CMS Announces Resumption of Survey Activity and Issues Updated Enforcement Guidance
The Centers for Medicare and Medicaid Services (CMS) issued Quality, Safety & Oversight memo QSO-20-35-ALL to states on Monday August 17, 2020 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. Of note, Michigan utilized its state discretion beginning in early June to resume survey activity.
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 Monday August 17, 2020. This process involves four components that are described in the QSO memo:
- Expanding the Desk Review policy for Plans of Corrections (POCs);
- Processing enforcement cases that were started BEFORE March 23, 2020;
- Processing enforcement cases that were started ON March 23, 2020, THROUGH May 31, 2020; and
- Processing enforcement cases that were started ON OR AFTER June 1, 2020.
The expansion of Desk Review offers the opportunity to complete a desk review for all open surveys exiting through May 31, 2020 and cited at any level of non-compliance, including noncompliance cited at the IJ level, when the IJ finding has been verified as removed or abated.
This updated guidance will be used to clarify the date of compliance for those facilities currently pending review of state agency assigned dates of compliance vs facility determined dates of compliance. In addition, CMS shared policy does not allow for retroactive impositions of Denial Of Payment For New Admissions (DPNA), and thus the only remedies that are permitted are per instance or per day Civil Monetary Penalties (CMPs).
Those providers who held back on submitting a Plan of Correction (POC) during the suspension period will now have 10 calendar days to submit their POC, until August 27, 2020.
HHS ECHO Partnership as Part of $5B Distribution Plan
In last week's US Department of Health & Human Services (HHS) press release concerning the $5B distribution and AHCA discussions with HHS staff afterward, HHS announced that nursing facilities could receive some funds if they voluntarily participate in project ECHO developed with funding from Agency of Health Care Research and Quality (AHRQ). The ECHO project teams plan to start recruiting nursing facilities this week and to reach out to AHCA and LeadingAge state associations this week. Below is a summary of what we know so far.
The ECHO team has partnered with Institute for Healthcare Improvement (IHI) and held a call last night, August 17, 2020, for organizations interested in serving as hubs. The ECHO team is looking to create 150 hubs that are based at Academic Universities or Medical Centers with geriatric or infectious disease faculty to run each hub. They have 25 so far in their existing network. They plan to launch this program on Sept 8th, which "allow SNFs to get the $2.5B to support additional PPE, staffing and testing resources needed to participate in this effort". The ECHO team told all the potential universities to start recruiting nursing facilities tomorrow (i.e., today Tuesday August 18, 2020) to have them read to start by Sept 8th.
The ECHO team expects the inclusion of approximately 100 nursing facilities per hub. Nursing facilities must participate in weekly 90 min Zoom meetings for a required minimum 16 weeks in order to receive the HHS voluntary payment amount, which is yet to be determined. They will limit each session to 34 nursing facilities to allow for exchange and discussion (which means that a hub with 100 nursing facilities will need to run three concurrent sessions each week). The first 8 weeks will serve as a "boot camp" for COVID related infection control practices, with the next 8 weeks focused on implementation science & strategies with quality assurance and quality improvement (QAPI) to "build long term infrastructure and systems for quality". Following this, nursing facilities would continue with optional weekly sessions for an additional 36 weeks. Each nursing facility will need to conduct a quality improvement project based on areas identified for changes.
Each nursing facility must have 4 individuals per facility participating in the project: the Medical Director, two Registered Nurses (RN) and one other staff. Participating facility staff will receive compensation for participation with each Medical director receiving $200 per session, each RN receiving $100 per session, and other staff receiving $50 per session, paid from the central ECHO office. The payment methodology has not been fully worked out yet. The ECHO team did not mention if there is any additional payment to nursing facilities. AHCA was verbally told by HHS staff that it may be in the range of $10,000 per facility that participates however it is not yet clear if that is in addition to the payment to the 4 staff participating in 16 weekly sessions or as a stand-alone payment.
IHI will assign each Hub a quality improvement expert and will build a curriculum based on QAPI with a focus on infection control. They also will provide national experts on infection control from academics and nursing facility leaders participating with IHI to identify best practices for COVID to share with participants in each hub. The goal is "to build a stable long-term learning network that not only will help with COIVD-19 response but can address any future problems or emergencies."
Hubs are encouraged to notify their state and national nursing facility associations "right away", starting "tomorrow to get their support". HHS stated they are planning a call with LeadingAge and AHCA later this week to discuss further and share additional information. Hubs should also reach out to their state public health director and governor to gain support. As additional information becomes available we will share with members.
MDHHS Releases Updated Direct Care Worker Wage Increase FAQs
On Friday, August 14 2020 the Michigan Department of Health & Human Services (MDHHS) issued an updated Direct Care Worker (DCW) Wage Increase FAQs. The updates included are highlighted for easy reference and include further clarification on base wage rates, allowing scheduled expirations of premium pay shared with employees prior to July 1, 2020 to proceed as planned.
Medicaid QMI Resident Satisfaction Survey
The Medicaid Quality Measure Initiative (QMI) program requires an annual survey on resident satisfaction. In late June, Medicaid issued L 20-36 notifying facilities of this requirement and where to send the survey results, along with establishing a due date for submission of data by September 18, 2020. If your facility does not submit survey data timely, your QMI payment will be reduced by 15 percent. Don't lose this funding by not getting your survey results in by the due date.
HCAM does not anticipate any changes to the satisfaction survey process. Medicaid has not specified a certain survey tool but allows providers to use their own tool each year. The facility will need to complete a new survey from previous years to reflect the residents who recently were provided services. Medicaid has established a QMI website where additional information and materials are available. Be aware the website still references 2019 materials, however these are still applicable for use. Any questions about QMI payments may be emailed to MDHHS-NFQMI@michigan.gov.
AHCA/NCAL Website Updates
On Monday, August 24, AHCA/NCAL will launch a redesigned www.ahcancal.org. This project was initially delayed due to COVID-19, however AHCA/NCAL staff shared they believe the association is now in a good place to make this transition. Member log-ins will remain the same as before. Member only content will be labeled with a little lock icon, and when logged in, the icon appears unlocked.
Beyond a more modern look, some anticipated key features and updates include:
- A new homepage featuring top issues and programs based on most trafficked areas of the site.
- A re-organized site designed to make content easier to find, and a collapsed menu bar that easily expands, to help users navigate throughout the entire site.
- NCAL.org will be integrated into AHCANCAL.org. Many resources and programs are applicable to both skilled nursing and assisted living, which users can find throughout the site. The site will have a special section dedicated uniquely to assisted living and NCAL.
- The Blog will be incorporated into AHCANCAL.org. Website analytics indicated that users are primarily interested in fresh content and updates on key topics. The blog was previously housed at www.longtermcareleader.com, which will be archived.
- Whether using the search tool, or browsing through events, press releases and blog posts, the website will offer easy-to-use filters to help users narrow their search.
- The website is optimized to perform and look better on mobile phones and tablets.
FEMA Proposed Rule Notice in the Federal Register: Prioritization and Allocation of Certain Scarce and Critical Health and Medical Resources for Domestic Use
In April, the Federal Emergency Management Agency (FEMA) issued a temporary final rule to allocate certain health and medical resources for domestic use, so that these resources may not be exported from the United States without explicit approval by FEMA. The rule covered several types of personal protective equipment (PPE), including N95 respirators, surgical masks, gloves, and gowns. While this rule remains in effect, and subject to certain exemptions stated below, no shipments of such designated materials may leave the United States without explicit approval by FEMA. This notice extends the duration of the temporary final rule through December 31, 2020.
For questions or concerns please contact Cathy Sunlin at CathySunlin@HCAM.org.
Aug. 18, 2020