These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues.

The updates include the following SNF FAQ: If a new benefit period was granted pursuant to the section 1812(f) waiver, and the PHE ends in the middle of that new benefit period, would the beneficiary be entitled to the full 100 days of renewed SNF benefits, or would that entitlement end on the day the PHE ends?

The Centers for Medicare & Medicaid Services (CMS) released an additional list of Frequently Asked Questions (FAQs) to Medicare providers regarding the Department of Health & Human Services’ (HHS) Provider Relief Fund and the Small Business Administration’s Paycheck Protection Program payments, also referred to as coronavirus disease 2019 (COVID-19) relief payments.  The FAQs provide guidance to providers on how to report provider relief fund payments, uninsured charges reimbursed through the Uninsured Program administered by Health Resources and Services Administration, and Small Business Administration (SBA) Loan Forgiveness amounts. The FAQs also address that provider relief fund payments should not offset expenses on the Medicare Cost Report.  

The MDS 3.0 QM User’s Manual V14.0 has been posted. The MDS 3.0 QM User’s Manual V14.0 contains detailed specifications for the MDS 3.0 quality measures and includes a Notable Changes section that summarizes the major changes from MDS 3.0 QM User’s Manual V13.0. The MDS 3.0 QM User’s Manual V14.0 can be found below, grouped with other Skilled Nursing Facility (SNF) and Nursing Home user’s manuals in a zip file titled Users-Manuals-Updated-10-19-2020.  The zip file titled User Manuals - Updated 01-21-2020 (ZIP) containing the MDS 3.0 QM User’s Manual V13.0 has been moved to the Quality Measures Archive webpage.

Five files have been posted:

1. MDS 3.0 QM User’s Manual V14.0 (MDS-3_0-QM-USERS-MANUAL-v14_0.pdf) contains detailed specifications for the MDS 3.0 quality measures, as well as the Quality Measure Reporting Module Table that documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. MDS 3.0 QM User’s Manual V14.0 is available under the Downloads section of this webpage.
2. Nursing Home Compare Claims-based Quality Measure Technical Specifications (Nursing Home Compare Claims-based Measures Tech Specs.pdf) contains detailed technical specifications for all nursing home quality measures.
3. Nursing Home Compare Quality Measures Technical Specifications Appendix (APPENDIX - Claims-based measuresTechnical Specifications.pdf) contains tables and appendices related to the Nursing Home Compare Claims-based Quality Measures.
4. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual V3.0 (SNF Measure Calculations and Reporting User's Manual V3.0_FINAL_508C_081419.pdf) contains detailed specifications for all SNF QRP Quality Measures.
5. SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 (SNF-QRP-QM-Users-Manual-V3_0_1-Addendum-Change-Table.pdf) contains appendices for the SNF QRP Measure Calculations and Reporting Manual V3.0, including a risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks.

Memo # QSO-21-02-NH

Posting Date 2020-10-05

Fiscal Year 2021

CMS QSO Memo: Compliance with Residents’ Rights Requirement Related to Nursing Home Residents’ Right to Vote

Summary

• The Centers for Medicare & Medicaid Services (CMS) is affirming the continued right of nursing home residents to exercise their right to vote.

• While the COVID-19 Public Health Emergency has resulted in limitations for visitors to enter the facility to assist residents, nursing homes must still ensure residents are able to exercise their Constitutional right to vote.

• States, localities, and nursing home owners and administrators are encouraged to collaborate to ensure a resident’s right to vote is not impeded.

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. 

The Resident Assessment Validation and Entry System (jRAVEN) was developed by the Centers for Medicare & Medicaid Services (CMS). jRAVEN is a free Java based software application which provides an option for facilities to collect and maintain MDS Assessment data for subsequent submission to the appropriate state and/or national data repository. jRAVEN displays the MDS Item Sets similar to the paper version of the forms. Please consult the jRAVEN Installation and User Guides for additional information.

jRAVEN v1.7.6 is now available for download. Users do not need a previous version of jRAVEN to download, install or use jRAVEN v1.7.6.

jRAVEN v1.7.6 includes the following enhancement:

• The new PDPM Grouper, V1.0008, included in this are the six ICD-10 codes that were added in the 1.0007 version.

JRAVEN v1.7.6 replaces jRAVEN (version 1.7.5), which contained the following updates:  

• The new PDPM Grouper, v1.0007, along with its source code and test cases, which was updated to include the 6 ICD-10 codes that were inadvertently excluded from the previous release (1.0006).  This version, V1.0007, adds six ICD-10 codes that were inadvertently excluded from the NTA calculation: 

• T8484XA, 
• T8389XA, 
• T8321XA, 
• T82399A, 
• T82392A, and 
• T83021A. 

• The OBRA PDPM Grouper Calculation screen (for states requiring PDPM scores on OBRA comprehensive NC & NQ assessments) was updated to allow for entry of an End Date to go up through 12/31/2099
• The updates included with jRAVEN 1.7.4 (MDS Item Set v1.17.2, Data Specification Errata v3.00.5, the MDS VUT v3.4.0)

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.

###

Creating and implementing a policy and procedure to ensure that facility staffing levels are sufficient to meet the needs of residents during an emergency, such as the COVID-19 pandemic, is an essential component of emergency preparedness—and part of the COVID-19 Focused Survey for Nursing Homes, according to the Quality, Safety, and Oversight (QSO) memo QSO-20-38-NH from the Centers for Medicare & Medicaid Services (CMS). However, the following staff management tips also can help providers prepare for another outbreak in their community:

Staying on top of COVID-19 is exhausting, acknowledges Katrina Anderson, LVN, director of skilled nursing and part-time infection preventionist for the John C. Fremont Healthcare District in Mariposa, CA, as well as a member of the Disaster Preparedness Program Advisory Council at the California Association of Health Facilities (CAHF). “Everyone is stressed out and tired, but in order to survive this, you have to stay on top of it and be diligent about obtaining the information and getting that information out to your staff as education and training.”

While a number of frameworks, guidance documents, and resources are available to help healthcare systems and stakeholders prepare for and respond to the emergence of crisis standards of care, relatively few address the unique circumstances and information needs of post-acute and long-term care (PALTC) facilities. In response to the COVID-19 pandemic, the Federal Healthcare Resilience Working Group has developed COVID-19: Considerations, Strategies, and Resources for Crisis Standards of Care in PALTC Facilities to inform changes to operations and care processes. It is intended to complement, not supplant, existing state and/or local guidance and plans for implementing crisis standards of care. Similarly, sample tools and resources are provided for illustrative purposes only and should be modified to locally adopted protocols as necessary.

In this article, AAPACN will cover the need and purpose for the Healthcare Resilience Working Group (HRWG) project, the standards of care and areas of impact, how a facility should use this document to guide decisions, and how to access this important new resource.

Skilled Nursing Facilities (SNFs) must issue a notice to Original Medicare (fee for service - FFS) beneficiaries in order to transfer potential financial liability before the SNF provides:

• an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or
• custodial care.

For Part A items and services: SNFs use the SNF ABN as the liability notice.

For Part B items and services: SNFs use the Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. The ABN and information on this notice can be found at /Medicare/Medicare-General-Information/BNI/ABN.

Note: The SNFABN process is separate from the expedited determination process. So the SNFABN does not replace the Notice of Medicare Noncoverage (NOMNC). Each notice is used to meet the requirements of the separate processes.