Page One Topics:   Biden-Harris Administration CARES ACT   CDC – Infection Prevention in Nursing Homes CDC – Morbidity and Mortality Weekly Report CDC – Other Resources CDC - Training resources for healthcare providers CDC – Vaccination Resources   CMS CMS - ICD-10 CMS – Nursing Facility Specific Visitation and PPE Guidance CMS - Waiving the 3-day Stay Requirement   Coronavirus Commission for Safety & Quality in Nursing Homes   GAO   Guidance on Therapy In Nursing Homes

Page Two Topics:   HHS   MLN Matters   Monoclonal Antibody Treatment   NHSN Reporting   OIG OSHA Project Echo Regulations   Senate Aging Committee Senate Finance Committee   Telehealth Telehealth Funding   Testing   Vaccination Resources - CDC Vaccination Resources - Other   NASL and Members in the News

 

Biden-Harris Administration

 

• Biden Administration to Invest More Than $12 Billion to Expand COVID-19 Testing  3/17/21
   
• Biden-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine effective for COVID-19 vaccines administered on or after March 15th  3/15/21
   
• President Signs Executive Order to Strengthen Medicaid and the Affordable Care Act.  President Biden signed an executive order opening a Special Enrollment Period (SEP) from February 15, 2021 to May 15, 2021, in order to give Americans that need health care coverage during the COVID-19 pandemic the opportunity to sign up. 1/28/21
   
• President-Elect Biden President-elect Biden Announces American Rescue Plan
   
• Emergency Legislative Package to Fund Vaccinations, Provide Immediate, Direct Relief to Families.  1/14/21
   
• President-Elect Biden and Vice President-Elect Harris Announce Additional Members of the White House COVID-19 Response Team 1/15/21
   
• Consolidated Appropriations Act of 2021 [Including Coronavirus Stimulus & Relief] – Signed by the President on 12/27/20  Read NASL’s Summary here.  Table 106 of the final rule may be found here.

 

• The Consolidated Appropriations Act of 2021 (H.R. 133), a sweeping bipartisan $1.4 trillion dollar year-end government funding piece of legislation, which includes $900 billion in COVID relief.  The bill now heads to the President’s desk for final signature, which we expect to occur this week.  Read NASL’s Summary of H.R. 133 and the partial fix to the Physician Fee Schedule cuts scheduled to begin January 1. 12/22/20

 

 

CARES Act 
 

• Post-Payment Notice of Reporting Requirements  6/11/21  Updated FAQs are available here.
   
• HHS Expected to Distribute Initial Round of Incentive Payments to Nursing Facilities Drawn from the Provider Relief Fund Next Week  10/28/20

 

• HHS Announces $20 Billion in New Phase 3 Provider Relief Funding  10/1/20  ($20 billion in new funding for providers on the frontlines of the COVID-19 pandemic.  Providers can apply for funds between October 5 and November 6, 2020.)

 

• HHS Announces Provider Relief Fund Application for Assisted Living Facilities  9/1/20 (HHS, through HRSA, announced assisted living facilities may now apply for funding under the Provider Relief Fund Phase 2 General Distribution allocation.)

 

• Trump Administration Announces the Distribution of $2.5 Billion to Nursing Homes for COVID-19 Relief Funding  8/27/20  (Administration announces release of $2.5 billion in funding of the $5 billion promised from the Provider Relief Fund. Eligible facilities will receive a per-facility payment of $10,000 plus a per-bed payment of $1,450 in this initial distribution. A facility must have at least 6 certified beds to be deemed as eligible for payment.)
   
• HHS Extends Application Deadline for Medicaid Providers and Plans to Reopen Portal to Certain Medicare Providers  7/31/20  Starting August 10th, certain Medicare providers who previously missed the June 3, 2020, deadline to apply for Provider Relief Fund payments may now submit their application for possible funds by August 28, 2020. 
   
• CARES Act Provider Relief Fund FAQ 7/22/20 (Answers questions regarding the Provider Relief Fund.)

 

• Small Business Administration and Treasury Department Issue Initial Regulations Implementing PPP Flexibility Act  6/10/20 (Provides initial guidance concerning the Flexibility Act, which extended the PPP loan forgiveness covered period, published updated application forms for borrowers and lenders for loans made on or after 6/5/20.)
   
• CARES Act Provider Relief Fund Frequently Asked Questions  6/1/20 (Revised FAQ captures modifications to the CARES Act Provider Relief Fund as it relates to SNF distribution.) 
   
• Text of the CARES Act
  • NASL Summary (member login required)
     
• HHS CARES Act Provider Relief Fund Information Page
  • NASL snapshot of the distribution process for the first $20 billion to be distributed under the Provider Relief Fund (member login required)
     
• House of Representatives Budget Committee FAQ on Sequester 3/27/20
   

CDC – Infection Prevention in Nursing Homes

 

• Interim Public Health Recommendations for Fully Vaccinated People | CDC  Updated 7/21/21
   
• Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination  3/30/21
   
• CDC updated their website page for Infection Control Guidance regarding use of personal protective equipment (PPE). The CDC’s updated Infection Control Guidance can be accessed at: Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC.  2/10/21
   
• CDC social media campaign Roll your #SleeveUp to #FightFlu, advocating for everyone, but particularly healthcare personnel, to get a flu shot. 

 

• CDC updated information about how COVID-19 spreads to include airborne transmission. Read the updated scientific brief.  10/5/20 

 

• CDC Guidance for General Laboratory Safety Practices during the COVID-19 Pandemic  7/6/20 (CDC published new online guidance to address general safety concerns for laboratory personnel during the COVID-19 pandemic. The guidance addresses social distancing, face coverings, hygiene and disinfection, as well as general risk assessments and health and safety planning.)
   
• Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings Updated 6/25/20 (Checklist to be used as one tool to develop a comprehensive COVID-19 response plan.)
   
• CDC updated its guidance on infection prevention in nursing homes  5-19-20  (Includes new guidance based on each of the phases in CMS’s plan, which was announced on May 18th. Among the changes is the emphasis on the importance of having a full-time infection control leader at each nursing home.
   
• CDC has also developed guidance to implement facility-wide testing in nursing homes and updated the interim testing guidance to integrate testing with other core prevention strategies.

 

• Considerations for Memory Care Units in Long-term Care Facilities  5/12/20 (Provides considerations for memory care units, including when residents in a memory care unit are suspected or confirmed to have COVID-19.)
   
• Infection Control Assessment and Response (ICAR) tool 5/8/20 (Developed to help nursing homes prepare for and respond to COVID-19, should be used as one tool to develop a comprehensive COVID-19 response plan. May also contain content relevant for assisted living facilities.)

• Long-term Care Facility Letter to Residents, Families, Friends and Volunteers  (Communicate to residents, families and volunteers the actions your nursing home facility is taking to protect its residents and staff. 
   

CDC – Morbidity and Mortality Weekly Report
 

• Outcomes Among Patients Referred to Outpatient Rehabilitation Clinics After COVID-19 diagnosis — United States, January 2020–March 2021  7/9/21 
   
• Morbidity and Mortality Weekly Report (MMWR) — COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021  5/28/21
   
• Morbidity and Mortality Weekly Report (MMWR) — Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity  5/28/21
   
• Morbidity and Mortality Weekly Report  on COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination — United States, September and December 2020  2/9/21
   
• Morbidity and Mortality Weekly Report summarizing data from the first month of COVID-19 vaccination of staff and residents in skilled nursing facilities conducted through the federal Pharmacy Partnership for Long-Term Care Program.  2/1/21
   
• Morbidity and Mortality Weekly Report  Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020
   
• MMWR – Morbidity and Mortality Weekly Report on the ACIP’s COVID-19 vaccine recommendations.  12/22/20
   
• Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home — Maryland, April 2020  8/11/20 (Investigation of a COVID-19 outbreak in a Maryland nursing home identified a significantly higher prevalence among residents receiving dialysis than among those not receiving dialysis.)  Download a pdf of the report here.
   
• Facility-Wide Testing for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020 8/11/20 (Performing facility-wide testing rapidly following identification of a case in a nursing home might facilitate control of transmission among residents and health care personnel. Strategies are needed to optimize facility-wide testing without a reported case.)  Dowload a pdf of the report here.

• Kaiser Family Foundation maintains a database of State Reports of Long-Term Care Facility Cases and Deaths Related to COVID-19  6/25/20
   
• CDC Morbidity and Mortality Weekly Report:  U.S. Department of Health and Human Services Centers for Disease Control and Prevention Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans 5/22/20
   
• CDC Morbidity and Mortality Weekly Report  COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020 COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020  3/18/20

 

CDC - Training resources for healthcare providers

 

• The CDC has created a hub of job aids in their free Laboratory Training eLearning courses and turned them into PDF and MS Word documents.  Many of the job aids are relevant to SARS-CoV-2 testing and come from the trainings listed on their Preparing and Supporting Laboratories Responding to COVID-19 page.  12/4/20
   
• CMS and CDC will have subject matter experts available on bi-weekly webinars from August 27, 2020, through January 7, 2021, from 4–5pm ET, to answer questions. Registration is required for these Question & Answer sessions. 8/25/20
   

• Preparing for COVID-19 Webinars: Long-term Care Facilities, Nursing Homes – CDC continues to focus efforts on supporting long-term care facilities. These new webinars are intended to be a training tool/resource for frontline long-term care staff members. 
  • Sparkling Surfaces
  • Clean Hands
  • Closely Monitor Residents
  • Keep COVID-19 Out!
  • PPE Lessons

CDC – Other Resources

 

• CDC has created a map, Percent of Delivered First Vaccine Doses Administered by U.S. States & Territories, showing percentages as of June 28, 2021.
   
• Evaluating and Caring for Patients with Post COVID Conditions:  Interim Guidance  CDC interim guidance on post-COVID Conditions (Provides new information to assist healthcare professionals with evaluating, managing, and caring for patients who may experience long-term effects after a COVID-19 infection.)  6/14/21
   
• CDC’s NHSN Nursing Home COVID-19 Dashboard as of July 5, 2021.
• CDC's COVID-19 Data Tracker for Vaccinations.  
• COVID Data Tracker Weekly Review 5/7/21
• CDC COVID Data Tracker  (maps and charts tracking cases, deaths, and trends of COVID-19 in the United States, updated daily by 8 pm ET) 
   
• NHSN COVID-19 data as of April 19, 2021
   
• LTC Pharmacies participating in Federal Retail Pharmacy Program  3/25/21
   
• Resident Mood Interview (PHQ-9©) for the Skilled Nursing Facility (SNF) Setting Video Tutorial  4/2/21
   
• CDC’s NHSN dashboard on COVID-19 as of March 29, 2021
   
• CDC SARS-CoV-2 Variant Classifications & Definitions webpage  3/23/21
   
• CDC  webpage/chart re: Variant Proportions in the U.S.  3/23/21
   
• CDC COVID-19 Data Tracker, updates daily by 8pm Eastern.
   
• Nursing Home Covid-19 Data Dashboard, updates weekly on Wednesday mornings.
   
• Small Gathering Guidance - Updated 2/8/21
   
• CDC COVID-19 Science Update – Released 2/5/21
• Requirement for Face Masks on Public Transportation Conveyances and at Transportation Hubs - Updated 2/4/21
   
• Genomic Surveillance for SARS-CoV-2 Variants – Updated 2/2/21
   
• Case Investigation & Contact Tracing in Non-healthcare Workplaces: Information for Employers – 10/22/20
   
• Infographics for the BD Veritor™ Plus System, Quidel® Sofia® and Sofia 2®, and Abbott BinaxNOW™ antigen tests for rapid detection of SARS-CoV-2. 12-28-20 
   
• Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020 | MMWR (cdc.gov)

• Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing | CDC

• CDC updated Toolkit for Healthcare Providers.     11/18/20 
   
• CDC Guidance on Holiday Celebrations and Small Gatherings  Updated 11/11/20
   
• CDC COVID-19 Vaccination Resources – Updated CDC updated webpage with resources relating to the COVID-19 Vaccination Program Interim Operational Guidance for Jurisdictions Playbook – Version 2.
   
• CDC FAQs about the Pharmacy Partnership for Long-Term Care Program (revised 10/23/20)
   
• CDC Announces Retail Pharmacy Partners for COVID-19 Vaccine Distribution 10/16/20  (CDC shared additional details about the new program and partnership with retail pharmacies CVS and Walgreens, who are expected to deliver end-to-end management of the COVID-19 vaccination process.)
   
  • CDC Overview Pharmacy Partnership for LTC Program 101620
  • CDC Pharmacy Partnership for LTC Program FAQ 101620
  • CDC SNF Partner Packet Pharmacy Partnership for LTC Program 101620
  • CDC ALF Partner Packet Pharmacy Partnership for LTC Program 101620
  • For further details, read NASL’s full summary of CDC’s briefing on COVID-19 vaccine distribution plans.
     
• CDC’s Overview of Testing for SARS-CoV-2 (COVID-19) Web page  9/18/20 (Reinforces the need to test asymptomatic persons, including those who have been in close contact with a confirmed case of COVID-19.  See also CDC Division of Laboratory Systems’ clarified guidance on testing for SARS-CoV-2.)
   
• HHS Secretary Alex Azar declared a Public Health Emergency (PHE) in Oregon, retroactive to September 8. 9/17/20 (The waivers that CMS has issued relative to COVID-19 are also usable for the wildfire areas.)
   
• Slide presentation from the Office of the Assistant Secretary of Health regarding their Abbott BinaxNOW™ Webinar for assisted living facilities.  9/18/20 (Includes an especially good slide (#39) on Understanding SARS CoV-2 Tests.)
   

• CDC COCA Call webpage - for COCA Call recordings and slides.
   
• The Centers for Disease Control & Prevention (CDC) updated its Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance). 8/10/20  
   
• CDC's Rural Health Surge Readiness 8/10/20 (Curates essential rural healthcare resources, tools and trainings designed to assist providers in various care settings who are responding to surge events and navigating financial challenges related to the pandemic workers and organizations.  For more information, contact Federal Healthcare Resilience Working Group.)
   
• COVID-19 Counseling Reimbursement.  7/31/20  (Reimbursement is now available for healthcare providers counseling patients on isolation and quarantine when testing for COVID-19.)
   
  • 3 Key Steps to Take While Waiting for Your COVID-19 Test Result
  • Infographic describing what to expect during contact tracing
  • Health care provider Q&A about reimbursement for counseling
  • Provider-patient counseling talking points
  • Provider counseling checklist  
• CDC Health Alert Network Advisory - Serious Adverse Health Events Associated with Methanol-based Hand Sanitizers  7/5/20  (Advised consumers not to use any hand sanitizer manufactured by "Eskbiochem SA de CV" in Mexico, due to the potential presence of methanol as an active ingredient.)
• Guidance for Nursing homes and staff who work in them (Includes guidance on facility wide testing, performing testing and key strategies) 5/19/20
   
• CDC’s Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for COVID-19  5/4/20
   
• CDC Revised Guidance for Testing Priority  5/3/20 (Updated recommendations for testing, specimen collection, reporting patients and positive test results, and specification of testing priorities.)
   
• CDC’s Evaluating and Testing Persons for COVID-19 - CDC Updated recommendations for testing, specimen collection, and reporting patients and reporting positive test results and specification of testing priorities    5/3/20 
   
• Criteria to Guide Evaluation and Laboratory Testing for COVID-19 (Updated priorities for testing patients with suspected COVID-19 infection.)    4/27/20 
   

• CDC webinars – one provides an overview of the COVID-19 LTCF Module, and the other reviews the expedited enrollment process for facilities to be able to access the NHSN for electronic reporting.  5/1/20 
  • ​Overview of COVID-19 LTCF Module
  • NHSN Enrollment Process
  • CDC’s Enrollment Guidancefor details on the 4-step process for enrolling with CDC’s NHSN to access the COVID-19 Module
     

• COVID-19 Testing and Reporting by Laboratories: Q & A   4/20/20
   
• CDC updated Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19  4/13/20
   
  • CDC:  Strategies to Optimize the Use of PPE
     
• COCA Call: March 27, 2020 – Underlying Medical Conditions and People at Higher Risk for the Coronavirus Disease 2019 (COVID-19)
   

CMS
 

• CMS has posted county positivity rates as of July 12, 2021.
   
• Nursing home data for week ending July 11, 2021. 
• CMS has posted the COVID-19 Test Positivity Rates by County as of June 28, 2021.
   
• CMS’ Nursing Home COVID-19 Data for the week ending June 27, 2021 
   
• CMS posted the county positivity rates as of June 21, 2021.
   
• CMS’ Nursing Home COVID-19 data for the week ending June 13, 2021.
   
• COVID-19 Nursing Home Data from CMS, CDC and NHSN for the week ending June 6, 2021
   
• Nursing home data for week ending May 16, 2021.
• NHSN's Nursing Home Covid-19 Data Dashboard as of May 24, 2021.
   
• CMS issued Medicare and Medicaid Programs; COVID-19 Vaccine Requirements for Long-Term Care (LTC) Facilities and Intermediate Care Facilities for Individuals With Intellectual Disabilities (ICFs-IID) Residents, Clients, and Staff (5/11/21) 
• CMS has posted the latest COVID-19 county positivity rates for May 10, 2021.
   
• CMS has posted the nursing home COVID-19 data for week ending April 25, 2021
   
• CMS nursing home data for week ending April 11, 2021
   
• State Operations Manual Appendix Z- Emergency Preparedness for All Provider and Certified Supplier Types Interpretive Guidance
   
• ​Repayment of COVID-19 Accelerated and Advance Payments began on March 30, 2021
   
• CMS Posted the Latest COVID-19 County Positivity Rates for March 29, 2021  3/30/21
   
• CMS has posted updated Nursing Home COVID-19 Data for the week ending March 21, 2021 
   
• CMS released an updated data snapshot for claims received by January 22, 2021 detailing the impact of COVID-19 on Medicare beneficiaries, particularly among underserved beneficiaries including racial and ethnic minorities, adults 85 years old and older, and people with certain pre-existing conditions. 
• CMS has posted updated Nursing Home COVID-19 Data for the week ending March 14, 2021.
• CMS Posts the Latest COVID-19 County Positivity Rates – March 22, 2021
   
• CMS Graphic – Mom’s Vaccinated:  When Can I Visit Her Nursing Home?   Read the full press release and review the graphic in English and Spanish.  3/16/21  
   
• CMS has posted the COVID-19 county positivity rates for March 15, 2021.  Regulations for testing based on county positivity rates are found here; past postings are found here.  
   
• Nursing Home Visitation - COVID-19 (REVISED) | CMS 3/10/21
   
• In addition to updating the visitation policy for nursing facilities, QSO-20-39-NH, CMS also updated its memo to State Survey Agency Directors, QSO-20-28-NH.  3/10/21  The memo includes a section on access to Ombudsman and includes an FAQ on patient visitation. 
   
• County positivity rates for COVID-19 dated March 8, 2021 are posted here. 
   
• CMS posted the latest county COVID-19 positivity data - February 16, 2021

• CMS posted the latest county COVID-19 positivity data -  February 8, 2021
   
• “Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19” updated 2/1/21 with information on  coverage for Monoclonal Antibody Therapies. 
   
• Medicare COVID-19 Data Snapshot fact sheet (PDF) reports COVID-19 cases and hospitalizations data for Medicare beneficiaries diagnosed with COVID-19 and includes Medicare advantage data.  
   
• CMS posted the latest county COVID-19 positivity data - January 25, 2021
   
• QSO-21-11-ALL policy memorandum outlines the new changes to submission of 1135 Waiver requests/inquiries as well as resources available to providers and suppliers during the current COVID-19 Public Health Emergency (PHE) and future emergency events
   
• Medicare Administrative Contractor (MAC) COVID-19 Test Pricing  1/25/21 CMS published the updated individual payment rates for COVID tests from different MACs.
   
• ​Medicare COVID-19 Snapshot – updated 12/18/20, covering the period January 1 to November 21, 2020.
   
• COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing   updated 12/3/20  (this is now a 159-page document.)
   
• COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers updated 12/1/20 
   
• COVID-19 Nursing Home Dataset – NH Rates for week ending November 15, 2020
   
• CMS Urging Nursing Homes to Follow Established COVID Guidelines This Holiday Season (11/20/20)  View the Alert.
   
• CMS Nursing Home Podcast Series for Front Line Clinicians and Staff  11/19/20 (Discusses training and infection control practices in nursing homes to help combat the spread of COVID-19.)
   
• CMS Nursing Home Resource Center, a new online resource center that will consolidate all nursing home information, guidance and resources into a user-friendly, one-stop-shop.  10-30-20
   
• Two New Video Tutorials have been released by CMS 10/28/20
   
  • Brief Interview for Mental Status (BIMS) Video Tutorial - video tutorial to assist providers in SNFs with standardized data assessment guidance and strategies for the cognitive assessment known as the Brief Interview for Mental Status (BIMS).
  • Confusion Assessment Method (CAM©) Video Tutorial – video tutorial to assist providers in SNFs with standardized data assessment guidance and strategies for the cognitive assessment known as the Confusion Assessment Method (CAM©).
     
• CMS guidance memo, “COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115” updated to include nursing facility requirement to report their COVID testing results from the Point of Care devices performed in their facility to the National Healthcare Safety Network (NHSN).  CMS is giving providers until November 20, 2020 to be ready to report through NHSN. Please note that the updated memo still has the old June 4th date on it. 
   
• Enforcement Discretion Relating to Consolidated Billing During PHE  10/16/20  (To facilitate the efficient administration of COVID-19 vaccines to SNF residents, CMS will exercise enforcement discretion with respect to consolidated billing statutory provisions.) 
   
• CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing.  10/16/20 (Starting January 1, Medicare will pay $100 to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected; laboratories that take longer than two days will be paid $75. 
   
• MLN Matters #11982 re: Change Request 11982 10/15/20 (Revised due to an incorrect date for one of the codes)
   
• CMS Updates PDPM Grouper DLL V1.0008  10/9/20 (Corrects Issue That Can Cause Incorrect PDPM Recalculation.  Select PDPM_V1.0008_Package (ZIP) to download the file containing the updated PDPM DLL V1.008.) 
   
• CMS Announces New Repayment Terms for Medicare Loans made to Providers during COVID-19 10/8/20  (Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment.)  
   
• CMS FAQs on Nursing Home Visitation 10/6/20 (Facilities may use creative means to allow visits before reaching phase 3, such as outside visits. However, all precautions to prevent COVID-19 transmission should still be enforced during such visits.  For those patients who are unable to participate in outdoor visits, Civil Money Penalty (CMP) reinvestment funds may be used for programs to provide adaptive communicative technologies so these patients may enjoy virtual visits.)
   
• CMS Releases Medicare COVID-19 Data Snapshot Monthly COVID-19 Data Release for services provided from January 1 to August 15, 2020. 10/2/20 
   
  • Review the data here.
  • Read the FAQ on the monthly COVID-19 Data Release for more details about this data.
  • To review the latest COVID-19 Nursing Home Data for the week ending September 20, 2020, go here.
    ​
• CMS Updates Medicare COVID-19 Snapshot  11/19/20 (Monthly update covering the period from January 1 to September 12, 2020 of the impact of COVID-19 on the Medicare population, showing over 1 million COVID-19 cases among the Medicare population and over 332,000 COVID-19 hospitalizations.)
   
• CMS Updates COVID-19 Testing Methodology for Nursing Homes  9/29/20 (Facilities are expected to use the county-level, color coded rating system to determine the frequency for testing facility staff and residents in accordance with CMS guidance.)
   
• Updated SNF Quality Reporting Program COVID-19 Public Reporting Tip Sheet Posted 9/8/20  (The purpose of this Tip Sheet is to help providers understand CMS’ public reporting strategy for the PAC QRP in the midst of the COVID-19 public health emergency).
   
• CMS Updates Nursing Home Visitation Guidelines  9/17/20 (Provides a roadmap for resuming indoor visits based on community COVID-19 spread and emphasizes the importance of meeting residents’ psychosocial needs.)
   
• CMS has updated the Nursing Home COVID-19 data for the Week Ending: 09/06/2020.
   
• CMS Shares Tip Sheets on Its Public Reporting Strategy for PAC QRP During COVID-19  9/8/20 (Each tip sheet details CMS’ strategy to account for quality data that has been exempted from public reporting due to the pandemic and how these exemptions impact updates to the corresponding provider Compare websites.) 
   
  • Skilled Nursing Facility (SNF) QRP COVID-19 Public Reporting Tip Sheet
  • Inpatient Rehabilitation Facility (IRF) QRP COVID-19 Public Reporting Tip Sheet
  • Long Term Care Hospital (LTCH) QRP COVID-19 Public Reporting Tip Sheet
  • Home Health QRP COVID-19 Public Reporting Tip Sheet
     
• FAQ addressing CMS’ temporary enforcement discretion for the duration of the COVID-19 public health emergency under CLIA for the use of SARS-CoV-2 POC antigen tests on asymptomatic individuals. Specifically, CMS will not cite facilities with a CLIA Certificate of Waiver when SARS-CoV-2 POC antigen tests are performed on asymptomatic individuals, as described in the FDA FAQ.  8/20
   
• CMS released two guidance memos that correspond to the 3rd Interim Final Rule with Comment (IFC) also released this week.  These memos address testing requirements for nursing homes that include all staff which CMS defines in the memos to include contractors.
  Laboratory Testing Update: QSO-20-37-CLIA, NH
  Nursing Home Testing Update: QSO-20-38-NH

 

• CMS has announced targeted COVID-19 Training for Frontline Nursing Home Staff & Management, with five specific modules designed for frontline clinical staff and 10 designed for nursing home management.  8/25/20
   
• CMS and CDC will have subject matter experts available on bi-weekly webinars from August 27, 2020, through January 7, 2021, from 4–5pm ET, to answer questions. Registration is required for these Question & Answer sessions. 8/25/20
   
• Center for Medicaid & CHIP Services Informational Bulletin Re: Nursing Home Strategies for COVID-19 Only Isolation of COVID-19 Residents   8/24/20  (Identifies flexibilities available to state Medicaid agencies to enhance payment for nursing facilities during the public health emergency to account for increased resident acuity levels and to support any necessary actions that facilities are implementing to mitigate the further spread of COVID-19.)
   
• Trump Administration Has Issued More Than $15Million in Fines to Nursing Homes during COVID-19 Pandemic  8/14/20  
   
• CMS has updated Nursing Home Infection Control Surveys  in an Excel spreadsheet zip file.  8/6/20.  You can also access this information on the Five-Star Quality Rating System webpage.  Scroll down to the bottom of the page to Related Links. 
   
• CMS has updated their FAQ on COVID-19 Testing at SNFs/Nursing Homes  8/5/20
   
• CMS Updates Data on COVID-19 Impacts on Medicare Beneficiaries 7-28-20
   
  • COVID-19 Medicare data snapshot updated 7/28/20
  • COVID-19 Data Release External FAQs
     

• Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes . . . Version 6.  Updated 7/27/20 (Updated reference to PA Department of Health release of three-step process for reopening skilled nursing facilities.)
   

• CMS has issued tip sheets to help LTCH, IRF, SNF, and Home Health providers understand each setting’s Quality Reporting Program (QRP) during COVID-19.
   
  • Go to the LTCH QRP Training webpage or download LTCH_QRP COVID_19_PHE_Tip_Sheet _July_2020 (PDF)
     
  • Go to the IRF QRP Training webpage or download IRF_QRP COVID_19_PHE_Tip_Sheet _July_2020 (PDF)
     
  • Go to the SNF QRP Training webpage or download SNF_QRP COVID_19_PHE_Tip_Sheet _July_2020 (PDF)
     
  • Go to the Home Health QRP Training webpage or download HH QRP COVID-19 PHE Tip Sheet July 2020 (PDF)
     

• CMS had delayed the release the Q4FY19 PEPPER reports for many provider types.  CMS has now directed the PEPPER team to resume PEPPER distribution according to the following schedule:
  • July 16, 2020: Q1FY20 ST PEPPERs (originally scheduled release date: June 3, 2020)
  • July 29, 2020: Q4FY19 PEPPERs for CAHs, LTACHs, IPFs, IRFs, hospices, and SNFs (originally scheduled release date: April 6, 2020)
  • August 12, 2020: Q4CY19 PEPPERs for HHAs and PHPs (originally scheduled release date: July 8, 2020)
  • More information can be found on the CMS page where this was announced. 
     
• CMS Frequently Asked Questions to Assist Medicare Providers Updated 7/15/20 (Section on cost reporting updated to reflect delayed filing deadlines for various cost reports.)
   
• CMS Directs Additional Resources to Nursing Homes in COVID-19 Hotspot Areas  7/10/20  (CMS will deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in hotspot areas as identified by the White House Coronavirus Task Force.)
   
• Five Things About Nursing Homes During COVID-19  7/9/20 (CMS Administrator Seema Verma discusses the five major steps that CMS has taken to safeguard and protect the well-being of patients and residents in nursing homes.)
   
• CMS Ends Emergency Blanket Waiver for the Nursing Home Staffing Data Submission Requirement  6/25/20  (Ends the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System.)​
   
  • ​Memorandum to states and nursing home stakeholders providing updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System.
     
• CMS released claims data on the impact of the coronavirus disease 2019 (COVID-19) pandemic on the Medicare population. 6/22/20
   
  • FAQ on this data release
  • Blog by CMS Administrator Seema Verma
    ​
• CMS Recommendations - Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare  6/8/20  (Recommendations to help guide healthcare systems and patients as they consider seeking in-person, non-emergency treatment.)
   
  • Re-Opening America:  What Patients Should Know about Seeking Healthcare
• ​ Nursing Home COVID-19 Data and Inspections Results Available on Nursing Home Compare  6-4-20  (CMS posted the initial data collected from nursing homes’ reports to the CDC's NHSN.)
   
  • Targeted inspections conducted after changes to the survey process were announced in March - zip file 
  • Map of COVID-19 statistics listed by individual facility
     
• CMS memo to State Survey Agency Directors Re COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes  (Recommendations for stepped up survey efforts around COVID-19 to include the use of CARES Act funding for state survey activities.) 6-1-20 
  ​
  • Press Release: Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results
  • Related Joint Letter from CMS and CDC to the Nation’s Governors
     
• CMS’ Quality Improvement Organization (QIO) Program (Training slides and worksheets from CMS’ first of eight weekly training sessions on setting up an infection control and prevention program.  Sign up here to receive information on future installments in the National Nursing Home Training Series.)
   
• CMS State Survey Memo regarding Nursing Home Reopening Recommendations for State and Local Officials  5/19/20 (Details crucial steps nursing homes and communities should take prior to relaxing restrictions implemented to prevent the spread of COVID-19)
   
  • NASL Summary  
  • CMS Guidance
  • FAQs
     
• CMS Announcement re Nursing Home Reporting Requirement 5/15/20 (Nursing homes are required to report the first week of data to the CDC beginning May 8 but no later than May 17.) 
   
• Verma: COVID-19 Data Will Appear on Nursing Home Compare, First Public Report by End of May  Skilled Nursing News, 5/14/20 (CMS Administrator Verma confirmed in a call with reporters that newly required COVID-19 data will eventually appear on Nursing Home Compare)
   
• CMS releases an updated COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (updates do not seem to apply to nursing facilities) 5/15/20 
   
• CMS Issues Nursing Homes Best Practices Toolkit to Combat COVID-19  (updated 5/13/20)  (Includes additional resources to aid in the fight against the COVID-19 pandemic within nursing homes.)
   
• IPPS and LTCH PPS:  FY 2021 Proposed Rule  5/11/20  (Updates Medicare payment policies for hospitals paid under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System for FY 2021.)
   
  • Fact Sheet
  • Proposed Rule
     
• Updates to the COVID-19 Focused Survey for Nursing Homes (CMS updated the facility self-assessment on page 4 of 21 page document; COVID-19 Focused Survey for Nursing Homes begins on page 6.)  5/6/20
   
• Letter from Seema Verma to Nursing Home Management and Staff 5/11/20 (Expressing gratitude for the unwavering dedication and commitment of nursing home management and staff in keeping residents safe and for continuing to compassionately care for them during this unprecedented time.)  5/11/20  
   

• CMS updated errata (V3.00.4) for the current MDS 3.0 Technical Data Specifications  5/15/20  (Item Sets support states’ abilities to calculate PDPM payment codes that was problematic under the previous MDS 3.0 Item Sets v1.17.1.)
   
  • MDS 3.0 Technical Information webpage
  • Updated MDS 3.0 Item Sets v1.17.2
  • Technical Data Specifications:  0_Final_Item_Sets_v1.17.2 for October 1 2020 zip (ZIP)
  • CMS updated Errata V3.00.4for MDS 3.0 V3.00.1 (FINAL) Data Submission Specifications  4-30-20
     

• CMS Interim Final Rule with Comment Period - Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program  5/8/20  (directs SNFs and NF) to provide two types of reports about cases of COVID-19 among nursing home residents and staff:  1) public health reporting that shares data with the CDC and 2) facility reporting to inform residents, their representatives & families about any occurrences of COVID-19 within a facility.)
   
• CMS Memo to State Survey Agency Directors regarding release of Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes  5/6/20
   
• Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency 4/30/20  (Allows health care professionals previously ineligible to furnish and bill for Medicare telehealth services, including PTs, OTs, and SLPs, to receive payment for Medicare telehealth services for the duration of the COVID-19 emergency BUT NO CLARITY AS TO WHETHER THIS APPLIES TO THE NURSING FACILITY SETTING; Medicare will now pay when labs send trained techs to collect samples from homebound or non-hospital inpatients for COVID-19 diagnostic testing; Medicare will no longer require an order from the treating physician for beneficiaries to get COVID-19 tests.) 4/30/20
   
  • NASL’s Short Summary   
  • Text of the Interim Final Rule  
  • CMS’s Press Release    
  • CMS updated Fact Sheets related to the COVID-19 Response  
     
• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19 (Compilation of nursing home related waivers including new requirement to report COVID cases) 4/29/20
   
• Nursing Home Five Star Quality Rating System Updates – Nursing Home Staffing, PBJ & FAQs  (announced the hold on the inspection domain, the PBJ changes and FAQs) 4/24/20
   
• CMS Memo to State Survey Directors regarding Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions.   4/24/20 (CMS will post a list of the inspection surveys and their findings through a link on the Nursing Home Compare website; CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home each day, to help direct adequate personal protective equipment and testing to nursing homes*; and another list of FAQs to clarify certain actions taken related to visitation, surveys, waivers, and other guidance.)  
  *The Vice President later announced that PPE was being shipped directly to all 15,000 nursing homes around the country.
   
• CMS Quality, Safety & Oversight Group Memo to State Survey Agency Directors regarding Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID19 Persons under Investigation) Among Residents and Staff in Nursing Homes Ref: QSO-20-26-NH  4/19/20  
   
• CMS Memo to State Survey Agency Directors re: Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID19 Persons under Investigation) Among Residents and Staff in Nursing Homes  4/19/20
   
• CMS recommendations for communities that are in Phase 1 of the Guidelines for President Trump’s Opening Up America Again with low incidence or relatively low and stable incidence of COVID-19 cases. 4/19/20
   
• The Guidelines for Opening Up America Again (in general)  4/18/20
   
• CMS Memo to State Survey Agency Directors re: 2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios 4/13/20
   
• COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers    4/9/20  (some SNF-specific information)
   
• “Dear Clinician” letter from CMS  4/7/20  (Information on advanced payments, swabs, virtual check ins, telehealth, workforce flexibilities.  Seems to package up current information and gear it towards clinicians.)
   
• CMS’ COVID-19 Long-Term Care Facility Guidance 4/2/20
   
• COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers  3/30/20  (SNF waivers including 3-day stay, MDS, PASARR, PBJ, Physician environment, physician visits to SNF by telehealth, also includes some hospital, IRF information)
   
• Expansion of CMS' Accelerated and Advance Payment Program for Medicare Participating Health Care Providers and Suppliers (3/28/20):
   
  • CMS Press Release
  • CMS Fact Sheet 
     
• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID   3/28/20  (Early information on flexibilities and waivers, information on Medicare appeals in Fee for Service, Medicare Advantage and Part D, CMS Facility without Walls.)
   
• COVID-19 Provider Burden Relief Frequently Asked Questions (FAQs)   3/20 (Short document.  Includes suspension of medical review, Review Choice Demonstration for Home Health Services) 
   
• COVID-19 Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs)  3/20  (Includes information on waiving state licensure of practitioners, and Part A provider enrollment.
   

• CMS tapped into the Civil Money Penalty Reinvestment Program as a means for addressing the issue of resources to facilitate virtual visits between nursing facility residents and their families. A template application, COVID-19 Application for State CMP Funds for Communication Technology, has been posted or adapted by various State Medicaid Agencies.  Questions regarding CMP fund use should be directed to your state agency’s CMP contact. 
  
  Additional Resources:

 

• CMS’ Civil Money Penalty Reinvestment Program webpage
• CMS memo on State CMP Funds for COVID-19, QSO-20-28-NH
• CMS memo on State CMP Funds, S&C Memo 12-13-NH
• CMS’ CMPRP FAQs
• Examplesof 8 CMP-funded projects 
• Examples of recently funded projects listed by state
• CMS’ CMP Reinvestment Application Resources
   

CMS - ICD-10

 

• New CDC ICD-10-CM codes added 12/3/20 for the 2019 Novel Coronavirus (COVID-19) to allow more information to be captured by CDC surveillance and through health care claims. 
   
• CMS updates for the FY 2021 2021 ICD-10-CM diagnosis codes. Providers should use these codes for discharges and patient encounters that occur from October 1, 2020, through September 30, 2021.  6/12/20
   
• CMS has posted FY 2021 ICD-10-PCS procedure code updates, to include a complete list of code titles, on the 2021 ICD-10-PCS webpage. CMS will post updated FY 2021 ICD-10-CM diagnosis codes later. 5/28/20
   

• CMS also rescinded MLN Matters article MM11749, released on May 1, 2020 entitled, International Classification of Diseases, 10^thRevision (ICD-10) & Other Coding Revisions to National Coverage Determination (NCDs) – October 2020 Update. The article was rescinded on May 26, 2020, when Change Request 11749, Transmittal 10092, which also was dated May 1, 2020, was rescinded in its entirety. CMS notes, “… any coding changes to National Coverage Determination 90.2, Next Generation Sequencing, contained in CR 11749 are null and void.”
   

CMS – Nursing Facility Specific Visitation and PPE Guidance

 

• Severe Staffing And Personal Protective Equipment Shortages Faced By Nursing Homes During The COVID-19 Pandemic, Health Affairs, 8/20/20
   
• CMS Memo from the Center for Clinical Standards and Quality/Quality, Safety & Oversight to State Survey Agency Directors regarding Long-Term Care Facility Transfer Scenarios   4/13/20  (Supplemental information for transferring or discharging residents between facilities for the purpose of co-horting residents based on COVID-19.)
   
• COVID-19 Long-Term Care Facility Guidance  4/2/20 (Should be read in conjunction with the March 13^th memo below.  Includes guidance that facilities should use separate staffing teams for COVID-19-positive residents and to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents.)
   
• CMS Memo from Center for Clinical Standards and Quality/Quality, Safety & Oversight Group to  State Survey Agency Directors RE: Guidance for Infection Control and Prevention of Coronavirus Disease (COVID19) in Outpatient Settings: FAQs and Considerations  3/30/20 
   
• CMS Memo from Center for Clinical Standards and Quality/Quality, Safety & Oversight Group to State Survey Agency Directors RE: Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (REVISED)   3/13/20  (This is the current guidance on infection control including transmission and visitation in nursing homes.)
   
• OSHA:  Enforcement Guidance for Respiratory Protection and the N95 Shortage Due to the Coronavirus Disease 2019 (COVID-19) Pandemic 4/3/20 (Interim Guidance to employers to extend the use of N95 respirators, use and reuse of them.)        
               
• Enforcement Guidance for Use of Respiratory Protection Equipment Certified under Standards of Other Countries or Jurisdictions During the Coronavirus Disease 2019 (COVID-19) Pandemic    4/3/20 (Allows employers in certain circumstances to use respirators approved by another country, where NIOSH-approved respirators are not available.)
   

CMS - Waiving the 3-day Stay Requirement
 

• Declaration of Public Health Emergency 3/1/20 (Establishes the date that the 3-day stay waiver authorities began.)
   
• CMS Transmittal on the 1812f Waiver 3/13/20
   
• CMS’ FAQ – Medicare Fee-For-Service Additional Emergency & Disaster-Related Policies & Procedures That May Be Implemented Only With An §1135 Waiver
   
• CMS’ Current Emergencies Webpage
   
• AHCA's 3-Day Stay & Spell of Illness FAQ
   
• CMS COVID-19 Emergency Declaration Health Care Providers Fact Sheet
   

Coronavirus Commission for Safety & Quality in Nursing Homes

 

• NASL letter urging the Commission to prioritize nursing facility patients, the providers who care for them and the services that they need as the Commission identifies best practices for nursing facilities to enable rapid and effective identification and mitigation of transmission of COVID-19 and other infectious diseases. 7/17/20
   

• 25 EXPERTS NAMED TO INDEPENDENT CORONAVIRUS COMMISSION FOR SAFETY AND QUALITY IN NURSING HOMES  6/19/20  (Members of the White House’s new Coronavirus Commission for Safety and Quality in Nursing Homes includes 25 stakeholders with a variety of different backgrounds and experience in nursing home management as well as safety and quality. The deadline to issue its report is September 1, 2020.)
   
• CMS Press Release:  Trump Administration Announces Call for Nominations for Nursing Home Commission  5/14/20
   
• CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes  (CMS announced an independent Commission to  conduct comprehensive assessment of the nursing home response to COVID-19 pandemic) 4/30/20
   

GAO

 

• GAO report entitled, “Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic.”  5/20/20  (82% of nursing homes surveyed from 2013-2017 were cited for infection prevention and control deficiencies.)
   
• Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare Is Needed. (Found on page 17 of 4/23/20 letter to Secretary Azar re Priority Open Recommendations: Department of Health and Human Services.)  Recommendation: CMS should establish standard Medicaid reporting requirements for all states to annually report key information on critical incidents.
   

Guidance on Therapy in Nursing Homes

 

• Preparing for COVID-19: Long-term Care Facilities, Nursing Homes Updated 6/25/20
   
• AHCA Guidance Document - Steps to Limit COVID-19 Spread and Outbreaks in Long Term Care 4/2/20
   
• AHCA guidance document Making Decisions on Essential Staff Entering Your Building The guidance helps nursing facilities assess the risk-benefit of working with various essential services such as rehabilitation therapy, lab and portable x-ray.   3/24/20
   
• AHCA Guidance Document - The Role of Physical and Occupational Therapy and Speech-Language Pathology Personnel in LTC Facilities During the COVID-19 Pandemic  3/19/20
   
• Skilled Nursing News Article - CDC: Sharing Staffers Among Multiple Nursing Homes Hastened Coronavirus Spread  3/18/20