• COVID-19 Testing: CDC Says Repeated Point Prevalence Surveys Can ID Asymptomatic Cases in SNFs (7/20)

    Wednesday, July 1, 2020 | CDC

    Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

    Early Release / July 1, 2020 / 69

    Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

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    Summary

    What is already known about this topic?

    Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

    What is added by this report?

    Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

    What are the implications for public health practice?

    Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

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  • Calendar Q2 2020 PBJ Staffing Data Due Aug. 14, 2020 and Five-Star/Nursing Home Compare Updates From CMS (6/20)

    Friday, June 26, 2020 | CMS

    Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

    Memo #QSO 20-34-NH

    Posting Date 2020-06-25

    Fiscal Year 2020

    Summary

    The Centers for Medicare & Medicaid Services (CMS) is committed to transparency about changes in publicly reported information on nursing homes during the COVID-19 public health emergency. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

    • Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.

    o Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.

    • Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant.

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  • COVID-19: Many States Have Multiple State-Specific Section 1135 Waivers (6/20)

    Friday, June 19, 2020 | CMS

    CMS approved additional state Medicaid waiver requests under Section 1135 of the Social Security Act (Act). The waivers were approved within days of states’ submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states. The waivers were approved within days of states' submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states.

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  • OIG Targets Monitoring Psychotropic Drug Use in Nursing Homes (5/20)

    Monday, May 18, 2020 | OIG
    Previous OIG work found that elderly nursing home residents who were prescribed antipsychotics, a type of psychotropic drug, were at risk for harm. In response, the Centers for Medicare & Medicaid Services (CMS) took steps to address the risk of harm to nursing home residents. One such step was introducing a quality measure to track the rates of antipsychotic drug use in residents without an appropriate diagnosis. Recently, CMS and researchers expressed concerns that some nursing homes underreport antipsychotic drug use and may inaccurately report certain patient diagnoses in order to avoid CMS monitoring. Additionally, research on antipsychotic drug use has highlighted the need to closely monitor all psychotropic drug use to accurately oversee drug use in nursing homes. We will determine the extent to which there are inconsistencies, if any, between (1) Medicare claims data for residents prescribed psychotropic drugs compared to nursing home self-reported data on residents who received psychotropic drugs, and (2) Medicare claims data as it relates to the diagnoses that exclude residents from monitoring in the antipsychotic quality measure compared to nursing home self-reported data on resident diagnoses.
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  • CMS COVID-19 Stakeholder Engagement Calls – Week of 5/18/20

    Monday, May 18, 2020 | CMS

    CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

    Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. 

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  • LTCSP Survey F-Tag List by Regulatory Grouping UPDATED and Additional Resources (5/20)

    Sunday, May 17, 2020 | CMS
    These resources from CMS include a list of F-tags by regulatory grouping used in the Long-term Care Survey Process (LTCSP) effective Nov. 28, 2017, and a crosswalk between old and new F-tags. CMS updated the tag list in May 2020.
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  • CMS Finetunes Targeted Infection Control Inspections; Tells SNFs/NFs to Complete Voluntary Self-Assessment With COVID-19 Focused Survey Tool (3/20)

    Monday, March 23, 2020 | CMS

    Memorandum Summary

     

    • On Friday, March 13, 2020, the President declared a national emergency, which triggers the Secretary’s ability to authorize waivers or modifications of certain requirements pursuant to section 1135 of the Social Security Act (the Act). Under section 1135(b)(5) of the Act, CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks.
    • During this three-week time frame, only the following types of surveys will be prioritized and conducted:
    • Complaint/facility-reported incident surveys: State survey agencies (SSAs) will conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level. A streamlined Infection Control review tool will also be utilized during these surveys, regardless of the Immediate Jeopardy allegation.
    • Targeted Infection Control Surveys: Federal CMS and State surveyors will conduct targeted Infection Control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). They will use a streamlined review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.
    • Self-assessments: The Infection Control checklist referenced above will also be shared with all providers and suppliers to allow for voluntary self-assessment of their Infection Control plan and protections
    • During the prioritization period, the following surveys will not be authorized: Standard surveys for long term care facilities (nursing homes), hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices. This includes the life safety code and Emergency Preparedness elements of those standard surveys; and revisits that are not associated with IJ.
    • Furthermore, for Clinical Laboratory Improvement Amendments (CLIA), we intend to prioritize immediate jeopardy situations over recertification surveys, and generally intend to use enforcement discretion, unless immediate jeopardy situations arise.
    • Finally, initial certification surveys will continue to be authorized in accordance within current guidance and prioritization.

     Additional Instructions for Nursing Homes

    We are disseminating the Infection Control survey developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations. We expect facilities to use this new process, in conjunction with the latest guidance from CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19. This document may be requested by surveyors, if an onsite investigation takes place. We also encourage nursing homes to voluntarily share the results of this assessment with their state or local health department Healthcare-Associated Infections (HAI) Program. Contact information for each state’s health departments is identified on the Centers for Disease Control & Prevention’s (CDC’s) website at:https://www.cdc.gov/HAI/state-based/index.html.

    Furthermore, we remind facilities that they are required to have a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility, and when and to whom possible incidents of communicable disease or infections should be reported (42 CFR 483.80(a)(2)(i) and (ii)). CDC recommends that nursing homes notify their health department about residents with severe respiratory infection, or a cluster of respiratory illness (e.g., > or = 3 residents or HCP with new-onset respiratory symptoms within 72 hours). Local and state reporting guidelines or requirements may vary. Monitor the CDC website for information and resources to help prevent the introduction and spread of COVID-19 in nursing homes (CDC Preparing for COVID-19: Long-term Care Facilities, Nursing Homes:https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html ).

    We urge providers to review the tools and implement actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.

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  • CDC Updated List of People at Higher Risk for Severe COVID-19 Illness (3/20)

    Monday, March 23, 2020 | CMS

    Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.


    Based upon available information to date, those at high-risk for severe illness from COVID-19 include:

    • People aged 65 years and older
    • People who live in a nursing home or long-term care facility
    • Other high-risk conditions could include:
      • People with chronic lung disease or moderate to severe asthma
      • People who have serious heart conditions
      • People who are immunocompromised including cancer treatment
      • People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
    • People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

    Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.

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  • OIG Will Do Medicaid Nursing Home Life Safety and Emergency Preparedness Reviews (3/20)

    Tuesday, December 31, 2019 | OIG
    Previous OIG audits on Medicaid nursing home life safety and emergency preparedness have identified multiple issues that put vulnerable populations at risk and indicated that nursing homes in various States are not complying with these requirements. In 2016, CMS updated its health care facilities' life safety and emergency preparedness requirements to improve protections for all Medicare and Medicaid beneficiaries, including those residing in long-term-care (LTC) facilities. In addition, in 2019 CMS also issued expanded guidance on emerging infectious disease control to ensure that health care facilities are prepared to respond to threats from infectious diseases. OIG is reviewing this area because residents of LTC facilities are particularly vulnerable to risks such as fires, natural disasters, or disease outbreak. Our objective is to determine whether LTC facilities that received Medicare or Medicaid funds complied with new Federal requirements for life safety and emergency and infectious disease control preparedness.
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  • LTCSP Procedure Guide - Updated (11/19)

    Monday, November 25, 2019 | CMS

    The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the Long-term Care Survey Process. Surveyors use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually participating. The LTCSP steps are organized into seven parts: 1) offsite preparation; 2) facility entrance; 3) initial pool process; 4) sample selection; 5) investigation; 6) ongoing and other survey activities; and 7) potential citations. Below is a broad overview of the key onsite parts of the LTCSP (parts 3 – 7).

     
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