| CMS Announces Changes to 1135 Waivers | https://publish.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Announces-Changes-to-1135-Waivers.aspx | CMS Announces Changes to 1135 Waivers | | | | | 4/9/2021 4:00:00 AM | | <p></p><div>This week, CMS <a href="https://www.cms.gov/files/document/qso-21-17-nh.pdf" target="_blank">issued</a> a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 Public Health Emergency (PHE). These changes are effective May 10, 2021. The four waivers that will be ending relate to prior notification of room and roommate change, prior notice of transfer/discharge, certain care planning requirements and MDS submission. </div><div> </div><div>CMS also provides clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs). Currently, CMS is <strong>keeping</strong> the current nurse aide waiver. </div><div> </div><div><strong>Summary of Removed Waivers</strong> </div><div><br></div><div>CMS is making the following changes to blanket 1135 waivers, effective May 10, 2021. CMS’ rationale for removing these waivers is that facilities have developed processes for completing these requirements at this point. </div><div><br></div><div><ul><li>Resident roommates and grouping: <span style="font-size:11pt;"></span></li><ul><li><span style="font-size:11pt;">Ending: waiver of notification prior to Resident Room or Roommate Change at 42 CFR §483.10(e)(6). </span></li><li><span style="font-size:11pt;"></span>Keeping: related waivers at 42 CFR 483.10(e)(5) and (7) when change of rooms is done solely for purposes of cohorting due to COVID-19. </li><li>I<span style="font-size:11pt;">mpact: You must provide notice before a room or roommate change except when the change is solely for COVID-19 cohorting. </span></li></ul><li>R<span style="font-size:11pt;">esident transfer and discharge:</span></li><ul><li>Ending: waiver of notification prior to Transfer and Discharge at 42 CFR §483.15(c)(4)(ii) </li><li>Keeping: related waivers at 42 CFR 483.10(c)(5) as well as 483.15(c)(3), (c)(5)(i) and (iv) and (c)(9), and (d) that allow providers to transfer or discharge residents to another long term care facility solely for cohorting purposes without prior written notice. </li><ul><li><strong>Note:</strong> It is important to <a href="https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf" target="_blank">read</a> the details of these waivers to ensure you are applying them correctly and provide notice as soon as possible when transferring or discharging residents for cohorting purposes. </li></ul><li>Impact: You must provide written notice of transfer or discharge at least 30 days in advance, or as soon as practicable in certain situations, before the transfer or discharge. </li></ul><li>Care planning requirements: </li><ul><li>Ending: waiver of certain care planning requirements at §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) for residents transferred or discharged for cohorting purposes. </li><li>Impact: You must complete baseline care plans within 48 hours of admission and comprehensive care plans within seven days of completion of the comprehensive assessment, according to current regulations. </li></ul><li><span style="font-size:11pt;">Minimum Data Set (MDS): </span></li><ul><li>Ending: waiver of timeframe requirements for completing and transmitting resident assessment information at 42 CFR §483.20. </li><li>Keeping: waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR). </li><li>Impact: You must complete and transmit MDS assessments according to current regulations. <br></li></ul></ul></div><div><strong><br>Additional NATCEP Information </strong></div><div> </div><div>AHCA/NCAL is pleased that CMS has recognized that time worked by the nurse aides during the PHE may count towards meeting the federal 75-hour training requirement and is encouraging states to evaluate their NATCEP to consider time worked during the PHE to help temporary nurse aides become certified nurse aides (CNA). CMS has also clarified that the four-month regulatory timeframe for completing the nurse aide training and competency evaluation requirements after hire will be reinstated when the blanket waiver ends and <strong>will start at that time</strong>. Nurse aides will have the full four-month period starting from the end of the blanket waiver to successfully complete the required training and certification, regardless of the amount of time worked during the time the waiver was in effect. Federal requirements do not specify whether training must be delivered in a classroom versus a nursing home setting, and CMS acknowledges that training on many of the required topics can be obtained in a nursing home setting while working as a nurse aide under the waiver and through onsite experience and observation. </div><div> </div><div>AHCA/NCAL strongly encourages states, providers and temporary nurse aides to explore ways to complete the nurse aide training and certification requirements as soon as possible to retain the thousands of individuals who have provided vital care and support to residents throughout the pandemic. The process of transitioning from a temporary nurse aide to a CNA takes time and these pathways vary depending on the state. We encourage you to contact your state licensing agency, state affiliate or AHCA/NCAL at <a href="mailto:educate@ahca.org" target="_blank">educate@ahca.org</a> with any questions. States must ensure that all of the required areas of training per 42 CFR §483.152(b) are addressed, and any gaps in onsite training that are identified are fulfilled through supplemental training. Nurse aides must still successfully pass the state’s competency exam per 42 CFR §483.154. </div><div> </div><div>Currently, it is <a href="https://ccf.georgetown.edu/wp-content/uploads/2021/01/Public-Health-Emergency-Message-to-Governors.pdf" target="_blank">expected</a> that HHS will renew its declaration of public health emergency through the end of 2021 and will provide 60 days’ notice prior to ending it. As long as the PHE is in place, CMS may retain its 1135 waivers. However, CMS could decide to phase out other waivers prior to the end of the PHE if it determines they are no longer needed. CMS will continue to monitor the emergency blanket waivers and may provide future updates. </div><div><br></div><div>You can access <a href="https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf" target="_blank">more information</a> regarding these changes and current waivers that remain in place. For questions, please contact <a href="mailto:covid19@ahca.org" target="_blank">covid19@ahca.org.</a> <br></div> | This week CMS issued a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 PHE. | |
| PRF Use – A Refresher and Preparing for Reporting | https://publish.ahcancal.org/News-and-Communications/Blog/Pages/PRF-Use-–-A-Refresher-and-Preparing-for-Reporting.aspx | PRF Use – A Refresher and Preparing for Reporting | | | | | 4/8/2021 4:00:00 AM | | <p></p><div>All recipients of Provider Relief Fund (PRF) payments must comply with the reporting requirements described in the <a href="https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#terms-and-conditions" target="_blank">Terms and Conditions</a> and specified in directions issued by the U.S. Department of Health and Human Services (HHS) Secretary. Recipients of PRF payments exceeding $10,000 in aggregate must register in the <a href="https://prfreporting.hrsa.gov/s/" target="_blank">Provider Relief Fund Reporting Portal</a>. At present, there is no deadline for completing registration in the portal. Recipients will later receive a notification about when they should complete the second step of submitting reporting requirements information on the use of funds. The Health Resources and Services Administration (HRSA) will send a broadcast email to the email address you provide during the registration process. The registration process will take at least 20 minutes to complete and must be completed in one session. You cannot save a partially complete registration. Make sure you have all of the information required to register before you begin. </div><div><br></div><div>It is important to note that, as of now, PRF must be expended no later than June 30, 2021. HHS will provide directions in the future about how to return unused funds. HHS reserves the right to audit PRF recipients now or in the future, and is authorized to collect any PRF amounts that were overpaid or not used in a manner consistent with program requirements or applicable law. All payment recipients must attest to the Terms and Conditions, which require the submission of documentation to substantiate that these funds were used for health care-related expenses or lost revenue attributable to coronavirus. </div><div><br></div><div>More details on the reporting requirements can be found on the <a href="https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/index.html" target="_blank">HHS webpage</a>. AHCA/NCAL also has a <a href="https://educate.ahcancal.org/products/prf-reporting-requirements-updated-january-25th" target="_blank">pre-recorded webex</a> available on the January 15, 2021 PRF reporting registration instructions as well as the updated reporting guidance for members. The recording includes detail on registration, important registration FAQs, recommended terms and conditions, compliance controls, and a PRF reporting update overview. Finally, AHCA/NCAL has a dedicated <a href="/Reimbursement/Pages/COVID-19-Funding.aspx" target="_blank">PRF webpage</a> with resources and information you might find of assistance – including an AHCA/NCAL document that offers detail on use of funds for health care related expenses and transfer of funds to higher need buildings. Please send any PRF related questions to <a href="mailto:COVID19@ahca.org" target="_blank">COVID19@ahca.org</a>.<br></div> | All recipients of PRF payments must comply with the reporting requirements described in the Terms and Conditions and specified in directions issued by the HHS Secretary. | |
| Nursing Homes Face Imminent Closures Without Financial Support from Congress | https://publish.ahcancal.org/News-and-Communications/Press-Releases/Pages/Nursing-Homes-Face-Imminent-Closures-Without-Financial-Support-From-Congress.aspx | Nursing Homes Face Imminent Closures Without Financial Support from Congress | | | | | 4/8/2021 4:00:00 AM | | <p></p><div>Nursing homes across the country are in economic turmoil. Long-standing financial shortfalls, largely due to Medicaid underfunding, have been magnified by the COVID-19 pandemic. In addition, the pandemic has worsened chronic workforce shortages and has contributed to a drastic decline in patient census. Many nursing homes were already operating at a loss, and without immediate financial assistance, closures are imminent. </div><div><br></div><div>As Modern Healthcare <a href="https://www.modernhealthcare.com/post-acute-care/pandemic-prompts-rethinking-long-term-care-models" target="_blank">reports</a>, “The pandemic has thrown the long-term care industry into a tailspin.” Andy Edeburn, a principal at consulting organization Premier, said, “Not all nursing homes are going to come back,” and added, “I don’t know that the nursing home industry will ever go back to the way it was … It’s an industry in crisis for a number of reasons.” </div><div><br></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) <a href="https://d3dkdvqff0zqx.cloudfront.net/groups/ahca/attachments/protect%20access%20to%20long%20term%20care_ib.pdf" target="_blank">estimates</a> that within a two-year period (2020-2021), the long term care industry will lose $94 billion due to the increased costs needed to fight the pandemic and declining revenues. For example, in 2020 alone, nursing homes spent roughly $30 billion on personal protective equipment (PPE) and additional staffing. </div><div><br></div><div>Nursing homes experienced fewer short-term stays amid the pandemic, such as patients coming from the hospital for physical therapy and rehabilitation. From 2020 to 2021, nursing home occupancy declined by 16.5 percent to 68.5 percent. </div><div><br></div><div>More than <a href="https://d3dkdvqff0zqx.cloudfront.net/groups/ahca/attachments/protect%20access%20to%20long%20term%20care_ib.pdf" target="_blank">1,600 nursing homes</a> could close this year as a result of mounting financial challenges. Closures have a devastating impact on residents, their families, and staff. When a nursing home closes, vulnerable seniors are uprooted from their communities and forced to find new care options. The average age of a nursing home resident is 85 – most of whom have multiple underlying health conditions. These residents require a high level of specialized care that in-home care is often unable to provide. </div><div><br></div><div>AHCA and LeadingAge have proposed the <a href="https://www.mcknights.com/news/clinical-news/nursing-home-advocates-urge-24-hour-nurses-ppe-mandates-in-sweeping-reform-agenda/" target="_blank">Care For Our Seniors Act</a> – a package of policy reforms that will help address many of the long-standing challenges in America’s nursing homes. However, implementation will not be possible without a significant investment from Congress and state governments – this includes immediate and long-term solutions to address chronic Medicaid underfunding. Sixty percent of nursing home residents rely on Medicaid for their daily care, and without a commitment from lawmakers to increase Medicaid reimbursement rates, most nursing homes will be unable to afford the substantive reforms required to continue improving quality of care. </div><div><br></div><div>Nursing homes care for our nation’s most vulnerable population, and demand for long term care services will only increase in the years to come. Without support from federal and state lawmakers, financial challenges will continue. We must work together to improve nursing home care and ensure all seniors have access to high-quality long term care options. </div><div><br></div><div><strong>ABOUT AHCA/NCAL </strong></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit <a href="/Pages/default.aspx" target="_blank">www.ahcancal.org</a>.<br></div> | Nursing homes across the country are in economic turmoil. | |
| AHCA Statement on Proposed Rule for Skilled Nursing Facilities’ Medicare Rates and Vaccination Reporting Requirements | https://publish.ahcancal.org/News-and-Communications/Press-Releases/Pages/AHCA-Statement-on-Proposed-Rule-for-Skilled-Nursing-Facilities’-Medicare-Rates-and-Vaccination-Reporting-Requirements.aspx | AHCA Statement on Proposed Rule for Skilled Nursing Facilities’ Medicare Rates and Vaccination Reporting Requirements | | | | | 4/8/2021 4:00:00 AM | | <p></p><div><strong>Washington, D.C.</strong> — Mark Parkinson, President and CEO of the American Health Care Association (AHCA), made the following statement regarding the Skilled Nursing Facility Prospective Payment System (SNF PPS) FY 2022 proposed rule released by the Centers for Medicare and Medicaid Services (CMS) today. </div><div> </div><div>“CMS proposes to increase Medicare rates to skilled nursing facilities 1.3 percent in the next fiscal year which would result in an increase of approximately $444 million in Medicare Part A payments to SNFs in FY 2022. </div><div><br></div><div>“Nursing homes across the country continue to dedicate extensive resources to protect their residents and staff from COVID-19. This ongoing work makes government support and robust reimbursement rates more important than ever. With the skilled nursing profession grappling with an economic crisis and hundreds of facilities on the brink of closure due to the pandemic, it is critical that Medicare remain a reliable funding source and reflect the increasing costs providers are facing. </div><div> </div><div>“We also recognize the importance of quality measures associated with COVID-19 including a proposed measure of the COVID-19 Vaccination Coverage among health care personnel. We thank Acting Administrator Richter and the Administration for their support through the pandemic.”</div><div><br></div><div><strong>ABOUT AHCA/NCAL </strong></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit <a href="/Pages/default.aspx" target="_blank">www.ahcancal.org</a>.<br></div> | Mark Parkinson, President and CEO of AHCA, made the following statement regarding the SNF PPS FY 2022 proposed rule released by CMS today. | |