CMS Releases Updated Guidance on Visitation & Use of CMP Funds NOTE: The Michigan Department of Licensing & Regulatory Affairs (LARA) and the Michigan Department of Health & Human Services (MDHHS) are aware of the conflicts between the federal and state guidance. They are working internally to review and issue collaborative guidance. HCAM/MCAL will share as soon as available.
On Thursday evening, the Centers for Medicare & Medicaid Services (CMS) issued S&C Memo QSO 20-39-NH, providing updated guidance to begin allowing visitation in nursing facilities. The memo also provides the opportunity for providers to apply for Civil Monetary Penalty (CMP) funds to purchase items to support safe visitation. The CMS directive was released on the heels of the Coronavirus Commission for Safety & Quality in Nursing Homes recommendations, released publicly on September 16th.
In the S&C memo, CMS identifies the Core Principles of COVID-19 Infection Prevention, sharing these principles must be adhered to at all times. Within the scope of these principles, CMS shares that facilities are to begin opening visitation through the use of outdoor visits, and through indoor visits in certain situations. Likewise, communal dining and activities occurring within the scope of the core principles may begin. Failure to facilitate visitation, without adequate reasons related to clinical necessity or resident safety will be considered a violation of the federal regulations and subject to citation and enforcement actions.
The Core Principles identified by CMS include:
Under the guidance issued, outdoor visitation is preferred as it presents a lower risk of transmission. Facilities should create accessible and safe outdoor spaces for outdoor visitation as well as determine processes to limit the number and size of visits occurring simultaneously to support safe infection prevention. CMS also recommends limiting the number of individuals visiting a given resident at any one time.
In addition, facilities should accommodate and support indoor visits if a facility has had no new onset of COVID cases in the past 14 days and is not currently conducting Outbreak Testing. Indoor visits may be allowed beyond compassionate care situations in green or yellow counties as designated by the CMS County Positivity Rates. If in a red county, indoor visits must be limited to compassionate care situations. Indoor visits must comply with the Core Principles. Facilities should identify processes to limit the number of visitors per residents, and within the building at any given time. Visits may be scheduled for limited periods of time to accommodate all requested visits, and visitor movement within a building must be limited to moving from an entrance to the designated visitation area and back.
While adhering to the Core Principles, communal dining and activities may also resume for residents who are not in isolation for observation, or COVID affected.
To support providers efforts to facilitate visitation, CMS is allowing the use of CMP funds to purchase items such as tents or dividers to create physical barriers. Funds will be limited to $3,000 per facility. To apply or receive additional information please email MDHHS-CMPGrants@michigan.gov.
CMS Clarifies Data Release Schedule and Updates County Positivity Rates The Centers for Medicare & Medicaid Services (CMS) has clarified their data release schedule for county positivity rates, and indicated a move to weekly releases. CMS will continue to modify and update the method to classify a county as green, yellow or red and include a percentage rate in the database. Providers should identify a plan and process to check the CMS data weekly.
The most recent update this week demonstrates that all Michigan Counties remain at either green or yellow status.
As a reminder, the current Michigan Department of Health & Human Services (MDHHS) COVID testing requirements dictate a weekly cadence for routine staff testing. If a new positive result is identified in either staff or residents a facility must move to the CMS outbreak testing cadence of all residents & staff every 3-7 days until at least 14 days elapses with no further positives identified.
Additional Details on Nursing Home Incentive Payment Program Released Yesterday the US Department of Health & Human Services (HHS) released additional information on how the $2 billion in incentive payments will be distributed to nursing homes under the CARES Act. AHCA has shared a summary of those details as below:
Two Gateway Criteria for Incentive Payments For a facility to be eligible for an incentive payment, they must pass both criteria:
Incentive Payment Schedule and Performance Period The $2 billion in incentive payments will be split into five distributions of up to $400 million. Four of the distributions will be based on month long performance periods from September 2020 through December 2020. The fifth distribution will be an aggregated four-month performance period of September 2020 through December 2020.
Performance Period Tentative Payment Date Tentative Audit Date Incentive Pool Incentive Payment Calculation For each performance period and incentive distribution, the first 80% of the pool ($320 million) will be based on rate of infection. The other 20% of the pool ($80 million) will be based on mortality.
Infection Measure Calculation A facility's COVID infection performance will be measured on two factors. The first is the amount by which their rate is lower than their county's. The second is their total patient volume. Patients admitted to the facility with COVID will not be counted against the facility.
Mortality Measure Calculation A facility's mortality measure will be adjusted to account for facility-level characteristics and resident-level health and demographic characteristics. Additionally, direct outreach will be made to facilities with at least one death in the performance period and a mixture of COVID admissions and in-facility infections. This outreach will be used to determine how many of their reported COVID deaths were due to in-facility infections versus COVID admissions. NHSN data will be used as the primary source of identifying COVID deaths.
AHCA is inquiring for more details about the performance measure calculations and thresholds. We will share additional information as it becomes available. In the meantime, maintaining efforts to prevent COVID from entering a building and spreading among residents remains to be the most effective means for success under this incentive program.
Michigan's Insurers to Provide COVID-19 Testing, Treatment at No Cost Through the End of 2020 This morning, Governor Whitmer announced agreements with most of the state's health insurers to waive all out of-pocket costs for COVID-19 testing and treatments through the end of 2020. These agreements cover copays, deductibles, and coinsurance.
Through the end of 2020, individuals with coverage through the below listed individual or group health plans will not be charged for medically appropriate COVID-19-related medical treatment, such as primary care visits, diagnostic testing, emergency room visits, ambulance services, and U.S. Food and Drug Administration-approved medications and vaccines when they become available.
The insurers who have agreed to waive cost-sharing include:
Under the U.S. Families First Coronavirus Response Act, consumers with health insurance through Oscar, UnitedHealthcare, and other insurers not named in the state agreement currently have COVID-19 coverage without out-of-pocket costs during the federal public health emergency, which is currently set to expire in late October. These insurers may extend their coverage with no out-of-pocket costs so consumers should contact their agent or call the number on the back of their card to ask about their coverage before incurring costs for COVID-19 testing or treatment. In accordance with federal law, consumers with Medicaid or Medicare may also receive a no-cost COVID-19 test and related services provided by a health care provider.
For questions or concerns please contact Cathy Sunlin at CathySunlin@HCAM.org.
Sept. 18, 2020 |