Survey Readiness and Management

Survey readiness is what happens every day that the surveyor does not step onto the floor, all in preparation for the day that he or she does. Be ready.Learn about all of the trends in the new Survey process, how to get ready for survey, manage it while the surveyors are in your facility, to responding to deficiencies. Check back here frequently for survey news!

  • COVID-19 Testing and Reporting Requirements: Summary Slide Deck (9/20)

    By CMS - September 10, 2020

    CMS slide deck summarizing resident and staff testing  and reporting requirements, considerations for using and interpreting antigen tests, and educational resources and training available to nursing homes.

    Read more
  • Resource: Discharge Planning During the COVID-19 Pandemic (9/20)

    By HHS - September 09, 2020

    HHS' Assistant Secretary for Preparedness and Response recently published Discharge Planning and Care Coordination during the COVID-19 Pandemic, a resource developed in partnership with ACL and the Centers for Medicare & Medicaid Services.

     

    This tool is designed to support nurses, social workers, case managers, and others conducting discharge planning for adults with disabilities after COVID-19 treatment.

    The resource:

    • Describes legal protections for people with disabilities including the Olmstead decision;
    • Explains the CMIST (Communication, Maintaining Health, Independence, Services and Support, Transportation) framework and person-centered planning;
    • Provides considerations for three potential discharge scenarios to facilitate person-centered discharge planning and care coordination to the most integrated setting; and
    • Highlights state and federal resources, including the aging and disability networks, to assist care coordinators and discharge planners.
    Read more
  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (9/20)

    By CMS - September 08, 2020

    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.

    Read more
  • Sept. 24 ASPR TRACIE Webinar: COVID-19: Optimizing Healthcare PPE & Supplies

    By HHS - September 08, 2020

    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702

    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702


    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702


    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702


    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

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

    By CMS - August 31, 2020
    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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  • LTCSP Survey Resources: Surveyor Tools Updated (8/20)

    By CMS - August 31, 2020

     

    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).

     8/31/20 

    COVID-19 Focused Survey folder

    Updated the following:

    • CMS Memorandum QSO-20-38-NH Added a new requirement related to the testing of residents and staff for COVID-19 (F886) and provides surveyor guidance.

    • COVID-19 Focused Survey for Nursing Homes

    Added two critical elements (CE)- #10 CE Infection Preventionist (IP) and #11 Staff and Resident Testing.

    Added instructions for selecting a sample of residents and staff. Provided updates based on CMS’ Nursing Home Reopening Guidance (QSO-20-30-NH) and CDC recommendations.

    • COVID-19 Focused Survey Protocol Revised to incorporate changes related to the nursing home testing requirements.

    • Entrance Conference Worksheet Revised to include documentation related to the nursing home testing requirements.

    • Mapping document Added the following tags: F847, F848, F882, F884, F885, F886 • F-Tag Job Aid- Added tags F882 and F886. 

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  • COVID-19 Testing in Nursing Homes: Interim Final Rule Effective 9/02/20, Two QSO Memos With Related Survey Changes, & Algorithm for Interpreting Test Results (8/20)

    By CMS - August 30, 2020

    Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION: Interim final rule with comment period.

    SUMMARY: This interim final rule with comment period (IFC) revises regulations to strengthen CMS’ ability to enforce compliance with Medicare and Medicaid long-term care (LTC) facility requirements for reporting information related to coronavirus disease 2019 (COVID-19), establishes a new requirement for LTC facilities for COVID-19 testing of facility residents and staff, establishes new requirements in the hospital and critical access hospital (CAH) Conditions of Participation (CoPs) for tracking the incidence and impact of COVID-19 to assist public health officials in detecting outbreaks and saving lives, and establishes requirements for all CLIA laboratories to report COVID-19 test results to the Secretary of Health and Human Services (Secretary)in such form and manner, and at such timing and frequency, as the Secretary may prescribe during the Public Health Emergency (PHE).

    DATES: Effective date: These regulations are effective on 09/02/20.


    QSO-20-38-NH

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s healthcare facilities continue to respond effectively to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

    • On August 25, 2020, CMS published an interim final rule with comment period (IFC). This rule establishes Long-Term Care (LTC) Facility Testing Requirements for Staff and Residents. Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the HHS Secretary. This memorandum provides guidance for facilities to meet the new requirements.

    • Revised COVID-19 Focused Survey Tool - To assess compliance with the new testing requirements, CMS has revised the survey tool for surveyors. We are also adding to the survey process the assessment of compliance with the requirements for facilities to designate one or more individual(s) as the infection preventionist(s) (IPs) who are responsible for the facility's infection prevention and control program (IPCP) at 42 CFR § 483.80(b). In addition, we are making a number of revisions to the survey tool to reflect other COVID-19 guidance updates.

     

    QSO-20-37-CLIA,NH

    Memorandum Summary

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

    • On August 25, 2020, an interim final rule with comment period (IFC) went on display at the Federal Register.

    • CLIA regulations have been updated to require all laboratories to report SARS-CoV-2 test results in a standardized format and at a frequency specified by the Secretary.

    • Failure to report SARS-CoV-2 test results will result in a condition level violation of the CLIA regulation and may result the imposition of a Civil Money Penalty (CMP) as required under §§ 493.1804 and 493.1834.

    • Long-Term Care (LTC) Enforcement requirements at 42 CFR part 488 have been revised to include requirements specific to the imposition of a CMP for nursing homes that fail to report requisite COVID-19 related data to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) per §483.80(g)(1) and (2).

    • LTC Facility Testing Requirements for Staff and Residents- Facilities are required to test staff and to offer testing to all nursing home residents.

     

    Considerations for Interpreting Antigen Test Results in Nursing Homes Algorithm pdf icon[PDF – 200 KB]  – August 26, 2020

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  • Voluntary CMS/CDC COVID-19 Infection Control Trainings for Frontline Staff and Management Certificate Program (8/20)

    By CMS - August 29, 2020
    Read more
  • CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management (8/20)

    By CMS/CDC - August 18, 2020

    Starting on August 20, using a pre-recorded, self-paced format, the new CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management training series will include 13 topics that nursing homes must know to manage the COVID-19 pandemic. These trainings will be housed on QIOProgram.org for 24/7 access.

    New, pre-recorded trainings will be released every Thursday at 4:00 p.m. EST through September 2020. CMS and CDC will have subject matter experts available on bi-weekly Q&A sessions through early January 2021 to answer questions you may have about the trainings.

    Critical Topics

    Establishing an Infection Prevention Program in a Nursing Home, with an emphasis on COVID-19
    Is your Nursing Home ready to handle the demands of the COVID-19 Pandemic? Assessing Readiness: Advice from the CDC 
    COVID-19 surveillance to enable early detection and response to outbreaks. Includes NHSN mandatory data collection
    COVID-19 Testing - coming soon
    Cohorting Strategies
    Cleaning Environmental Surfaces and Shared Equipment 
    Establishing a Dedicated COVID-19 Care Center - coming soon
    Hand Hygiene and Personal Protective Equipment (PPE) Strategies for COVID-19 Care: Supply, Use, Re-use, Removal, and Disposal
    Accepting new patients during an active pandemic: considerations of both transfers from hospitals, and admissions from the community - coming soon
    Telehealth in Nursing Homes
    Transparency: Resident and Family Notification. Department of Health and other Notifications
    Clinical Care/‚ÄčManaging COVID positive residents in the Nursing Home
    Managing Staffing Challenges, Including Employee Health Considerations

    Looking for which trainings you need? Take the Training Fundamentals Self-Assessment.

    What isn’t Changing: Access to certificates of participation are still available for those who complete Fundamentals trainings and those who have participated in the live training series. 

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  • CMS Tells States to Resume Standard State Surveys (8/20)

    By C MS - August 18, 2020
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  • FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    By CMS - August 10, 2020

    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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  • Medicare Part B Physician Fee Schedule Proposed Rule (8/20)

    By CMS - August 03, 2020

    Proposed Rule: Medicare Program: CY 2021 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; etc.

    On August, 3 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. In addition to proposing several changes significant to Medicare Part B therapy, CMS is seeking comment on several policies that could impact nursing homes long-term. For example:

    Furnishing Telehealth Visits in Inpatient and Nursing Facility Settings, and Critical Care Consultations

    The long term care facility regulations at § 483.30(c) require that residents of SNFs receive an initial visit from a physician, and periodic personal visits subsequently by either a physician or other nonphysician practitioner (NPP). In the CY 2010 PFS final rule with comment period (74 FR 61762) we stated that these regulations ensure that at least a minimal degree of personal contact between a physician or a qualified NPP and a resident is maintained, both at the point of admission to the facility and periodically during the course of the resident’s stay. In that rule we stated that we believe that these federally-mandated visits should be conducted inperson, and not as Medicare telehealth services. We therefore revised § 410.78 to restrict physicians and practitioners from using telehealth to furnish the physician visits required under § 483.30(c).

    During the PHE for the COVID-19 pandemic, we waived the requirement in 42 CFR 483.30 for physicians and nonphysician practitioners to personally perform required visits for nursing home residents, and allowed visits to be conducted via telehealth (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).

    We are seeking public comment on whether it would be appropriate to maintain this flexibility on a permanent basis outside of the PHE for the COVID-19 pandemic. We invite public comment on whether the in-person visit requirement is necessary, or whether two-way, audio/video telecommunications technology would be sufficient in instances when, due to continued exposure risk, workforce capacity, or other factors, the clinician determines an inperson visit is not necessary.

    We have also received requests to revise our frequency limitations for telehealth subsequent inpatient and nursing facility visits. Currently, we limit the provision of subsequent inpatient visits via Medicare telehealth to once every 3 days and subsequent nursing facility visits to once every 30 days. We received a request to remove the frequency limitation on the subsequent inpatient services and a separate request to revise the subsequent nursing facility visits to once every 3 days, rather than 30 days.

    As we stated in the CY 2019 PFS final rule, we believed the potential acuity of illness of hospital inpatients is greater than that of patients who are likely to receive services that were on the Medicare telehealth services list at that time. We also stated that it would be appropriate to permit some subsequent hospital care services to be furnished through telehealth to ensure that hospitalized patients have frequent encounters with their admitting practitioner. In addition, we expressed our belief that the majority of these visits should be furnished in person to facilitate the comprehensive, coordinated, and personal care that medically volatile, acutely ill patients require on an ongoing basis. Because of our concerns regarding the potential acuity of illness of hospital inpatients, we finalized the addition of CPT codes 99231-99233 to the Medicare telehealth services list, but limited the provision of these subsequent hospital care services through telehealth to once every 3 days. We continue to believe that admitting practitioners should continue to make appropriate in-person visits to all patients who need such care during their hospitalization. Our concerns with, and position on, the provision of subsequent hospital care services via telehealth have not changed (83 FR 59493). Therefore, we are not proposing to modify our current policy.

    In the CY 2018 PFS final rule, we reiterated that we believed it would be appropriate to permit some subsequent nursing facility (NF) care services to be furnished through telehealth to ensure that complex nursing facility patients have frequent encounters with their admitting practitioner, but because of our concerns regarding the potential acuity and complexity of NF inpatients, we limited the provision of subsequent NF care services furnished through telehealth to once every 30 days. We also stated that we continued to have concerns regarding more routine use of telehealth given the potential acuity and complexity of NF inpatients, and therefore, we were not proposing to remove the frequency limitation for subsequent NF care services (83 FR 59494). We have received comments from stakeholders who stated that the once every 30-day frequency limitation for subsequent NF visits furnished via Medicare telehealth limits access to care for Medicare beneficiaries in the NF setting. Stakeholders stated that the use of Medicare telehealth is crucial to maintaining a continuum of care in this setting and that CMS should leave it up to clinicians to decide how frequently a visit may be furnished as a Medicare telehealth service rather than in person depending on the needs of specific patients. We are persuaded by the comments from these stakeholders, and therefore, are proposing to revise the frequency limitation from one visit every 30 days to one visit every 3 days. We believe this interval strikes the right balance between requiring in-person visits and allowing flexibility to furnish services via telehealth when clinically appropriate to do so. We are also seeking comment on whether frequency limitations broadly are burdensome and limit access to necessary care when services are available only through telehealth, and how best to ensure that patients are receiving necessary in-person care.

     

     Additional information from the CMS fact sheet:

    Therapy Assistants Furnishing Maintenance Therapy

    In this CY 2021 PFS proposed rule, we are proposing to make permanent our Part B policy for maintenance therapy services that we adopted on an interim basis for the PHE in the May 1st COVID-19 IFC that grants a physical therapist (PT) and occupational therapist (OT) the discretion to delegate the performance of maintenance therapy services, as clinically appropriate, to a therapy assistant – a physical therapist assistant (PTA) or an occupational therapy assistant (OTA).  We are making this proposal because we no longer believe all such maintenance therapy services require the PT or OT to personally perform them and to better align our Part B policy with that paid under Part A in skilled nursing facilities and the home health benefit where maintenance therapy services may be performed by a PT/OT or a PTA/OTA.  Our proposed policy would allow PTs/OTs to use the same discretion to delegate maintenance therapy services to PTAs/OTAs that they utilize for rehabilitative services.  We are also proposing to revise our subregulatory provisions to clarify that PTs and OTs no longer need to personally perform maintenance therapy services and to remove the prohibitions on PTAs and OTAs from furnishing such services.  Should the PHE end before January 1, 2021, the PT or OT would need to personally furnish the maintenance therapy services until the proposed policy change takes effect. 

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

    By CMS - August 02, 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.


    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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  • CDC COVID-19 Interim Infection Prevention and Control Recommendations for Healthcare Personnel Updated (7/20)

    By CDC - July 19, 2020

    Below are changes to the guidance as of July 15, 2020:

    • Added language that protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glass
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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (7/20)

    By CDC - July 15, 2020

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

    Read more
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