The Lead June 11, 2021 - LeadingAge Illinois

From the Desk of Karen Messer, President and CEO

Supportive Living:
On-Site Reviews Are Underway

Nursing and Rehabilitation:
Vaccination Reporting Update
Monthly Occupied Bed Provider Assessment

Independent/Subsidized Housing:
HUD Publishes Guide for Virtual Service Coordination
ACL Webinar on Housing Plus Services
Federal Bill Establishes Entitlement to Housing Assistance
HUD Reinstates Affirmatively Furthering Fair Housing Rule

Home and Community Based Services:
CMS increases reimbursement rate for homebound vaccinations

Technology:
LeadingAge Supports New “Audio-Only” Telehealth Legislation Targeting Rural, Underserved Areas

Other:
OSHA News
World Elder Abuse Awareness Day
Fraud Alert: LeadingAge National Annual Meeting & EXPO Offers
Artmails Program

From the Desk of Karen Messer, President and CEO:
U.S. Congress is back to work and negotiations on the proposed infrastructure bill and funding for key programs is happening now. We need members to demand funding for safe and affordable housing and home and community-based services for older adults. Tell Congress to fund our aging services infrastructure now.

At a time when millions of older adults—a large proportion of them from marginalized communities—are facing hardships, it’s critical for Congress to take action by providing more support and resources. Tell your representatives in Congress that any infrastructure bill that goes forward must provide for safe and affordable housing designed specifically for older Americans, as well as home and community-based services.

With gratitude,

Karen

Top Stories:

Interim final Rule CMS-3414-IFC
CMS released interim final rule CMS-3414-IFC on vaccine education, offering, and reporting on May 13. The rule went into effect on May 21 and enforcement on vaccine and therapeutics reporting begins this coming Monday, June 14. More info is available in this CMS memo. Here’s a couple FAQs:

When/how often do I report? CDC wants the data to be as accurate as possible. The reporting week is Monday – Sunday so they say you can report on Mondays for the previous week or you can report on your regular day, then go back in later to correct the data. CMS says, “As long as you report once per week, you are in compliance.”
What does “cumulative” reporting mean in this requirement? The rule was effective May 21, and QSO-21-19-NH states that nursing homes must “begin including vaccination and therapeutics data by 10:59 p.m. CST on Sunday, June 13.” When you report, you are reporting on any eligible resident or staff member in that reporting week, regardless of whether they were vaccinated that week or 6 months ago, and regardless of whether they were vaccinated in your nursing home or at a location in the community.

Comments on this rule are due July 12. LeadingAge will be submitting comments on the rule and we encourage states and individual members to do so as well. We have developed this resource to assist in the process of submitting comments. If you have any questions on this resource or wish to discuss comments, please reach out to Jodi Eyigor at LeadingAge National.

Provider Relief Fund Update
U.S. Department of Health and Human Services (HHS) Secretary Becerra indicated this week that the department will be releasing new guidance soon that will address what providers can do with unspent Provider Relief Funds (PRF), how providers can “apply for and make use, good use, of their monies,” and also hinted that there would be some changes to how the remaining $24 billion in PRF monies is distributed. He would not say whether the deadline to spend Provider Relief Funds is June 30, 2021 will be adjusted in this guidance. Members should continue to spend their PRF monies by June 30, if possible.

Supportive Living:

On-Site Reviews Are Underway
The Illinois Department of Healthcare and Family Services (HFS) Supportive Living Program (SLP) staff have now resumed routine on-site reviews. HFS staff completing on-site reviews will be following guidance from the CDC and the Illinois Department of Public Health (IDPH). Staff who are not fully vaccinated will complete weekly COVID 19 testing. HFS staff will comply with your community’s assessment prior to entering the building. Additionally, HFS staff will have their own PPE available.

Since the phased attestation process for long term care providers was discontinued, HFS has developed new criteria to determine when routine on-site reviews can occur. Below is updated information.

When will my community receive an on-site review?
The following information is based on when HFS finalizes its processes for the resumption of routine on-site reviews. Routine on-site reviews, such as annual reviews, complaint investigations and follow up reviews for findings of non-compliance may begin after an SLP provider has not had a facility onset or associated case of COVID 19 for 14 consecutive days. Please note on-site reviews may occur prior to this time if there are immediate health and safety concerns.

When will my community’s annual review be scheduled?
SLP providers that have not had a facility onset or associated COVID 19 case in the last 14 days may be contacted to schedule an annual review. Due to the length of time since annual reviews have been completed, HFS staff will determine if some providers may skip an annual review year. For example, if an annual review was previously scheduled for May 2020, the FY20 annual review will be skipped and an FY21 annual review will be initiated. If your community was in the middle of an annual review when HFS discontinued on-site reviews in March 2020, that annual review will be scheduled with the provider for resumption.

How far back will documentation be reviewed during an annual review?
HFS will need to complete a record review for all current residents who were admitted since the last annual review. Since some providers will have an annual review skipped, the number of New Admit reviews HFS will be completing may be larger. There may also be additional Lag Admit Reviews, which are current residents who were admitted prior to the last annual review, however, due to a lag with admissions appearing in HFS’ system, these people were not reviewed as new admissions at that time. Some of these Lag Admits will include 2018 admissions. For example, an SLP’s last annual review was March 2019. There may have been 2018 admissions who were not included in the New Admit sample at that time. The March 2020 annual review did not occur due to the public health emergency. HFS will completed and FY21 annual review in May 2021. The Lag Admit review sample will include the 2018 admissions that were not reviewed during March 2019.

Record review for residents who are not new admissions will only examine the most current RAI, ISS/ISP, quarterly assessments. Other documents may be examined further back if a possible problem is identified, such as medication errors. The record review sample for these residents is a random representative sample that must include a minimum of 10 residents.

HFS will review hiring documentation for all current staff hired since the last annual review. The most recent annual staff training documentation will be reviewed. HFS will review the most current licensure and certification information for the building. This includes the kitchen inspection by the local health department, elevator inspection, etc. HFS will review the most recent resident satisfaction survey, TB Risk Assessment, etc.

Annual Level of Care Evaluations:
Requirements for annual Level of Care Determinations have been relaxed by federal CMS during the public health emergency. However, HFS still would like to complete as many as possible. These may be completed separately from an annual review.

When will complaint investigations take place?
SLP providers that have not had a facility onset or associated COVID 19 case in the past 14 days may receive on-site complaint investigations. These on-site reviews will continue to be unannounced. Federal CMS has approved flexibility with complaint investigations by allowing desk audits. All complaints received since March 2020 have been started as desk audits. Some complaints also require an on-site review. These will not be scheduled ahead of time. When there are multiple complaint investigations pending, HFS staff may complete an investigation for all during a single on-site review, especially when there is overlap with allegations, or if the information required is minimal. This will make the process more efficient for providers and HFS staff.

When will pending findings of non-compliance be issued?
SLP providers that have not had a facility onset or associated COVID 19 case in the past 14 days may receive findings for previously completed annual reviews and complaint investigations. These findings will be presented via phone and fax according to our normal exit procedures. Regional Supervisors will combine exits for complaint investigations and annual reviews together if there is an overlap with findings or a very small number of findings. The goal is to allow a provider to develop and implement one plan of correction if they have the same or similar findings for multiple reviews. This will also reduce the number of follow up reviews required. For example, if a complaint investigation and an annual review will have shared findings issued for 146.245 c RAI and 146.245 d Service Plan and also a finding for 146.230 b 3 Nursing Follow-up Care with the complaint, it make sense to issue at the same time since there is an overlap of findings and the plan of correction for all of the findings would also probably include in-servicing licensed nursing staff. Again, the goal is to have a more efficient process for providers and HFS staff.

Will my community be cited for requirements impacted by the COVID 19 pandemic?
HFS plans to be reasonable when determining findings related to requirements that were impacted by COVID 19. This includes but is not limited to untimely fingerprint checks when vendors were closed, expired CPR certification when training with a return demonstration was not being provided and late staff training. There were also some allowances made during the public health emergency, such as preadmission assessments being completed by phone and allowed as a post screen if completed within 10 days. Also the use of Temporary Nurse Aides (no longer allowed). Additionally, communal dining, large group activities and activities outside of the building have not been allowed at various points.

What processes do HFS staff have to follow for an on-site review?
HFS staff completing onsite reviews will be tested for COVID. They will also complete the assessment required by your community for entry to the building. HFS staff will have their own PPE.

Please continue to submit reports of facility onset and associated COVID cases to Kara Helton so that HFS can plan/adjust our schedules around outbreaks. You can also contact Kara with questions.

Nursing and Rehabilitation:

Vaccination Reporting Update
CMS included the first round of vaccination data in the most recent data update on the nursing home data site. The data reported is for reporting week Monday, May 24 – Sunday, May 30. Enforcement begins Monday, June 14, which means nursing homes must begin including vaccination and therapeutics data in weekly reporting by this Sunday, June 13 at 10:59 p.m. CST. NHSN has provided several resources to assist providers in reporting this data, available here. Some to highlight: training video and slides, the Tables of Instructions and printable forms for data collection, Guidance to COVID-19 Data Entry Screens, Uploading Group Data, Data Tracking Worksheets and Reference Guide, and Line Lists of COVID-19 Vaccination Data.

Monthly Occupied Bed Provider Assessment
The Illinois Department of Healthcare and Family Services (HFS) reports that the Monthly Occupied Bed Provider Assessment for long term care providers for the May 2021 assessment period and February 2021 reporting period is due June 15, 2021.

Independent/Subsidized Housing:

HUD Publishes Guide for Virtual Service Coordination
HUD published an appendix to its Service Coordinator Resource Guide that reviews strategies and considerations for virtual Service Coordination. The publication comes after many HUD-assisted senior housing properties shifted Service Coordinators to off-site or remote job functions during the pandemic. The 6-page document discusses technology and equipment needs and outlines methods for maintaining resident connection throughout remote Service Coordination. The document is available here.

ACL Webinar on Housing Plus Services
The Administration on Community Living is offering a webinar, “What it Takes to Age in Place: Bringing Housing and Home and Community-Based Services Together,” on Thursday, June 17 from 1:00 – 2:00 p.m. CST. Speakers from the National Center on Law and Elder Rights will present information on the connection between housing and services and talk about how Medicaid funds HCBS. The webinar is free but registration is required.

Federal Bill Establishes Entitlement to Housing Assistance
A draft bill, which LeadingAge supports, would issue hundreds of thousands of vouchers each year for the next several years and, after 2026, make housing assistance an entitlement to income-eligible households. The bill would all vouchers to be project-based, directs the HUD Secretary to encourage regional consortia of public housing agencies to administer vouchers, requires the use of small area fair market rents to determine the value of the vouchers, prohibit housing discrimination based on source of income, provide additional funding for the national Housing Trust Fund, and provide funding to integrate and coordinate assistance provided through HUD’s homeless assistance programs with health care funded by federal programs, in collaboration with the United States Interagency Council on Homelessness and the Secretary of Health and Human Services. More in a LeadingAge National article here.

HUD Reinstates Affirmatively Furthering Fair Housing Rule
On June 10, HUD will publish an interim final rule to reinstate Affirmatively Furthering Fair Housing (AFFH) definitions and certifications, which were revoked under a 2020 rule published under Secretary Carson. Effective July 31, the new interim final rule is narrowly focused to meet what the rule calls an “urgent need” to withdraw the Trump Administration’s actions to roll back AFFH requirements. HUD’s new interim final rule, titled “Restoring Affirmatively Furthering Fair Housing Definitions and Certifications,” is a limited-in-scope rule that does not impose new requirements.

It specifically reinstates relevant AFFH definitions. The interim final rule also reinstates the regulatory requirement that certain HUD grantees and program participants certify actions to address disparities in housing needs. While the federal register publication provides notice that HUD will once again offer technical support and other assistance for the voluntary completion of fair housing planning, it does not require HUD program participants to undertake any specific type of fair housing planning to support their certifications. LeadingAge supports further guidance and resources from HUD to fully reinstate the agency’s previous AFFH regulatory framework and requirements. HUD is requesting public comment for 30 days on the interim final rule; send comments or questions to Juliana Bilowich at LeadingAge National. More info here.

Home and Community Based Services:

CMS increases reimbursement rate for homebound vaccinations
CMS announced that they are increasing the rate for providing the vaccine to those who administer the vaccine in home to those who are having trouble accessing the vaccine. LeadingAge has been engaged in advocacy around the critical need to provide vaccines in the home and community and are excited to see CMS respond with some additional financial support for those who are having trouble vaccinations from vaccine sites. LeadingAge National has an article on this new guidance here.

Technology:

LeadingAge Supports New “Audio-Only” Telehealth Legislation Targeting Rural, Underserved Areas
The Protecting Rural Telehealth Access Act has been introduced in U.S. Congress to make current telehealth flexibilities under the Medicare program permanent, after the COVID-19 pandemic. LeadingAge is one of the 20 stakeholder organizations that support this bill.

This legislation would primarily ensure rural and underserved community healthcare providers are able to continue offering telehealth services after the current public health emergency ends. These services include the ability to offer audio-only telehealth appointments because many rural Americans don’t have reliable, affordable broadband access. Additionally, it would permanently waive the geographic restriction allowing patients to be treated in their homes, and lift the restrictions on “store and forward” technologies, and allow new telehealth services for critical access hospitals and rural health and federally qualified health clinics. Background information on the Protecting Rural Telehealth Access Act can be found here. Bill text can be found here.

Other:

OSHA News
We have a couple of updates today on the Occupational Safety and Health front.

OSHA Emergency Temporary Standard for Healthcare Settings
Committee on Education & Labor Examine DOL Priorities, and Highlight the Release of the OSHA Workplace Rules

OSHA Emergency Temporary Standard for Healthcare Settings:
The U.S. Department of Labor’s Occupational Safety and Health posted an emergency temporary standard for health care settings. It focuses on healthcare workers most likely to have contact with someone infected with COVID. It will be effective immediately upon publication in the Federal Register and employers will have to comply with most requirements within two weeks. Here is a brief summary of the provisions of the rule.

Committee on Education & Labor Examine DOL Priorities, and Highlight the Release of the OSHA Workplace Rules:
The U.S. House Education and Labor Committee held a June 9 hearing titled, “Examining the Policies and Priorities of the U.S. Department of Labor (DOL).” Secretary of Labor Marty Walsh, the hearing witness, reflected on how the Biden Administration’s American Jobs Plan (AJP), the American Families Plan (AFP) and the President’s fiscal year (FY) 2022 federal budget impacts workforce development programs, and how as a nation, we should sufficiently invest in our workforce infrastructure. The hearing also provided Secretary Walsh with an opportunity to address the above-mentioned long-awaited workplace protections for COVID-19 from the Occupational Safety and Health Administration. Here is an article about the hearing.

World Elder Abuse Awareness Day
In recognition of World Elder Abuse Awareness Day on June 15, 2021, the Illinois Department on Aging (IDoA) has produced a six-minute video which defines abuse and provides the viewer with the Adult Protective Services (APS) Hotline number for reporting. Please take time to view and encourage staff to do the same. In addition, other efforts can be done on June 15 to recognize World Elder Abuse Awareness Day, such as wearing purple. APS services are available to individuals age 60 or older AND those ages 18-59 with disabilities Additionally, IDoA staff will be offering training to Supportive Living providers later this summer, for LeadingAge Illinois on August 3. More details to come in the near future.

Fraud Alert: LeadingAge National Annual Meeting & EXPO Offers
Please beware of any companies reaching out with hotel or other offers claiming to be related to the 2021 LeadingAge National Annual Meeting & EXPO. These companies are not associated with LeadingAge. Hotel reservations and registration will be available only through the annual meeting website beginning in July. If you don’t see a LeadingAge logo, beware! Questions? Email LeadingAge National.

Artmails Program
The Artmails Program has ended, but members can access the entire Artmails series by visiting the Artmail ARTchives page on the LeadingAge Illinois website view the each Artmail (installments #1-#25)! Provider members can access the series by logging in. If you have trouble logging in, please send an email to info@leadingageil.org.

Artmails is an arts education and entertainment series designed to be shared with your residents that you can access and utilize – at no cost to LeadingAge Illinois provider members. The series was created and curated by a Norwalk, Connecticut-based nonprofit executive concerned about the negative impact of the Covid-19 lockdown on his 91-year-old mother, a resident of a senior living community and a lifelong amateur artist. Each Artmail profiles a different modern or contemporary artist. Each episode lasts approximately 30-40 minutes. The focal point is the embedded YouTube videos that display the profiled artist’s work. Each profile typically includes biographical information as well as additional opinions and commentary provided by the Artmails creator.