The legislature approved HB 6159 yesterday, granting immunity to health care providers and facilities, including nursing facilities and homes for the aged and their staff, for medical services provided in response to COVID-19. These liability protections are granted from March 29 through July 14, when the state and the profession were hardest hit by the virus. The liability protections would not apply to gross negligence or willful misconduct. The bill was included in negotiations between the legislature and administration, and it is expected that it will be signed by Governor Whitmer. HCAM continues to advocate for immunity for facilities as they continue to fight COVID-19 today and for the foreseeable future. You may find the bill and track its progress by clicking HERE.
SB 1094 - Placement of COVID-19 Residents
The legislature unanimously approved Senate Bill 1094 early this morning, and it is expected the bill will be signed by Governor Whitmer in the coming days. The bill reflects the Nursing Homes COVID-19 Preparedness Task Force recommendations on the establishment of Care and Recovery Centers (CRC) and the placement of COVID-19 residents. Under the bill, a nursing facility is precluded from admitting or retaining a resident who tested positive for COVID-19 unless the resident has recovered from COVID-19, the facility is approved by the Michigan Department of Health and Human Services (MDHHS) to be a CRC, or the facility demonstrates to the department that it meets the requirements in the bill to have a designated area to care for an individual who has tested positive for COVID-19. The bill gives priority to CRCs for the admission/retention of COVID-19 positive individuals unless the department determines there are "rare and unique" circumstances to protect the health and safety of the individual.
The bill also contains a provision directing MDHHS to implement a statewide policy for in-person indoor and outdoor visitation in nursing facilities. The policy may limit this visitation based on COVID presence in the facility and surrounding community.
HCAM advocated for changes in the bill to allow for flexibility in the admission and retention of COVID-19 residents to avoid unnecessary transfers. We will continue to work with the department on the implementation of this legislation and provide updates as policies are finalized.
HB 6137 - Reporting
The Michigan House of Representatives reported House Bill 6137 to the Senate, which requires MDHHS to post on the department's website data including total COVID-19 tests administered, positive cases, and deaths in nursing homes each week. This data will include cumulative data as well as weekly data. We do not anticipate the reporting requirements or methods for nursing facilities to change due to this bill. You may find the bill by clicking HERE.
Licensed Health Professional CE Update
The Michigan Bureau of Professional Licensing (BPL) recently shared with HCAM that participation in interactive, virtual programs that are presented live, and offer continuing education (CE) credit, may be utilized to satisfy in person CE requirements for relicensure. Educational programing that members attend in a live, virtual format can be included, however any pre-recorded or archived viewing of recorded sessions will not satisfy requirements for in person or face to face events.
The Nursing Home Administrator General Rules permit any number of continuing education credits to be earned in a format that permits "live interaction between the presenter and the licensee." R 339.14024(5). The credits do not need to be earned in-person, but the licensee must be able to interact with the presenter in real time.
Similarly, the Social Work General Rules permit any number of continuing education credits to be earned in a format that uses "live, synchronous contact" per R 338.2962(1).
The Nursing General Rules do not limit the total number of on-line continuing education hours. However, R 338.10602(1)(a) does limit the number of on-line hours earned in a 24-hour period as follows: "No more than 12 credit hours must be earned during a 24-hour period for online or electronic media, such as videos, internet web-based seminars, video conferences, online continuing education programs, and online journal articles."
CMS QRP Reporting Suspended - QRP QMs Frozen Until April 2022
The Centers for Medicare & Medicaid Services(CMS) released an updated tip sheet on the SNF QRP program several weeks ago detailing the strategy regarding data submissions during the COVID-19 public health emergency. These changes will impact the publicly reported quality measure data reported on Nursing Home Compare(NHC) and included in the Quality Reporting Program (QRP). CMS will now hold the data constant following the October 2020 refresh, which will include data from the fourth quarter of 2019. The site won't refresh and will remain frozen through Oct. 2021. Public reporting will resume in Jan. 2022 and a normal refresh will happen in April 2022.
This suspension will affect those QMs included in the QRP program:
Discharge to Community (DTC) - Post Acute Care (PAC) SNF QRP
Potentially Preventable 30-Days Post-Discharge Readmission Measure (PPR) for SNF QRP
Medicare Spending Per Beneficiary (MSPB) - PAC SNF QRP
Application of Percent of Long-Term Care Hospital Patients (LTCH) with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function (NQF #2631)
Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (NQF #0674)
Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
New OSHA Guidance for COVID-19 & AHCA/NCAL Resource Tools
The Occupational Safety and Health Administration (OSHA) released guidance for enforcement discretion when considering issuing citations for respirators and fit testing. This guidance applies only to fit-testing of NIOSH-approved tight-fitting Powered Air Purifying Respirators (PAPRs) used as a contingency capacity strategy when performing job tasks with high or very high occupational exposure risk to COVID-19. It does not apply to:
PAPRs that have not been approved by NIOSH;
PAPRs used by any workers with low or medium exposure risk to COVID-19;
PAPRs used by any workers for protection against airborne hazards other than COVID-19 (e.g., chemical hazards); and
Loose-fitting hooded PAPRs that do not require fit-testing.
Due to N95 shortages, employers should prioritize the use of fit-testing supplies to protect employees who must use respirators for high risk procedures, such as aerosol producing procedures.
OSHA will, on a case-by-case basis, exercise enforcement discretion when considering issuing citations for fit-testing and respirators when an employer has:
Provided NIOSH-approved tight-fitting PAPRs to protect personnel against COVID-19 using a high efficiency (HE) particulate cartridge or filter, when initial and/or annual fit-testing is infeasible due to shortages of N95, N99, N100, R95, R99, R100, P95, P99, and P100 respirators and/or fit-testing supplies;
Monitored fit-testing supplies and made good faith efforts to obtain fit-testing supplies;
Implemented, to the extent feasible, engineering controls, work practices, and/or administrative controls that reduce the need for respiratory protection, such as using partitions, restricting access, and cohorting patients; and
Maintained a fully-compliant RPP, other than fit-testing requirements, including ensuring personnel are informed of new policies and trained on new procedures, ensuring employees receive required medical evaluations, ensuring batteries and filters for PAPRs are well maintained to provide positive pressure throughout the entire shift or procedure, and ensuring employees wearing tight-fitting PAPRs maintain neatly trimmed facial hair that does not compromise the seal of the respirator or come between the sealing surface of the facepiece and the face, and that does not interfere with valve function.
Please note - Where the above efforts are absent and respiratory protection use is required, or voluntary use is permitted, and an employer fails to comply with applicable medical evaluation, fit-testing, maintenance, care, and training requirements, citations can be issued.
OSHA issued frequently asked questions regarding COVID-19 reporting obligations. In the FAQs, OSHA has clarified what is considered an "incident" in the case of COVID-19, which triggers the time period for calculating whether a case meets the reportability criteria. The term "incident" is defined by OSHA as an exposure to COVID-19 in the workplace as opposed to when an employee develops symptoms or tests positive for COVID-19.
AHCA/NCAL now has an Occupational Safety and Health Administration (OSHA) Respiratory Protection Plan Template developed by our OSHA Experts at Littler. Providers should note that if respirators are being used (such as N95s) you must have a Respiratory Protection Program in place to comply with OSHA standards. OSHA has fined long term care providers for not having the protection plan in place during the COVID-19 pandemic. The template is designed to be reviewed and tailored by each individual facility. Facilities should review the Respiratory Protection Standard (29.C.F.R. 1910.134).
Michigan Five-Year Health Information Technology Roadmap for LTC and Post-Acute Care
The Michigan Department of Health and Human Services (MDHHS), through the Michigan Health Information Technology (IT) Commission, is gathering input from stakeholders across the health and human services ecosystems, including long term care, in Michigan on current and future health IT needs, capabilities, and gaps to support coordinated care, patient engagement, program administration, research, and reporting requirements, which will be captured in an updated Five Year Health IT Roadmap, a guide for future planning, investments, and governance of the health IT (HIT) and health information exchange (HIE) infrastructure for the state of Michigan.
The survey seeks to help identify the current state of health information technology (HIT) and health information exchange (HIE), the barriers and challenges impeding use of HIT and HIE, and a desired future state where accelerated use of HIT and HIE supports better outcomes, more efficient care, a more satisfied healthcare workforce, and lower costs of delivering long term care healthcare and social services across Michigan. Please take about 20 minutes to ensure your perspectives are included in this important work by completing the survey below.