• Residents With Acute Respiratory Symptoms? CDC Testing and Management Considerations When SARS-COV-2 and Influenza Co-Circulate (11/20)

    Monday, November 23, 2020 | CDC
    This document contains practices that should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities.
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  • CMS Podcast: Nursing Home Series for Front Line Clinicians and Staff (11/20)

    Thursday, November 19, 2020 | CMS

    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).

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  • CMS Urgent Call to Action: Staff, Managers Should Complete QSEP Nursing Home COVID-19 Training (11/20)

    Tuesday, November 17, 2020 | CMS

    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.

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  • CMS Alert Addressing Holiday Celebrations (11/20)

    Tuesday, November 17, 2020 | CMS

    In advance of the approaching holiday season, the Centers for Medicare & Medicaid Services (CMS) is urging nursing home staff, residents and visitors to follow established guidelines for visitation and adherence to the core principles of infection prevention. These guidelines include remaining six feet apart from individuals, wearing a face covering, and limiting the number of visitors in the nursing home at any one time. Adherence to these principles is critical in preventing the spread of the coronavirus disease 2019 (COVID-19) in America’s nursing homes. While the holiday season is typically a time for family and friends to gather, CMS implores staff, residents and visitors to exercise extreme caution this year. 

    “The approaching holiday season remains fraught with danger for the vulnerable residents of America’s nursing homes,” said Administrator Seema Verma. “They have already endured loss and loneliness to a degree that would have been unthinkable before this year began, but they and their families – along with facilities themselves – must not let their guard down over the holiday season, especially with a safe and effective vaccine so close to reality.”

    The agency understands the emotional and mental health impact that separation from loved ones during the pandemic has caused. In September, CMS provided guidance for how residents can safely receive visitors in the nursing home. With the holiday season approaching, residents will want to spend more time with their loved ones, and CMS is recommending that facilities find innovative ways of recognizing the holidays without having parties or gatherings that could increase the risk of COVID-19 transmission (e.g., virtual parties or visits).

    CMS also acknowledges that some residents may want to leave the nursing home temporarily to visit with family and friends for the holidays, or for other outings.  A resident has the right to leave the nursing home, and CMS urges that extra precautions be taken to help reduce the spread of COVID-19, which poses an elevated danger to the health of nursing home residents.  Nursing homes should double down on infection control and adhere to testing requirements.

    Extra precautions taken now will help to ensure that our loved ones stay healthy and safe for the short amount of time remaining until a safe and effective vaccine becomes available.  Leaving the nursing home could increase a resident’s risk for exposure to COVID-19. The risk may be further increased by factors such as a resident’s health status, the level of COVID-19 in the community (e.g., cases or positivity rate), or attendance at large gatherings. Residents are encouraged to discuss these and other risks with their family and nursing home staff.  Nursing homes should educate residents and families of the risks of leaving the facility, the steps they should take to reduce the risk of contracting COVID-19, and encourage residents can stay connected with loved ones through alternative means of communication, such as phone and video communication. 

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  • Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes (10/20)

    Tuesday, November 17, 2020 | CDC
    This document provides a summary of considerations for use of SARS-CoV-2 (the virus that causes COVID-19) antigen testing in nursing homes and is intended for nursing home providers and state and local public health departments.

    Also see: Guidance for SARS-CoV-2 Point-of-Care Testing

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  • OSHA COVID-19 Citations: Lessons Learned (11/20)

    Friday, November 13, 2020 | OSHA

    The Occupational Safety and Health Administration cites lessons learned from its COVID-19 inspections and citations, as well as noting nursing homes and other companies that have been fined since the COVID-19 pandemic began.

     Lessons Learned: Frequently Cited Standards Related to COVID-19 Inspections.(November 6, 2020).

    Common COVID-19 Citations: Helping Employers Better Protect Workers and Comply with OSHA Regulations. (November 6, 2020).

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  • CDC Study Shows How Community Transmission Can Impact Nursing Homes Miles Away (11/20)

    Tuesday, November 10, 2020 | CDC

    Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine — August 7–September 14, 2020

    Weekly / November 13, 2020 / 69(45);1686–1690

    Parag Mahale, MBBS, PhD1,2; Craig Rothfuss, MPA, MPH1,3; Sarah Bly1,3; Megan Kelley1,3; Siiri Bennett, MD1; Sara L. Huston, PhD1,3; Sara Robinson, MPH1 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Large gatherings pose a high risk for SARS-CoV-2 transmission.

    What is added by this report?

    A wedding reception with 55 persons in a rural Maine town led to COVID-19 outbreaks in the local community, as well as at a long-term care facility and a correctional facility in other counties. Overall, 177 COVID-19 cases were linked to the event, including seven hospitalizations and seven deaths (four in hospitalized persons). Investigation revealed noncompliance with CDC’s recommended mitigation measures.

    What are the implications for public health practice?

    To mitigate transmission, persons should avoid large gatherings, practice physical distancing, wear masks, stay home when ill, and self-quarantine after exposure to a person with confirmed SARS-CoV-2 infection.

     

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  • OSHA Respiratory Protection Guidance for Nursing Homes (11/20)

    Tuesday, November 3, 2020 | Occupational Safety and Health Administration

    Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and Other Long-Term Care Facilities During the COVID-19 Pandemic

    This guidance is designed specifically for nursing homes, assisted living, and other long-term care facilities (LTCFs) (e.g., skilled nursing facilities, inpatient hospice, convalescent homes, and group homes with nursing care). While this guidance focuses on protecting workers from occupational exposure to SARS-CoV-2 (the virus that causes COVID-19 disease) by the use of respirators, primary reliance on engineering and administrative controls for controlling exposure is consistent with good industrial hygiene practice and with OSHA’s traditional adherence to a “hierarchy of controls.”

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  • SARS-CoV-2 Exposure and Infection Among Health Care Personnel: LTC Staff More Likely to Work With Symptoms (10/20)

    Wednesday, October 28, 2020 | CDC

    SARS-CoV-2 Exposure and Infection Among Health Care Personnel — Minnesota, March 6–July 11, 2020

    Weekly / October 30, 2020 / 69(43);1605–1610

    Summary

    What is already known about this topic?

    Health care personnel (HCP) are at increased risk for COVID-19 from workplace exposures.

    What is added by this report?

    Among 21,406 Minnesota SARS-CoV-2 HCP exposures, 5,374 (25%) were higher-risk (within 6 feet, ≥15 minutes, or during an aerosol-generating procedure); exposures involved patient care (66%) and nonpatient contacts (34%). Compared with HCP working in acute care settings, those working in congregate living and long-term care more often worked while symptomatic and received positive SARS-CoV-2 test results.

    What are the implications for public health practice?

    HCP should recognize potential exposures unrelated to patient care and use prevention measures, including masks. HCP in congregate living and long-term care settings experience considerable risk and pose a transmission risk to residents. Improved access to personal protective equipment, flexible medical leave, and testing is needed.

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  • SNFs May Be Able to Furnish COVID-19 Vaccine as Mass Immunizer Roster Biller (10/20)

    Wednesday, October 28, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure all Americans, including the nation’s seniors, have access to the coronavirus disease 2019 (COVID-19) vaccine at no cost when it becomes available. Today, the agency released a comprehensive plan with proactive measures to remove regulatory barriers and ensure consistent coverage and payment for the administration of an eventual vaccine for millions of Americans. CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine once it is available.  These resources are designed to increase the number of providers that can administer the vaccine, ensure adequate reimbursement for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. In addition, CMS is taking action to increase reimbursement for any new COVID-19 treatments that are approved or authorized by the FDA.

    “We have developed a comprehensive plan to support the swift and successful distribution of a safe and effective vaccine for COVID-19,” said CMS Administrator Seema Verma. “As Operation Warp Speed nears its goal of delivering the vaccine in record time, CMS is acting now to remove bureaucratic barriers while ensuring that states, providers and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans.”

    To ensure broad access to a vaccine for America’s seniors, CMS released an Interim Final Rule with Comment Period (IFC) today that establishes that any vaccine that receives Food and Drug Administration (FDA) authorization, either through an Emergency Use Authorization (EUA) or licensed under a Biologics License Application (BLA), will be covered under Medicare as a preventive vaccine at no cost to beneficiaries.  The IFC also implements provisions of the CARES Act that ensure swift coverage of a COVID-19 vaccine by most private health insurance plans without cost sharing from both in and out-of-network providers during the course of the public health emergency (PHE).

    In anticipation of the availability of new COVID-19 treatments, the IFC also establishes additional Medicare hospital payment to support Medicare patients’ access to these potentially life-saving COVID-19 therapies.  In Medicare, hospitals are generally reimbursed a fixed payment amount for the services they provide during an inpatient stay, even if their costs exceed that amount. Under current rules, hospitals may qualify for additional “outlier payments,” but only when their costs for a particular patient exceed a certain threshold. Under this IFC, hospitals would qualify for additional payments when they treat patients with innovative new products approved or authorized to treat COVID-19 to mitigate any losses they may experience from making these therapies available, even if they do not reach the current outlier threshold. The IFC also makes changes to reimbursement for outpatient hospital services to ensure payment for certain innovative treatments for COVID-19 that occur outside of bundled arrangements and are paid separately. In addition, CMS released information to prepare hospitals to bill for the outpatient administration of a monoclonal antibody product in the event one is approved under an emergency use authorization (EUA).

    This rule also allows states to employ a broad range of strategies - based on local needs - to appropriately manage their Medicaid program costs. The guidance and flexibility provided to states in the IFC will help them maintain Medicaid beneficiary enrollment while receiving the temporary increase in federal funding in the Families First Coronavirus Response Act (FFCRA).

    CMS is also taking continued steps to ensure that price transparency extends to COVID-19 testing during the PHE.  Provisions in the IFC require that any provider who performs a COVID-19 diagnostic test post their cash prices online. Providers that are non-compliant may face civil monetary penalties.

    In addition to these provisions, the IFC:

    • Provides an extension of Performance Year 5 for the Comprehensive Care for Joint Replacement (CJR) model; and
    • Creates flexibilities in the public notice requirements and post-award public participation requirements for a State Innovation Waiver under Section 1332 of the Patient Protection and Affordable Care Act during the COVID-19 PHE.

    Along with these regulatory changes, CMS is issuing three toolkits aimed at state Medicaid agencies, providers who will administer the vaccine, and health insurance plans. Together, these toolkits will help ensure the health care system is prepared to successfully administer a safe and effective vaccine by addressing issues related to access, billing and payment, and coverage.

    Increasing Access to Vaccines for Medicare & Medicaid Beneficiaries

    The toolkits issued today give health care providers not currently enrolled in Medicare the information needed to administer and bill vaccines to Medicare patients. CMS is working to increase the number of providers that will administer a COVID-19 vaccine to Medicare beneficiaries when it becomes available, to make it as convenient as possible for America’s seniors. New providers are now able to enroll as a “Medicare mass immunizers” through an expedited 24-hour process. The ability to easily enroll as a mass immunizer is important for some pharmacies, schools, and other entities that may be non-traditional providers or otherwise not eligible for Medicare enrollment. To further increase the number of providers who can administer the COVID -19 vaccine, CMS will continue to share approved Medicare provider information with states to assist with Medicaid provider enrollment efforts. CMS is also making it easier for newly enrolled Medicare providers to also enroll in state Medicaid programs to support state administration of vaccines for Medicaid recipients.

    Coverage

    As a condition of receiving free COVID-19 vaccines from the federal government, providers will be prohibited from charging consumers for administration of the vaccine. To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:

    Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

    Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay directly for the COVID-19 vaccine and its administration for beneficiaries enrolled in MA plans. MA plans would not be responsible for reimbursing providers to administer the vaccine during this time.   Medicare Advantage beneficiaries also pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

    Medicaid: State Medicaid and CHIP agencies must provide vaccine administration with no cost sharing for most beneficiaries during the public health emergency.  Following the public health emergency, depending on the population, states may have to evaluate cost sharing policies and may have to submit state plan amendments if updates are needed.

    Private Plans: CMS, along with the Departments of Labor and the Treasury, is requiring that most private health plans and issuers cover a recommended COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing. The rule also provides that out-of-network rates cannot be unreasonably low, and references CMS’s reimbursement rates as a potential guideline for insurance companies.

    Uninsured: For individuals who are uninsured, providers will be able to be reimbursed for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

    Billing and Payment

    The toolkits also address issues related to billing and payment. After the FDA either approves or authorizes a vaccine for COVID-19, CMS will identify the specific vaccine codes, by dose if necessary, and specific vaccine administration codes for each dose for Medicare payment.  CMS and the American Medical Association (AMA) are working collaboratively on finalizing a new approach to report use of COVID-19 vaccines, which include separate vaccine-specific codes.  Providers and insurance companies will be able to use these to bill for and track vaccinations for the different vaccines that are provided to their enrollees.

    Medicare Payment

    CMS also released new Medicare payment rates for COVID-19 vaccine administration. The Medicare payment rates will be $28.39 to administer single-dose vaccines. For a COVID-19 vaccine requiring a series of two or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series. These rates will be geographically adjusted and recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine. Medicare beneficiaries, those in Original Medicare or enrolled in Medicare Advantage, will be able to get the vaccine at no cost.

    CMS is encouraging state policymakers and other private insurance agencies to utilize the information on the Medicare reimbursement strategy to develop their vaccine administration payment plan in the Medicaid program, CHIP, the Basic Health Program (BHP), and private plans. Using the Medicare strategy as a model would allow states to match federal efforts in successfully administering the full vaccine to the most vulnerable populations.

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