• SNF Healthcare-Associated Infections (HAI) Measure: Public Comments Due by Oct. 14

    Monday, September 14, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is seeking input from the public as part of the measure development process. CMS has posted Draft Measure Specifications: SNF Healthcare-Associated Infections Requiring Hospitalizations for the SNF QRP (SNF HAI measure).  This document contains conceptual and technical measure information and provides a link to the Final Technical Expert Panel Summary Report: Development of a Healthcare-Associated Infections Quality Measure for the SNF QRP for the public’s review.  Please review both of these documents and give us your feedback via the email:  SNFQualityQuestions@cms.hhs.gov.  

    CMS would also like to announce the SNF HAI measure will be a part of the Measures Under Consideration list later this year and it is our intention to present this measure for pre-rulemaking review at the Measure Applications Partnership Post-Acute Care/Long-Term Care Workgroup meeting in December.  CMS will be providing Confidential Dry Run Reports to alert each SNF of their SNF HAI performance score based on these draft measure specifications later this summer.

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  • SNF QRP Measure Calculations and Reporting User's Manual Plus Version 3.0.1 Addendum (9/20)

    Thursday, September 10, 2020 | CMS

     

    The SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available.

    This ZIP file includes:

    1. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum provides measure-related changes specified in a change table format in lieu of a complete update to the overall manual. Use this addendum to update the v3.0 manual.
    2. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 Risk Adjustment Appendix File contains current and historical intercept values, coefficient values, and the risk-adjustment schedule for each risk-adjusted quality measure reported under the SNF QRP. 
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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (9/20)

    Tuesday, September 8, 2020 | CMS

    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 9/08/20) 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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  • $2 Billion Provider Relief Fund Nursing Home Incentive Payment Plans (9/20)

    Thursday, September 3, 2020 | HHS

     Under the leadership of President Trump, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the latest update in the previously announced $5 billion in planned support to nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Other resources are also being dedicated to support training, mentorship and safety improvements in nursing homes.

    "The Trump Administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes," said HHS Secretary Alex Azar. "By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives."

    Nursing homes have been particularly hard hit by this pandemic. By tying continued relief payments to patient outcomes, the Trump Administration is demonstrating its commitment to preserving the lives and safety of America's seniors, who are especially vulnerable to COVID-19. Nursing homes will not have to apply to receive a share of this $2 billion incentive payment allocation; HHS will be measuring nursing home performance through required nursing home data submissions and distributing payments based on these data.

    Qualifications

    In order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from the Centers for Medicare & Medicaid Services (CMS). HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one of three data sources that will be used to establish eligibility and collect necessary provider data to inform payment: Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS).

    Performance and Payment Cycle

    The incentive payment program is scheduled to be divided into four performance periods (September, October, November, December), lasting a month each with $500 million available to nursing homes in each period. All nursing homes or skilled nursing facilities meeting the previously noted qualifications will be eligible for each of the four performance periods. Nursing homes will be assessed based on a full month's worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month's performance period.

    Methodology

    Using data from the Centers for Disease Control and Prevention (CDC), HHS will measure nursing homes against a baseline level of infection in the community where a given facility is located. CDC's Community Profile Reports (CPRs) include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity. Against this baseline, facilities will have their performance measured on two outcomes:

    • Ability to keep new COVID infection rates low among residents.
    • Ability to keep COVID mortality low among residents.

    To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) LTCF COVID-19 module. CMS issued guidance in early May requiring that certified nursing facilities submit data to the NHSN COVID-19 Module.  Data from this module will be used to assess nursing home performance and determine incentive payments.

    HHS will continue to provide more updates as it works to assist providers in slowing the spread of infection while simultaneously offering financial support to these frontline heroes combating the pandemic. Funding for this nursing home incentive effort was made possible from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act.  Incentive payments will be subject to the same Terms and Conditions applicable to the initial infection control payments announced last week (available here - PDF).

    For updates and to learn more about the Provider Relief Program, visit: hhs.gov/providerrelief.

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  • Sept 22 CMS National Partnership to Improve Dementia Care and QAPI Call to Address COVID-19: Register Now

    Monday, August 31, 2020 | CMS
    Date 2020-09-22

    Event Dementia Care Call

    Topic Dementia Care in Nursing Homes

    When: Tuesday, September 22, 2020, from 1:30 to 3 pm ET

    Registration:  Register for Medicare Learning Network events.

    Event Materials:

    ·         Presentation: Available prior to the event

    ·         Audio recording and transcript: Available approximately 2 weeks after the event

    Description:
    National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement

    During this call, learn about the unique challenges facing nursing home residents living with dementia during the COVID-19 pandemic and best practices to support them. A question and answer session follows the presentations.
    Speakers:

    ·         Cathleen Lawrence and Dara Graham, CMS

    ·         Kara Jacobs Slifka, MD, MPH, Centers for Disease Control and Prevention

    ·         Douglas Pace, Alzheimer’s Association

    Target Audience: Consumer and advocacy groups; nursing home providers; surveyor community; prescribers; professional associations; and other interested stakeholders.

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  • AHRQ National Nursing Home COVID Action Network Mentorship Program Begins With Webinar Series (8/20)

    Friday, August 28, 2020 | AHRQ

    Training and Mentoring for Nursing Homes

    To further support nursing homes, the Agency for Healthcare Research and Quality (AHRQ) will be partnering with America’s nursing homes to create the National Nursing Home COVID Action Network. Through the Network, AHRQ will offer training, and mentorship to the approximately 15,400 nursing homes across the country to supplement efforts aimed at protecting residents and staff. 

    The goals of the training and mentorship are to help nursing home professionals prevent COVID-19 from entering nursing homes via staff, visitors, and patients and prevent greater spread among patients, staff, and visitors if the virus is already present. This program will also guide nursing homes through best-practice care and treatment for patients who test positive for COVID-19; and protect staff from infection through evidence-based safety measures that will build their confidence in their ability to work and feel safe in the nursing homes.

    “AHRQ is proud to support HHS in this critical initiative,” said AHRQ Director Gopal Khanna. “AHRQ has a proven track-record in helping move evidence into practice to address critical needs like responding to COVID-19 and to achieve 21st century care for all Americans.”

    This program will provide interactive small-group, problem-based training and customized mentorship through an existing network of academic medical centers, health centers, and community organizations.  The training and mentorship program is designed to evolve as the needs of nursing homes continue to emerge though the fall.  AHRQ has already established a pilot test of small-group training and mentoring through a partnership with the University of New Mexico’s ECHO Institute. 

    Participation in training and mentoring will be voluntary and nursing homes that participate will receive compensation to cover the costs of staff training time.  Nursing homes will be able to begin signing up to participate in the Network in the coming weeks and training is expected to begin in September.

    In related news, registration is now open for a free webinar series featuring expert-led discussions on infection prevention strategies, telehealth, and COVID-19 testing in nursing homes. The series “Nursing Home Best Practices During the COVID-19 Pandemic” is part of the launch of AHRQ’s National Nursing Home COVID-19 Action Network.

    National Nursing Home COVID-19 Safety Conversations TeleECHO Program

    In partnership with the Agency for Healthcare Research and Quality (AHRQ), Project ECHO is mobilizing our national network of ECHO partners to rapidly deploy COVID-19 ECHO programs to train mentor, and support nursing home staff on infection prevention and control. With support from the Agency for Healthcare Research and Quality (AHRQ), the ECHO Institute will provide training, mentorship, and support to nursing home staff on infection prevention and control to an estimated 15,000 nursing homes across the country.


    This initiative will kick off with our Nursing Home Best Practices During the COVID-19 Pandemic mini-series, with three interactive TeleECHO sessions:

    Aug 25, 2020:
    Optimizing Clinical Care in the Time of COVID in Skilled Nursing Home Facilities
    Terry Fulmer, PhD, RN
    Kathleen Unroe, MD, MHA

    NOTE: If you missed this training, it is available here.

    Aug, 26, 2020:
    The Latest News on Testing, Cohorting, and Critical Infection Prevention Strategies
    Nimale Stone, MD
    Additional speaker, TBA

    NOTE: If you missed this training, it is available here.


    Sept 2, 2020:
    Telehealth in the Time of COVID
    Cheryl Phillips, MD, AGSF

    NOTE: If you missed this training, it is available here.

    Recent Study on Infection at Skilled Nursing Facilities
    Lewis Lipsitz, MD

     


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  • FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    Monday, August 10, 2020 | CMS

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

    16. Are nursing homes required to report results of any COVID-19 tests?

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (7/20)

    Sunday, August 2, 2020 | CMS

    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.


    CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. This manual provides in-depth descriptions of the ratings and the methods used to calculate them. 

     

    July 2020 Revisions: Temporary Changes due to COVID-19

     

    Staffing Rating Changes:

    Under the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, CMS waived the requirements at 42 CFR 483.70(q), which required nursing home providers to submit staffing data through the Payroll-Based Journal (PBJ) system. Because of the waiver, many facilities did not submit staffing data by the May 15, 2020 deadline, and thus, CMS will not be able to update the PBJ staffing measures and staffing domain star ratings at the next regularly scheduled update in July 2020. Therefore, staffing measures and ratings will be held constant and based on data submitted for October – December 2019.

    In addition, CMS recognizes that the waiver of the requirement prevented some facilities from improving their rating from their previous quarter’s submission. Specifically, facilities whose staffing rating was automatically downgraded to one-star due to missing the deadline for the previous submission, or for reporting four or more days in the quarter with no registered nurse, will not have the opportunity to correct and improve their staffing rating since the ratings will be held constant. Therefore, CMS will remove the one-star staffing rating downgrade, and instead, these facilities will have their ratings temporarily suppressed. Their staffing ratings will show “Not Available” for July, August, and September 2020.

     

    Quality Measure Rating Changes:

    Similar to the staffing data waiver, CMS waived requirements at 42 CFR 483.20 related to the timelines for completing and submitting resident assessment (minimum data set (MDS)) information. This information provides the underlying data used to calculate quality measures used on the Nursing Home Compare website and in the Five-Star Quality Ratings System. CMS believes that data from resident assessments conducted prior to January 1, 2020, can still be used to calculate quality measures (QMs). However, CMS is concerned that data from resident assessments conducted after January 1, 2020 were impacted by the waiver and the public health emergency. Therefore, beginning July 29, 2020, quality measures based on the data collection period ending December 31, 2019 will be held constant. Quality measures that were based on a data collection period prior to December 31, 2019 (e.g., ending September 30, 2019); however, will continue to be updated until the underlying data reaches December 31, 2019. We note that CMS is not holding the quality measure ratings constant, as a facility’s quality measure rating can still be updated by a quality measure with underlying data that is earlier than December 31, 2019.

    The MDS-based QMs will continue to cover 2019Q1 – 2019Q4. Four of the claims-based measures (long-stay and short-stay hospitalizations and ED visits) will be updated and will cover the time period January 1 – December 31, 2019. The short-stay QM, rate of successful return to home and community, will continue to cover October 1, 2016 – September 30, 2018.

     

    Health Inspection Rating Changes:

    Since the Nursing Home Compare (NHC) refresh in April 2020 and until further notice, the health inspection domain of the rating system is being held constant to include only data from surveys that occurred on or before March 3, 2020. Results of 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.

    CMS will continue to monitor inspections, including the restarting of certain inspections (i.e., surveys) per CMS memorandum QSO-20-31-ALL. CMS will restart the inspection ratings as soon as possible and will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website.

     

    January 2020 addition: Technical specifications for claims-based measures

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  • OIG to Assess Trends Re: the Use of Psychotropic Drugs in Nursing Homes (7/20)

    Wednesday, July 15, 2020 | OIG

    Assessing Trends Related to the Use of Psychotropic Drugs

    Previous OIG work found that elderly nursing home residents who were prescribed antipsychotic drugs—a type of psychotropic drug—were at risk for harm. CMS concurred with some OIG recommendations and developed new initiatives. However, policymakers continue to raise concerns about whether CMS has made sufficient progress in reducing the use of antipsychotic drugs to care for the elderly. We will report the changes over time for the following: (1) the use of psychotropic drugs for elderly nursing home residents; (2) citations and civil monetary penalties assessed to nursing homes regarding psychotropic drugs; and (3) the presence of diagnoses that exclude nursing home residents from CMS's measure of the use of antipsychotic drugs.

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  • CMS Will Increase Use of QIOs to Fight COVID-19 Hot Spots (7/20)

    Monday, July 13, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

    Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

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