Thursday, August 20, 2020

CDC Interim Guidance on Rapid Antigen Tests

This week, the Centers for Disease Control and Prevention (CDC) released new interim guidance on rapid antigen testing for COVID-19. The key points that members should be aware of include:
  • The two rapid antigen tests on the market (BD Veritor and Quidel Sofia2, which are being sent to all nursing homes by CMS) are currently intended for use in diagnostic testing of symptomatic patients within five days of symptom onset. 
  • Through this new guidance, CDC expands use of these rapid antigen tests to include use as screening tool in congregate settings (such as a nursing home) for staff and residents.
  • All long term care facilities must defer to state or local guidance on their use. If no such guidance exists, you may consider following CDC guidance. 
  • Evaluating the test results must be done in context with the person’s symptoms and how likely COVID-19 is in the group of people getting the tests, which is usually similar to the community’s rate of COVID-19. 
  • Providers who are utilizing these antigen test devices must undergo proper training and be able to demonstrate competency and completion.
It’s very important that providers who are utilizing the point of care antigen test device understand this new CDC guidance. AHCA/NCAL has developed a more comprehensive summary here that members can utilize. 

AHCA/NCAL has also added information on how to access training for both antigen devices (BD Veritor and Quidel Sofia2) to its summary of important steps providers must take in preparing to use these testing devices. 

Additionally, CMS is expected to update the list of nursing homes receiving the point-of-care (POC) antigen tests later today (Thursday, August 20). CMS provides a zip file (an excel file) with the names of all the nursing homes to receive either the Quidel Sophia-2 or BD POC antigen tests. You can also find this list on Data.CMS.gov under the paragraph “Supporting COVID-19 Testing.”

Please email COVID19@ahca.org for additional questions, or visit ahcancal.org/coronavirus for more information.

Wednesday, August 19, 2020

Updated List of Excluded Individuals and Entities (LEIE) Database File

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in August 2020. This new file replaces the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The updated files are posted on OIG’s website and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

Instructional videos explaining how to use the online database and the downloadable files are available at http://oig.hhs.gov/exclusions/download.asp.

As a best practice, long term care providers should check the LEIE on a regular basis.


71st AHCA/NCAL Virtual Convention Offers Essential Opportunity for Providers to United

 REGISTER NOW

The unrelenting challenges of the pandemic have hit the long term and post-acute care sectors especially hard. Over the last several months, providers have fought tirelessly to provide quality care and protect those that are most vulnerable to COVID-19.

The Virtual Convention & Expo taking place in October will unite providers from all across the country to reflect, learn, and share at this critical time.

“Now more than ever we need all levels of our profession to come together to discuss and share best practices, hear and learn from experts, and recognize the heroic work that many have done during this unprecedented time,” says AHCA/NCAL President and Chief Executive Officer Mark Parkinson.

Taking place from October 8 – 31, the Virtual Convention & Expo will offer 24 days of access to: 

  • 14th Annual NCAL Day
  • On-demand and live streaming sessions
  • Networking lounges
  • Moderated discussions 
  • Q&As with speakers and panelists
  • Expo Hall with more than 70 business partners
  • Awards and Recognitions

You can earn up to 50 CEs by participating in sessions on your own time and at your own pace. Watch and re-watch sessions as your schedule allows — the platform will be available 24/7.

Get-Together Thursdays on October 8, 15, and 22 will feature the live sessions, moderated discussions, networking lounges, National Quality Award ceremony, and much more.

Over the 24 days of convention, you will have access to education sessions in 17 tracks of learning on key topics relevant to you. There will be a wide range of exciting speakers attending.


So while we may not be gathering in person, the 71st AHCA/NCAL Virtual Convention & Expo is packed with the value, convenience, and connection you’ve come to expect and deserve.

Get details and register today at NCALConvention.org.


Webinar: Successful Approaches to Creatively Engage with Older Adults during COVID-19

Webinar Registration

Tuesday, August 25, 2020, 3:00 PM ET

As organizations continue to find new ways to engage older adults throughout the COVID-19 pandemic, creative engagement activities help older adults explore their creativity while bringing purpose and inspiration to their lives.

The National Resource Center for Engaging Older Adults will be hosting a webinar that will feature TimeSlips, a national organization focused on creative engagement among older adults. Attendees will also hear how an Area Agency on Aging (AAA) developed a virtual art gallery for senior center artists, and learn about another AAA’s choir for those living with Alzheimer's or another dementia, helping to bring meaning to the lives of the participating older adults. Speakers will address how programs have been adapted due to COVID-19.

Speakers:

Anne Basting, Founder, President, TimeSlips

Marla Fronczak, Chief Executive Officer, AgeGuide (IL)

Nobu Iizuka, Director, Weber/Morgan Area Agency on Aging (UT)


Tuesday, August 18, 2020

CMS to Return to Normal Survey Process

The Centers for Medicare and Medicaid Services (CMS) issued a Quality, Safety & Oversight (QSO) memo to states August 17 instructing them to return to normal survey process as soon as resources in the state allow and in accordance with states' reopening plans. It also provides guidance on how to resolve pending enforcement actions suspended as a result of prior QSO memos on March 23, 2020 and June 1, 2020 that suspended some survey enforcement actions during the COVID-19 pandemic.

On March 23, 2020, CMS issued the QSO 20-20-All memorandum, which limited survey activity to focused infection control surveys. On June 1, 2020, CMS issued the QSO 20-31-All memorandum that provided survey re-prioritization guidance to transition to more routine oversight and survey activities. This latest memo instructs states to restart all normal surveys as possible.

CMS intends to resolve suspended enforcement cases and provide guidance for closing them out going forward starting today. This process involves four components that are described in the QSO memo:
  1. Expanding the Desk Review policy for Plans of Corrections (POCs); 
  2. Processing enforcement cases that were started BEFORE March 23, 2020; 
  3. Processing enforcement cases that were started ON March 23, 2020, THROUGH May 31, 2020; and 
  4. Processing enforcement cases that were started ON OR AFTER June 1, 2020.
CMS is also issuing updated guidance for the re-prioritization of routine state survey agency (SA) Clinical Laboratory Improvement Amendments (CLIA) survey activities, subject to the SA’s discretion, in addition to lifting the restriction on processing CLIA enforcement actions, and issuing the Statement of Deficiencies and Plan of Correction (Form CMS-2567) for CLIA citations.

Providers with questions about past enforcement actions suspended during the pandemic should contact their state survey agency for guidance as there are many scenarios that may not be fully addressed by this memo.

Per CMS, questions about a specific enforcement cycle may be addressed with the specific CMS location.
General questions for AHCA should be sent to COVID19@ahca.org.

AHCA’s Online Trainings Deliver the SNF ICD-10 Coding Knowledge You Need

Dave Kyllo

AHCA and the American Health Information Management Association (AHIMA) offer two online in-depth ICD-10 trainings and two new 2.5-hour update trainings for staff with ICD-10 coding experience/knowledge.  

The Patient Driven Payment Model (PDPM) relies on rapid and accurate patient assessment and diagnosis, and on MDS and ICD-10 coding to determine payments for each SNF patient. Incorrect or insufficient coding can significantly impact the payment rate for each patient.  

More than 40,000 ICD-10 codes can be used to report the primary reason for a SNF stay on the PDPM MDS assessment. Building ICD-10 coding proficiency and capacity are essential to ensure proper reimbursement for needed care and services.  

The 2020 ICD-10 trainings are:
  • AHCA/AHIMA ICD-10 Training for PDPM – Full Length Coding and Documentation Training 16 CNEs for nurses or 16 AHIMA CEUs for Health Information Management (HIM) professionals upon completion.   Intended for New SNF Staff (or staff interested in a full re-fresher) with Responsibilities for MDS and Billing.   $499 AHCA Member | $599 Non-Member  
  • AHCA/AHIMA ICD-10 Training for PDPM– Full Length Training for Non-Coding Roles 4 CNEs or 4.5 NAB administrator CEs or 4 AHIMA CEUs upon completion.  Intended for New SNF Staff (or staff interested in a full re-fresher) Who Need Knowledge About ICD-10-CM Coding to Support Other SNF Staff (e.g., Administrators, Regional Managers, etc.)   $199 AHCA Member | $249 Non-Member   
  • AHCA/AHIMA ICD-10 Coding Updates for PDPM and Expanded Case Examples -- Updates Only Version  2.5 CNEs or 3 NAB administrator CEs or 2.5 AHIMA CEUs upon completion.  Short Update Training on CMS Changes to PDPM ICD-10-CM Codes Intended for Experienced  SNF Staff with Responsibilities for MDS and Billing.  $99 AHCA Member | $149 Non-Member  
  • AHCA/AHIMA ICD-10 General Updates for PDPM and Expanded Case Examples for Non-Coding Roles -- Updates Only Version 2 CNEs or 2.25 NAB administrator CEs or 2 AHIMA CEUs upon completion.  Short Update Training on CMS Changes to PDPM ICD-10-CM Codes Intended for Experienced SNF Staff Who Need Knowledge About ICD-10-CM Coding to Support Other SNF Staff (e.g., Administrators, Regional Managers, etc.)   $99 AHCA Member | $149 Non-Member   
Participants must pass a short test at the end of each module for all courses with a score of 70 or greater to receive CNEs/CEUs. 

To register for any of the four ICD-10 courses, go to ahcancal.org/icd10

Members will need to login with their AHCA/NCAL usernames and passwords to register. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.  

Learn How Daily Care Best Practices Improve Functional Outcomes

AHCA/NCAL’s online training titled Functional Outcomes Improvement is designed for all staff who have a role in improving patient functional outcomes quality and services, including nurses, CNAs, therapists, activities staff and recreational therapists.  

This course advances knowledge and skills about functional improvement through an array of learning tools and resources designed to meet the educational needs of various staff and departments. This includes learning about daily care best practices and real-world tools that improve functional outcomes.  

The Medicare Payment Advisory Commission (MedPAC), the IMPACT Act, and CMS called for the development of functional improvement measures based on the self-care and mobility sections of the Continuity Assessment Record and Evaluation (CARE) tool.
 
The program is flexible and can be completed in one sitting or one module at a time. The training is delivered in five modules, including:
  • Module 1 – Explores the connection between functional outcomes and person-centered care, and how utilization of evidence-based pragmatic programs leads toward continuous improvement.
  • Module 2 – Reviews the regulations related to functional outcomes including the CMS Requirements of Participation and how functional improvement impacts reimbursement.
  • Module 3 – Covers best care coordination practices for short- and long-stay patients, including coordinating with therapy processes, and provides an overview of effective restorative nursing programs.
  • Module 4 – Closely examines care practice application and what individuals can do to increase function, team engagement and concludes with a discussion of various quality initiatives that lead to better outcomes.
  • Module 5 – Reviews the tools and resources needed to further functional outcomes improvement approaches to person-centered care.     
The cost for the training program is $199 for AHCA/NCAL members and $650 for non-members and offers 6.5 NAB CE credits for administrators and 6.5 contact hours for nurses through the Iowa Board of Nursing. There is a quiz at the end of four of the five modules and participants must pass a final exam with a score of 80 or higher to receive credit. Click here to register or go to ahcancal.org/functionaloutcomes.  

Members will need to login with their AHCA/NCAL usernames and passwords to register. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.

Key Strategies for Navigating the Impacts of COVID-19 on Employee Healthcare Costs


The COVID-19 pandemic has created both a health and economic crisis, and it comes as no surprise that healthcare costs—which are inextricably linked to public health and the economy—are expected to rise over the next year. Considering that healthcare is already one of the largest expenses for businesses, this is not positive news for employers who are facing financial pressure.

The direct and indirect costs related to COVID-19 in the healthcare world will show themselves in the form of increased premium rates over the next few years. A study from Covered California estimated that premiums could increase between 4 and 40 percent nationally in 2021.

A lot is driving these projections. For one, the costs related to testing and treating COVID-19 are high—this year, they are estimated to be between $34- $251 billion. Factor in the possibility that there may be a resurgence in cases, and these costs are not likely to let up in the following year. At the same time, healthcare costs for non-COVID related services have likely dropped due to efforts to reduce elective procedures during the pandemic. Despite this, it is the cost of the uncertainty of healthcare demands in the near future that will be bringing an even greater financial burden to employers.

Being able to provide good and affordable healthcare plans for employees is most certainly a recruitment and retention strategy. This is a time of many unknowns in the long-term care industry, and employees want to feel supported by their plans. But this can be hard to achieve when these facilities are also financially strapped. What should employers be doing to balance their needs with their employee’s needs?

Employers should act now to create a more resilient health benefits strategy within their businesses in order to provide solid healthcare options to employees. This means avoiding making decisions that only benefit the short term—things like raising out of pocket costs for employees, such as copayments or deductibles, or dropping coverage altogether. Here are some longer-term strategies to help employers navigate the healthcare terrain as we move out of a pandemic:

Education is key
Businesses need to pay more detailed attention to their health plan spending and manage healthcare benefits with the same level of care and scrutiny as they would to other expenses within their business. Spend some analytical energy understanding why costs have been exceeding the benchmark.

Educating employees about their healthcare options will also lead to cost savings in the long run. Providing care navigation services that help them understand what kind of healthcare and treatment options they should receive will allow them to seek care at a fair price and reduce unnecessary appointments or procedures.

1. Prioritize preventative care
Employees of long-term care facilities are doing their best to provide preventative care to their patients amidst a pandemic. Promoting preventative care for the health and wellbeing of the employees themselves is a way to show that they are valued and supported by their healthcare plan and by their employer. 

A business that pushes preventative care both within the workplace and through preventative services offered in a healthcare plan will not only recruit and retain new employees but will save in the long run.

2. Promote technology
Offering telehealth options to employees will not only boost revenue but reduce healthcare costs for the employee. As we face an uncertain future, the promise of health care in virtual form will ensure that employees are still receiving the care they need.

3. Consider new healthcare plans
There is no better time to rethink and redesign your health benefit options to employees. Given that COVID-19 has hit long-term care facilities the hardest, it is important that health benefits be used as a tool to retain and recruit employees.

What if there was a plan that was designed with both employees and employers of long-term care facilities in mind? Compass Total Benefit Solutions has created a new minimum essential coverage (MEC) plan for both part-time and full- time workers.

This plan is as low as $161 a month, with copays for regular visits for only $20, and free Teladoc Health telemedicine services—making it very desirable for employees that are looking for basic coverage and a low deductible. Better yet, this plan only adds $1 per hour to the total compensation of each employee.

Read more about the Compass Plan by going to the Member Benefits section of the AHCA portal: www.AHCABenefits.org. Reach out to Nick Cianci, president of Compass Total Benefit Solutions, at Nick@compasstbs.com for help with the enrollment process.

CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management

 Live Q&A Sessions Advance Registration Required: Register here.

Starting on August 20, the live webinar series will transition to 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 your nursing home partners 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.

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. Watch your email for details on how to access these resources in the coming weeks.

To keep your nursing home training momentum going, please take a moment to complete the following:
Questions? Please contact the Nursing Home Trainings support team at NursingHomeTrainings@thebizzellgroup.com

Please note that these are not the trainings tied to Provider Relief Fund which CMS says will launch later this month and be hosted on this website, https://qsep.cms.gov/welcome.aspx.


Monday, August 17, 2020

OMHA Medicare Appeals Settlement Conference Facilitation - 2020 Expansion

Dan Ciolek

The United States Department of Health and Human Services (HHS) recently announced that the Office of Medicare Hearings and Appeals (OMHA) Settlement Conference Facilitation (SCF) 2020 Expansion is now open to the appellant community. SCF is an alternative dispute resolution process at OMHA. The process brings certain providers/suppliers and the Centers for Medicare & Medicaid Services (CMS) together to discuss the potential of a mutually agreeable resolution for eligible Medicare Part A and Part B claims appealed to OMHA or the Medicare Appeals Council (Council).

The 2020 SCF Expansion will increase the number of appeals eligible for SCF. Specifically, appeals involving request(s) for Administrative Law Judge (ALJ) hearing or Council review filed by the appellant on or before March 31, 2020 may now be eligible for SCF.  

All Medicare Part A and Medicare Part B providers and suppliers who have OMHA or Council appeals pending are encouraged to read the updated SCF 2020 expansion materials on the OMHA website. This includes a detailed discussion of the SCF process, updated eligibility criteria and required forms and documents, a revised settlement agreement template for this expansion, and a revised Frequently Asked Questions.  

SCF information is available here: https://www.hhs.gov/about/agencies/omha/about/special-initiatives/settlement-conference-facilitation/index.html.


Friday, August 14, 2020

Your Top-Line with NHSN COVID-19 Data Released

On Wednesday, August 12 the 2020-Q3 Top-Line for skilled nursing centers was released. For the first time, it allows facilities to compare their staff and resident COVID-19 case data to other nursing centers in their county and state. 

The publication summarizes COVID-19 case data required by CMS to be submitted to the National Healthcare Safety Network (NHSN) by nursing centers. The data released by CMS is updated every Thursday afternoon.


 

Center COVID-19 Data Alongside County and State Totals and Averages

The Top-Line has four tables summarizing resident and staff COVID-19 cases and deaths. Each table shows weekly incidence, as well as totals for all the available NHSN reporting periods. The image below is an example of a table on resident confirmed COVID-19 cases.

 

Nursing Center Cases Often Rise and Fall with the Community

Independent analyses from Kaiser Family Foundation and The Wall Street Journal, as well as our own, show that hotspot states with rising cases in the community often see cases rise among nursing centers. And the reverse is also often seen. Declining cases in the community are seen alongside declines in nursing centers.

In this edition of the Top-Line, the 7-day average of new cases in a state per 100,000 people (blue line) is trended alongside 7-day totals of new cases in nursing centers per 1,000 residents (red line). The image below is an example graph for the state of New Jersey.

 


COVID-19 NHSN and Other Resources

The Top-Line includes information on CMS’s and NHSN’s quality assurance (QA) process for publishing COVID-19 data. Check out NHSN’s recorded webinar or FAQs on common data entry issues. 

The Top-Line also includes links to the latest COVID-19 clinical and management resources, such as ahcancalED’s action briefs on COVID-19 prevention and control. As well as, other COVID-19 offerings on ahcancalED.

Access Your Center’s Top-Line Today Through LTC Trend Tracker

Once you are a registered user of LTC Trend Tracker, you will receive an email whenever a new publication is released. If you missed the email on March 9 or it got caught in a spam filter, you can always access current and historic Top-Lines within LTC Trend Tracker.

This NHSN COVID-19 edition of Your Top-Line can be found in the third quarter of 2020 edition (2020-Q3).

For help accessing or using LTC Trend Tracker, visit the Resource Center or email help@ltctrendtracker.com