Lead January 13, 2022 - LeadingAge Illinois

Supportive Living:
SLP Temporary Increase Update

Nursing and Rehabilitation:
CMS to Post Weekend Staffing Levels and Turnover in Medicare Care Compare
Testing for Legionella Bacteria Rules Update
MABs (Monoclonal Antibodies-Sotrovimab) and Oral Antivirals for Nursing Homes

Housing:
HUD, HHS Ramp up Test Kit Access for Housing Communities

Home and Community Based Services:
Clarification from CMS on Adult Day and CMS Mandate IFR Compliance
DoA Sets 2022 Regulatory Agenda

Top Stories:
Urge Your Senator to Sign on to SB2995
We need your quick actions and advocacy in contacting your State Senator and urging them to sign on to SB2995.

This bill is a result of months of discussions and negotiations with the Illinois Department of Healthcare and Family Services (HFS) and the other associations. LeadingAge Illinois supports this concept as a fix to staffing agency issues as well as tying staffing and quality to the Medicaid rate redesign.

Take Action Now

Here is what this bill does:

Staffing Agencies:

Prohibits nurse agencies from entering into covenants not to compete with nurses and certified nurse aides who are employed by the agencies
Supplemental healthcare staffing agencies must not bill nor receive payments from a licensed health care facility at a rate higher than 130% of the sum of total compensation plus associated payroll taxes for applicable employee classifications.The maximum charge must include all charges for administrative fees, contract fees, or other special charges in addition to compensation for the temporary nursing pool personnel supplied to a health care facility.

Medicaid Rate Reform:

It shall be a matter of State policy that HFS shall set nursing facility rates, by rule, utilizing an evidence-based methodology that rewards appropriate staffing, quality-of-life improvements for nursing facility residents, and the reduction of racial inequities and health disparities for nursing facility residents enrolled in Medicaid.
The language also focuses on the utilization of the Patient Driven Payment Model for nursing services reimbursements.
Directed payments to improve the quality of care delivered by nursing facilities.
Beginning January 1, 2022, an assessment in an amount varying with the number of paid Medicaid resident days.

Please contact your senator now and ask them to co-sponsor this legislation. After clicking here, all you have to do is enter your address and click submit to send a prepared message to your Senator.

LeadingAge Illinois Participates in Rural Workforce Presentation
Angela Schnepf, president and CEO of LeadingAge Illinois, represented long term care providers in discussing innovative solutions to workforce challenges in rural communities. Solutions included considering unpaid caregivers and pre-retirees as part of your ‘Grow Your Own’ strategy as well as reducing barriers to entry to the healthcare workforce.

Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests
As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th. The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement.

When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, nonphysician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

This effort is in addition to a number of actions the Biden Administration is taking to expand access to testing for all Americans. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicarecertified health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.

More Information:

IDPH 2022 Regulatory Agenda
The Illinois Department of Public Health (IDPH) has released their 2022 regulatory agenda. For assisted living, they will have rules on increasing licensing fees and fines, complaint review procedures, and infection prevention and control policies, procedures, and related training. For skilled nursing, they plan rules on:

social isolation;
electronic monitoring;
informed consent;
behavioral management;
closed captioning;
residency
restrictions for child sex offenders and identified offenders (for sheltered care also)
training requirements for temporary nursing assistants
Implementation Plan Amendment for the Colbert v. Pritzker Consent decree

Mental Health Resources
Throughout this most trying time, maintaining mental health can be a challenge. Through the Lead we will be sharing resources and information on mental health as well as speaking with legislators and regulators on assistance needed in our member communities. The Illinois Department of Human Services (DHS) has many resources for mental health, some of which are income-based and others for the general community.

Supportive Living:

SLP Temporary Increase Update
As part of the America Rescue Plan, Illinois’ plan for Home and Community Based Services included a temporary increase for Supportive Living. In following up with the Illinois Department of Healthcare and Family Services (HFS) recently, they stated that the $26 per day rate increase will be added to the rates in their payment system. For fee-for-service claims, they will be repriced automatically by the Department. Tentatively, this adjustment is set for February and would pay in March. The final information will be included in a provider notice. We will continue to seek updates from HFS.

Nursing and Rehabilitation:

CMS to Post Weekend Staffing Levels and Turnover in Medicare Care Compare
CMS released QSO-22-08-NH, a memo titled “Nursing Home Staff Turnover and Weekend Staffing Levels,” announcing that Medicare Compare will now include: the level of total nurse(RN, LPN and CNA) and RN staffing on weekends provided by the nursing home over the quarter using PBJ submissions. The posting of this data will begin in January 2022. CMS will add the measure of total nursing staffing on the weekends to the staffing rate domain in Care Compare – Five Star beginning in July 2022. CMS also released the plan to post staff turnover data in January 2022. This will include the percentage of RNs that left over the last year, the total number of nursing staff and the number of administrators. The information will be added to Care Compare this month and included in five star ratings in the staffing domain in July 2022.

Testing for Legionella Bacteria Rules Update
There are new proposed rules by the Illinois Department of Public Health (IDPH) for skilled nursing facilities (SNFs) on Testing for Legionella Bacteria (creates Section 300.700 in the SNF Code). The IDPH Long Term Care Advisory Board is currently discussing these rules. There was a bill last legislative session requiring water testing for assisted living and SNFs and included fines and penalties. The bill, which failed due to our opposition, was more burdensome than the proposed rules.

Here is what the rule language states:

A facility shall develop a policy for testing its water supply for Legionella bacteria.
The policy shall include the frequency with which testing is conducted.
The policy and the results of any tests and corrective actions taken shall be made available to IDPH upon request.
The policy shall be based on the ASHRAE Guideline “Managing the Risk of Legionellos is Associated with Building Water Systems” and the Centers for Disease Prevention and Control’s “Toolkit for Controlling Legionella in Common Sources of Exposure”.
The policy shall include, at a minimum:
- a procedure to conduct a facility risk assessment to identify potential Legionella and other waterborne pathogens in the facility water system;
- a water management program that identifies specific testing protocols and acceptable ranges for control measures; and
- system to document the results of testing and corrective actions taken.

MABs (Monoclonal Antibodies-Sotrovimab) and Oral Antivirals for Nursing Homes
CIMPAR has received 120 doses of sotrovimab and small supply of paxlovid and molnupiravir. If you are in need of these treatments they will be offering them on first come first serve basis. Email or call 708.665.1819.

Housing:

HUD, HHS Ramp up Test Kit Access for Housing Communities
Federal agencies announced in December that HUD-assisted housing communities can access COVID-19 test kits from Federally-Qualified Health Centers to distribute to residents. Despite challenges with supplies and partnerships, HUD and HRSA (the federal entity overseeing the community health centers) are ramping up efforts to increase access. LeadingAge encourages housing providers to reach out to their community health centers for access to test kits and then fill out our quick survey to let them know what worked, and what didn’t work. LeadingAge will use the results of the anonymous survey to help HUD and HRSA prompt health centers to forge better partnerships with HUD communities. More information here.

Home and Community Based Services:

Clarification from CMS on Adult Day and CMS Mandate IFR Compliance
For the states that are under the CMS vaccine mandate, CMS says: We do not have CoPs for Adult Day programs so they are not directly subject to the provisions of the regulation. However, they may be subject to the staff COVID-19 vaccination requirements if they have a contractual or other formal relationship with a covered provider, such as a nursing home or an intermediate care facility for individuals with intellectual disabilities (ICF-IID). I’ve attached a link to an infographic we’ve posted to help facilities determine if they are subject to the provisions of the interim final rule.

DoA Sets 2022 Regulatory Agenda
The Illinois Department on Aging (DoA) recently set their 2022 regulatory agenda. The agenda includes:

add mobile phone capability option to emergency home response service
add falls prevention options to emergency home response
changes in eligibility criteria for CCP
rate adjustments to maximum payment levels for in-home service and adult day service CCP providers;
update training requirements for in home service providers
updates to the Person-Centered Planning Process
Notifications and service using electronic means, including email, and methods when the department cannot confirm delivery via electronic notification and/or service.