with COVID-19 infections if they can provide effective airborne isolation;

    ·  patients recovering from COVID-19 need to have 2 negative tests on 2 consecutive days, as well as remain fever-free without mediation for at least 48 hours and not require ventilatory support that generates aerosols;

    ·  facilities should screen potential admissions for typical and atypical signs and symptoms of COVID-19, and;

    ·  facilities that are currently COVID-19 naïve should not accept any new admissions for whom there may be a concern for COVID-19.

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  • Infection Prevention and Control: Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand (4/20)

    By CDC - April 28, 2020

    Emerging Infectious Diseases

    Volume 26, Number 5—May 2020

    Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand


    A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.

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  • CMS Freezes Five-Star Inspection Domain, Releases New FAQs, and Posts New Staffing Data for Every Facility (4/20)

    By CMS - April 28, 2020

    Ref: QSO-20-28-NH

    DATE: April 24, 2020

    TO: State Survey Agency Directors

    FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the threat of the COVID-19.

    • Nursing Home Compare website & Nursing Home Five Star Quality Rating System: We are announcing that the inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.

    • Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website.

    • Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.

    • Frequently Asked Questions (FAQ): We are releasing a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

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  • COVID-19 Medicare FAQs and Fact Sheet Updated (4/23/20)

    By CMS - April 24, 2020
    These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.
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  • COVID-19 Insights From CMS Nursing Home Calls

    By Caralyn Davis, Staff Writer - April 20, 2020
    The Centers for Medicare & Medicaid Services (CMS) holds weekly COVID-19: Nursing Home calls, bringing together insights from CMS officials, experts at the Centers for Disease Control and Prevention (CDC), and nursing home staff who have been navigating COVID-19 in their facilities. Here are highlights from the April 8 and April 15 calls.
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  • COVID-19 Notification/Reporting Requirements Addressed in CMS QSO Memo (4/20)

    By CMS - April 19, 2020

    DATE: April 19, 2020

    TO: State Survey Agency Directors

    FROM: Director Quality, Safety & Oversight Group

    SUBJECT: Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID19 Persons under Investigation) Among Residents and Staff in Nursing Homes

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s health care facilities are prepared to respond to the 2019 Novel Coronavirus (COVID-19) Public Health Emergency (PHE).

    • Communicable Disease Reporting Requirements: To ensure appropriate tracking, response, and mitigation of COVID-19 in nursing homes, CMS is reinforcing an existing requirement that nursing homes must report communicable diseases, healthcare-associated infections, and potential outbreaks to State and Local health departments. In rulemaking that will follow, CMS is requiring facilities to report this data to the Centers for Disease Control and Prevention (CDC) in a standardized format and frequency defined by CMS and CDC. Failure to report cases of residents or staff who have confirmed COVID -19 and Persons under Investigation (PUI) could result in an enforcement action. This memorandum summarizes new requirements which will be put in place very soon.

    • Transparency: CMS will also be previewing a new requirement for facilities to notify residents’ and their representatives to keep them up to date on the conditions inside the facility, such as when new cases of COVID-19 occur.

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  • Opioid Treatments for Chronic Pain (4/20)

    By AHRQ - April 17, 2020

    AHRQ systematic review

    Purpose of Review

    To assess the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies. 

    Key Messages

    • Opioids are associated with small improvements versus placebo in pain and function, and increased risk of harms at short-term (1 to <6 months) followup; evidence on long-term effectiveness is very limited, and there is evidence of increased risk of serious harms that appear to be dose dependent.
    • At short-term followup, evidence showed no differences between opioids versus nonopioid medications in improvement in pain, function, mental health status, sleep, or depression.
    • Evidence on the effectiveness and harms of alternative opioid dosing strategies and the effects of risk mitigation strategies is lacking, although provision of naloxone to patients might reduce the likelihood of opioid-related emergency department visits, a taper support intervention might improve functional outcomes compared to no taper support, and co-prescription of benzodiazepines and gabapentinoids might increase risk of overdose.
    • No instrument has been shown to be associated with high accuracy for predicting opioid overdose, addiction, abuse, or misuse.
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  • Nonopioid Pharmacologic Treatments and Noninvasive Nonpharmacological Treatments for Chronic Pain (4/20)

    By AHRQ - April 17, 2020

    1. Nonopioid Pharmacologic Treatments for Chronic Pain

    AHRQ systematic review  

    Purpose of Review

    Evaluate the benefits and harms of nonopioid drugs in randomized controlled trials of patients with specific types of chronic pain, considering the effects on pain, function, quality of life, and adverse events.

    Key Messages

    • In the short term, improvement in pain and function was small with specific anticonvulsants, moderate with specific antidepressants in diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia, and small with nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis and inflammatory arthritis.
    • In the intermediate term, evidence was limited, with evidence of benefit for memantine in fibromyalgia and for serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants in low back pain and fibromyalgia.
    • In the long term, evidence was too limited to draw conclusions. In general, evidence on quality of life was limited and no treatment achieved a large improvement in pain or function.
    • Small to moderate, dose-dependent increases in withdrawal due to adverse events were found with SNRIs duloxetine and milnacipran, anticonvulsants pregabalin and gabapentin, and NSAIDs. Large increases were seen with oxcarbazepine. NSAIDs have increased risk of serious gastrointestinal, liver dysfunction, and cardiovascular adverse events.

    2. Noninvasive Nonpharmacological Treatment for Chronic Pain

    A Systematic Review Update

    Purpose of Review

    To assess noninvasive nonpharmacological treatments for common chronic pain conditions.

    Key Messages

    • Interventions that improved function and/or pain for ≥1 month:
    • Some interventions did not improve function or pain.
    • Serious harms were not observed with the interventions.




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  • CMS QSO Memo: 2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios (4/20)

    By CMS - April 13, 2020
    Memo # QSO-20-25-NH

    Posting Date 2020-04-13

    Fiscal Year 2020



    • CMS is providing supplemental information for transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status (i.e., positive, negative, unknown/under observation).

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  • FY 2021 SNF PPS Proposed Rule: CMS Holds Steady on the SNF QRP, SNF VBP

    By Caralyn Davis, Staff Writer - April 13, 2020

    On April 10, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the Fiscal Year (FY) 2021 Proposed Rule for the Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing (CMS-1737-P) as required by law. In a major break from recent years, CMS offers no proposals for updating the Skilled Nursing Facility Quality Reporting Program (SNF QRP) and only what the agency describes as “minor administrative proposals” related to the SNF Value-Based Purchasing (VBP) program.

    However, CMS does propose several other revisions in addition to the required Medicare Part A payment rate update. These include:

    • Multiple changes to the ICD-10-CM code mappings used for case-mix classification in the Patient-Driven Payment Model (PDPM);

    • Technical changes to the regulatory language in the Code of Federal Regulations, including a proposed change that will clarify the “practical matter” criterion of a Part A skilled level of care by removing an outdated example that referred to the repealed Part B therapy cap provision; and

    • Changes to how SNFs are identified as rural or urban for wage index classification, as well as a proposal to cap wage index decreases from FY 2020 to FY 2021 as a transition measure.

    CMS also is keeping its options open for future adjustments to the PDPM based on its ongoing monitoring efforts. Here are highlights of the FY 2021 proposed rule.

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