Wednesday, April 1, 2020

ICF/IIDs and PRTFs COVID-19 Guidance Released

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released guidance for infection control and prevention of COVID-19 in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs). CMS notes that these facility staff should regularly monitor the Centers for Disease Control and Prevention's (CDC) website for information and resources. These providers should also contact their state health agency if they have questions or suspect a client/resident of an ICF/IID or PRTF has COVID-19.

Tuesday, March 31, 2020

Federal Court Orders Appeal Rights on “Observation Status” Issue for Certain Medicare Hospital Patients

Dana Ritchie

In a decision issued on March 24, 2020, Judge Michael P. Shea of the U.S. District Court in Hartford, Connecticut found that certain Medicare beneficiaries who are placed on “observation status” at hospitals, rather than being admitted as “inpatients,” have the right to appeal to Medicare. The case, Alexander v. Azar, is a nationwide class action case filed by the Center for Medicare Advocacy that went to trial in August 2019. The ruling finds that as a matter of constitutional due process, patients who are initially admitted as inpatients by a physician, but whose status is later changed to observation by their hospital, have the right to appeal to Medicare and argue for coverage as hospital inpatients.

The decision opens the door to medically necessary services in skilled nursing facilities that Medicare beneficiaries might otherwise have to forgo because they cannot afford to pay for it themselves. The distinction between being labeled a hospital “inpatient” versus being placed on observation status is important because Medicare only covers subsequent care in a skilled nursing facility for patients who were hospitalized as inpatients for three or more consecutive days. Patients in observation status are considered “outpatients” and thus ineligible for coverage of care at nursing facilities. You can read the full press article about this on the Center for Medicare Advocacy’s website here.

As a result of this case, the Secretary of HHS must establish a procedure to allow certain Medicare beneficiaries to challenge decisions by hospitals to place them on observation status. The court outlines the beneficiaries who will be eligible to challenges these decisions:

All Medicare beneficiaries who, on or after January 1, 2009:

  1. have been or will have been formally admitted as a hospital inpatient; 
  2. have been or will have been subsequently reclassified as an outpatient receiving “observation services”; 
  3. have received or will have received an initial determination or Medicare Outpatient Observation Notice (MOON) indicating that the observation services are not covered under Medicare Part A; and 
  4. either 
    • (a) were not enrolled in Part B coverage at the time of their hospitalization; or 
    • (b) stayed at the hospital for three or more consecutive days but were designated as inpatients for fewer than three days, unless more than 30 days has passed after the hospital stay without the beneficiary’s having been admitted to a skilled nursing facility. Medicare beneficiaries who meet the requirements of the foregoing sentence but who pursued an administrative appeal and received a final decision of the Secretary before September 4, 2011, are excluded from this definition. 

The federal government may appeal this decision of the District Court but has not formally done so at this time. In addition, the ruling has no effect on the current waiver of the 3-day stay requirement that CMS issued under the public health emergency and the section 1812(f) waiver. 

VA Referrals to SNF During COVID-19 Emergency

Dan Ciolek and Dana Ritchie

Per an email to AHCA from the Veterans Administration (VA), Community care has halted non-urgent, non-emergent VA referrals to the community. However, referrals for geriatrics and extended care services (including all nursing home referrals) will continue but they are being clinically reviewed using guidance provided to the VA facilities and community care network (CCN) contractors “The community care office should carefully evaluate and prioritize referrals that are urgent/emergent and medically necessary based on clinical triage.”

NOTE: The VA and TriWest have delayed the deployment of CNN throughout Region 4 as Montana and Eastern Colorado will deploy June 8, 2020 and the remainder of Region 4 by August 31, 2020, so referrals in these regions for post-acute care would continue to be via local VA contracts or veterans care agreements (VCAs).

The following are useful web links to access updated VA information.
  • The VA provider latest news webpage is here.
  • The VA COVID-19 webpage  is here.
  • The Optum CCN Network COVID-19 webpage is here
  • The TriWest Network provider webpage is here.

A Virtual Continuing Education Opportunity that Delivers Variety, Flexibility, and Quality

Dave Kyllo

AHCA/NCAL has the online courses to help administrators, directors, and nurses meet their continuing education (CE) needs! The AHCA/NCAL 2019 Convention Education sessions are available to members and non-members in a package offering 70 online NAB and ANCC (nurses) approved courses. 

There are more than enough online courses in the package to meet most license requirements. Topics include those related to clinical practice, workforce, assisted living, technology, dementia care, and more!

The package is online, available 24-hours a day and the interface is easy. After purchasing the package, you choose a course, view the webinar, take and pass the quiz, print your CE certificate, and then self-report the course information to your NAB profile or nurse board.

The package costs $200. Once the package is purchased, access to the courses will be available until September 1, 2020. The package is for individual use only and access cannot be shared. Single courses are not available. You can access the package here.

Wednesday, March 25, 2020

CDC Releases COVID-19 Guidance for Retirement Communities and Independent Living

The Centers for Disease Control and Prevention (CDC) released guidance for retirement and independent living communities, including assisted living communities that do not provide medical services. AHCA/NCAL has learned that the CDC will be releasing guidance for assisted living communities in the coming days. Until that guidance is published, we strongly recommend that members follow AHCA/NCAL’s previously issued recommendations on visitors, communal dining and events. 

The CDC guidance for retirement communities and independent living is similar to AHCA/NCAL’s guidance in that they suggest canceling all public or non-essential group activities and events, cleaning and disinfecting all areas, screening visitors when appropriate and possible and posting information related to COVID-19.

In recognizing the home-like environment of these residences, the guidance also highlights asking residents to self-monitor, asking residents to ensure they have needed medications, etc. The guidance also recommends that providers work with the local department of health if a positive case of COVID-19 were to be found in the building. It is key to note that the guidance covers retirement communities, assisted living communities that are a less medical model, and CCRCs. Again, we recommend that members utilize AHCA/NCAL’s more robust guidance as well. 

For additional questions, please email and visit for more information and resources.

The LTC Career Center Offers National Exposure for Your Job Listings

Dave Kyllo

The LTC Career Center gives unprecedented targeted national exposure because it connects with the Health Care Career Network by providing visibility on the network’s nearly 300 national and state health care organizations and societies. Serious health care candidates look for jobs on this national network built for health care employers to reach health care professionals. 

Open positions can be posted on the AHCA/NCAL Long Term Care Career Center for $350 per 30-day posting. Rates for posting job vacancies are reduced for 60- and 90-day postings through November 30. This short video shows how easy it is to create an account and post a job vacancy. 

Posting on the site gives even more value because employers who utilize the LTC Career Center  receive free bonus exposure through rotating job listings on AHCA’s home page – the web site where long term care professionals go for news and information. In addition, employers that post vacancies through the AHCA/NCAL LTC Career Center get extra value through free rotating listings on the Long Term Care Career Center home page. 

Of course, the LTC Career Center is always free for job seekers and the LTC Career Center features many of the best positions the long term care profession has to offer. Graduates and experienced health care professionals utilize the Health Care Career Network to find the best health care openings. 

Visit the LTC Career Center Employer Page or call Robin at 866-964-2765 x2736 for more information about posting job vacancies on the LTC Career Center and other discounted job listing packages.   

March 31, 2020 PDPM Academy Open Discussion Forum Cancelled – PDPM Academy 2020 Subscriptions Still Available

Dave Kyllo

Due to the growing challenges providers are facing during the COVID-19 emergency and the need to free-up our virtual webinar technology calendar to provide essential COVID-19 related updates, AHCA is cancelling the scheduled upcoming AHCA PDPM Academy Open Discussion Forum (ODF) scheduled for March 31 from 3:00-4:00 PM EDT. 

Any updates related to the patient driven payment model (PDPM) during this crisis will be posted as they occur in the AHCA COVID-19 Email Updates that can be found on the left hand side of the AHCA COVID-19 resource page under the "Latest AHCA/NCAL Updates" header.

AHCA appreciates your understanding during this challenging time. Once we have passed this crisis, we will substitute this lost ODF session hour in your AHCA PDPM Academy 2020 subscription with a one-hour on-demand CE webinar related to PDPM.

If you have any immediate questions regarding PDPM, or if you have PDPM claims-related problems that your MAC is unable to resolve, please submit your questions to COVID-19 questions should be sent to

AHCA SNF provider members can still register for the AHCA PDPM Academy 2020 Subscription – Building Optimal Operational Capacities©. This exclusive “SNF provider member only” subscription package includes:

  • Seven pre-recorded one-hour educational webinars with 1.25 NAB continuing education (CE) credits and accompanied by AHCA-developed guidance toolkits and other resources covering these topics:
    • Holistic person-centered care planning
    • Evidence-based approaches for improving mobility
    • Effective care transitions at admission and discharge
    • Trend Tracker and other sources to monitor the quality impact of PDPM
    • Managing residents with complex nursing and NTA needs
    • Restorative nursing and skilled maintenance nursing and therapy– Available On- Demand March 31 (see course description below)
    • One additional CE webinar (topic to be announced in the future)
  • Five live PDPM Academy Open Discussion Forums: (On-demand recordings of these forums are available to Subscribers)
  • Access to AHCA’s complete library of 2019 and 2020 PDPM Academy materials 

The 2020 subscription fee is $299 per individual and is available only to AHCA SNF provider members (or individual contracted employees if registering through the AHCA provider member).  The materials, toolkits, forums and webinars in the AHCA PDPM Academy 2020 Subscription package come from the nation’s top experts and are hundreds of dollars less than what private consultants are charging. 

The first on-demand CE course will be available March 31 and is titled Restorative Nursing and Skilled Maintenance Nursing and Therapy. Nearly one-third of SNF resident stays would be eligible for restorative nursing case-mix payment adjustments within the PDPM Nursing Component. Additionally, new flexibilities in therapy service delivery permitted under PDPM create incentives to develop more effective restorative nursing programs to all Medicare Part A residents, including those on an active therapy care plan. This module will highlight restorative nursing and skilled maintenance nursing and therapy best practices under PDPM. 

The Restorative Nursing and Skilled Maintenance Nursing and Therapy session is free with a PDPM Academy 2020 subscription. This educational session can also be purchased a la care at: More in-depth education on specific PDPM related best practices are available for purchase here: The a la carte registration price per individual for each PDPM Academy 2020 CE session is $150 for AHCA members and $650 for non-members. 

To access ahcancalED and register for an AHCA PDPM Academy 2020 Subscription, members need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail with your name and facility contact information. 

HCS Survey Deadline Extended

In light of what skilled nursing and long term care facilities are currently dealing with pertaining to COVID-19, Hospital & Healthcare Compensation Service (HCS) has extended the Nursing Home Salary & Benefits study deadline to Monday, May 18.

Questionnaires are available at Please contact Rosanne Zabka with any questions. 

NEW Video Tutorials Available to Assist with Coding Specific Section GG Items

Dan Ciolek

The Centers for Medicare & Medicaid Services (CMS) released three short video tutorials to assist providers with coding three specific Section GG items of the Minimum Data Set (MDS). These videos, ranging from 5 to 10 minutes, are designed to provide targeted guidance using simulated patient scenarios. To access the videos, click on the links below:

If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk.

Medical Review Audits During COVID-19

Dan Ciolek

AHCA is aware that several members are receiving additional development review (ADR) medical review documentation requests for Medicare Part A, Part B, and Medicare Advantage (MA) services from Medicare contractors and MA plans. Such requests have a limited response time and often require front-line clinical staff to provide the supporting documentation. While AHCA is awaiting clarification from CMS about possible audit relief, we recommend that providers receiving any ADRs immediately contact the contractor or MA plan and request an extension due to the COVID-19 crisis.