The Lead February 6, 2025
From the Desk of Angela Schnepf, President and CEO
Reminder – Submit OSHA Electronic Data on Injury and Illness for CY 2024
Upcoming IDPH Education
IDPH Office of Health Care Regulation Monthly Educational Webinars
LeadingAge Develops Resources on Immigration Enforcement Preparedness
LeadingAge Launches Rural Provider Network
SIREN Platform to Update February 11
United Healthcare Makes Updates to Prior Authorization for Outpatient Therapy
United Healthcare Portal Changes Require Action by March 6
CMS Revises QSO Memo on Surveyor Guidance
HUD Publishes 2025 Annual Adjustment Factors
HUD Postpones HOME Final Rule
CMS Proposes Changes to Home Health CAHPS Measures
From the Desk of Angela Schnepf, President and CEO
U.S. Congress is developing a multi-trillion dollar package of policies that impact federal spending through the budget reconciliation process. Older adults and nonprofit and mission-driven providers who serve them must reach out to members of Congress to ensure that the needs of older adults and the people who serve them are met. The proposals below are actively being considered by Congress for inclusion in a budget reconciliation package. Click here to Contact Congress on this imperative issue.
Kindest Regards,
Angela
Reminder – Submit OSHA Electronic Data on Injury and Illness for CY 2024
A friendly reminder that providers meeting certain size and industry criteria are required to electronically submit injury and illness data from their OSHA (Occupational Safety and Health Administration) 300, 300A, and 301 forms annually. OSHA collects this work-related injury and illness data through the Injury Tracking Application (ITA) and began on January 2, 2025. Reporting must be submitted no later than March 2, 2025, for the calendar year (CY) 2024. You can visit the OSHA ITA webpage for additional information.
The Healthcare Associated Infection team is hosting upcoming webinar events for long-term and congregational care settings:
- February 7 from 1 – 2 p.m. Topic – Norovirus. Registration link: https://illinois.webex.com/weblink/register/rc627e20b1c20dd436e03f9157d67d81a
- February 21 from 1 – 2 p.m. Topic – Sepsis. Registration link: https://illinois.webex.com/weblink/register/rdc6a98099e652a0a34f1386f9a824b2b
- March 7 from 1 – 2 p.m. XDRO Registry. Registration link: https://illinois.webex.com/weblink/register/rd9bbce65807e50d763dde74f92472fe3
If you cannot register or get into the webinar, please email Michael.moore@illinois.gov. These webinars will be recorded with links of the recordings distributed.
IDPH Office of Health Care Regulation Monthly Educational Webinars
The Illinois Department of Public Health (IDPH) Office of Health Care Regulation (OHCR) will be hosting monthly educational webinars providing general information and topics of interest for long term care facilities. Updates will also be provided on new federal and state regulatory requirements and IDPH will also allow opportunities for questions and answers from the audience. Webinars will be announced several months in advance and registration will be required.
- February 26 from 1 – 2 p.m. Fall Risk Planning
- March 19 from 1 – 2 p.m. Identifying and Reporting Abuse
LeadingAge Develops Resources on Immigration Enforcement Preparedness
As immigration enforcement policies shift under the new administration, LeadingAge members have requested information about how to prepare for potential encounters with U.S. Immigration and Customs Enforcement Officials, including audits or visits relating to employment verification documentation and enforcement visits. LeadingAge developed an initial list of resources and will add additional items and information in the weeks ahead.
LeadingAge Launches Rural Provider Network
LeadingAge is launching a new member network for rural providers. The first meeting is scheduled for February 19, at 2 p.m. CT. The network will identify and address the unique challenges facing aging services organizations in rural areas and increase the visibility of these critical issues at the national level. This group brings together stakeholders in member communities nationwide to discuss problems such as staffing shortages, limited resources, geographic isolation, and more. The network will serve as a forum for members to share information and talk about best practices in rural health care delivery for older Americans. The group will convene on a bi-monthly network call inviting members to bring forth important and timely topics impacting them. You can register for this network here!
SIREN Platform to Update February 11
The Illinois Department of Public Health announced that beginning February 11, SIREN’s current platform will reach the end of life, and it will be transitioning to a new platform. While user’s accounts will be automatically transferred to the new platform, your information technology (IT) professionals may need to allow new domains to continue receiving SIREN emails.
According to the instructions, the domains included in the new platform are:
- @juvare.com
- @*.juvare.com
- @login.juvare.com
- @appmail.juvare.com
- @get.juvare.com
- @webeocasp.com
- @juvare.us
Also, Juvare uses a URL shortener in may solutions to reduce the number of characters in notifications. The short domain, https://juva.re, is used when a URL is added for message response.
To ensure the proper delivery of these emails and enable access to embedded links, the IT team is recommended to complete the following tasks:
- Adjust your spam filters to make sure all Juvare domains are trusted.
- Adjust your security systems to make sure URLs in these emails are trusted.
- Permit outbound traffic to juvare.com and juva.re domains.
- Adjust email filters to ensure the SMTP sender IP addresses included in the instructions are trusted.
If you need a copy of the instructions, please email Kellie Van Ree, Director of Clinical Services.
United Healthcare Makes Updates to Prior Authorization for Outpatient Therapy
On January 8, United Healthcare (UHC) further amended a policy requiring prior authorization for outpatient therapy and chiropractic services. While UHC still requires certain provider types to continue submitting prior authorization requests starting on or after January 13, 2025. However, UHC will cover the first six visits as long as those visits occur within the first eight weeks from service initiation. When this policy first rolled out, there was confusion about its applicability to skilled nursing providers and home health agencies even though the UHC policy indicated they were excluded. LeadingAge indicated that efforts have been made to clear up the confusion through changes in the provider portal and by educating the provider service representatives. You can find more information on the updated provisions here and the original policy here.
United Healthcare Portal Changes Require Action by March 6
United Healthcare (UHC) is making security updates to its provider portal, impacting how providers sign in to and access the portal. One of those changes is that providers will no longer be permitted to use email as a multi-factor authentication option. Providers must take steps now to prepare for the transition if they use the UHC Provider Portal. Additional details can be found here.
CMS Revises QSO Memo on Surveyor Guidance
On January 15, the Centers for Medicare & Medicaid Services (CMS) released a revised QSO memo – QSO-25-12-NH which again revises the surveyor guidance in Appendix PP and extends the effective date. The revisions outlined in the new QSO memo include additional guidance under Sufficient Nurse Staffing, the requirements for RN Coverage/Director of Nursing (DON), and Payroll Based Journal (PBJ). CMS is also extending the effective date from February 24, 2025, to March 24, 2025. In addition to previously announced changes in the surveyor guidance CMS has added the following to Appendix PP included as an advanced copy in the attached QSO memo. LeadingAge Illinois revised the posted on the resources webpage including the effective date.
F725 – Sufficient Nurse Staffing
Definitions of licensed nurse, charge nurse, and scope of practice were added to the interpretative guidance. A licensed nurse is defined as any nurse that requires the successful completion of a National Council Licensure Examination (NCLEX-PN or NCLEX-RN). At a minimum this would include a licensed practical nurse (LPN) or a registered nurse (RN). Licenses and titles are defined and protected by the Nurse Practice Act (NPA) for usage in the public. They are privileged and granted by the Board of Nursing (BON) after meeting the requirements of graduating from an accredited nursing educational programs, passing professional board examinations, background checks, and paying applicable fees.
A charge nurse is a licensed nurse with specific responsibilities designated by the nursing home that may include staff supervision, emergency coordinator, physician liaison, as well as direct resident care.
Scope of practice is defined as the services that a qualified health professional is deemed competent to perform and permitted to undertake – in keeping with the terms of their professional license.
Newly added interpretative guidance includes references to the facility assessment as it relates to identifying staffing decisions and skills and competencies that are necessary given the residents being served on any given day. In addition, CMS clarifies that the nursing home is required to provide licensed nursing staff 24-hours a day, along with other nursing personnel such as nurse aides and must designate a licensed nurse to serve as a charge nurse on each tour of duty. If surveyors identify concerns such as falls, weight loss, pressure ulcers, elopements, etc, it may provide insight into potential insufficient staff being available at the nursing home. The guidance instructs surveyors to discuss the concerns identified in their team meetings and investigate how or if adverse outcomes are related to potentially insufficient staffing. The guidance also states that compliance with State minimum staffing standards does not necessarily meet compliance with F725 as the nursing staff will still be expected to meet all of the residents’ basic and individualized care needs despite meeting State staffing minimums.
Finally, the guidance includes that surveyors should cite F725 only if there is non-compliance related to the nursing home not providing services by sufficient numbers of nursing personnel, not providing licensed nursing staff 24-hours per day, and/or not designating a charge nurse on each tour of duty.
The investigative procedures included in the revised F725 directs the surveyors to review the PBJ Staffing Data Report to potentially identify insufficient staffing numbers. The PBJ reports shall be used to determine if the nursing home failed to report RN hours as required in F727, did not have licensed nurse coverage 24-hours per day, reported excessively low weekend staff, or has a one-star staffing rating to determine potential non-compliance under F725, and if the nursing home failed to submit PBJ reports would be cited under F851. At a minimum, surveyors must review the PBJ Staffing Data Report on each recertification survey. The team coordinator on the survey team must inform the nursing home during the entrance conference of potential noncompliance based on the PBJ report such as a lack of 24-hour nurse coverage and instruct the nursing home that unless acceptable evidence is provided to the survey team that clearly shows licensed nurse coverage on the dates in question, that a deficiency will be issued. The guidance also indicates that a schedule of who was scheduled to work that day is not considered acceptable documentation and defines acceptable documentation as timecards, timesheets, or payroll information. If acceptable evidence is not provided, the scope and severity of the deficiency must be cited at a minimum of an F and potentially higher if investigations reveal potential harm. The investigative procedures outline questions for interviewing various staff members to determine the severity of resident harm with examples of noncompliance.
F727 – 8-hour RN and DON
There is not significant updates within the interpretative guidance, however, there are some potentially useful clarifications. The 8 consecutive hours of RN coverage can be met by multiple RNs and the hours worked by the DON are able to be counted as consecutive RN hours to meet compliance with F727. Similar to F725, the survey team coordinator must inform the nursing home during the entrance conference of concerns identified with the off-site review of the PBJ report related to RN coverage and inform the nursing home that they must provide acceptable evidence of coverage to not receive a deficiency. If the nursing home does not provide evidence of RN coverage on the dates indicated during the entrance conference the minimum scope and severity cited must be an F, with the potential for harm related deficiencies based on additional investigation.
F851 – PBJ Reporting
Additionally, F851 does not contain significant updates to the surveyor guidance in this revised QSO memo. However, it does direct the survey team that essentially any quarters without PBJ reporting should be considered non-compliance with only extremely rare exceptions. CMS directs the survey team that if they believe the nursing home should not be cited for F851 when PBJ reporting did not occur, they should email CMS for assistance.
Critical Element Pathway for Sufficient and Competent Nurse Staffing Review
Beginning on page 861 of the QSO memo, CMS included an advanced copy of the Sufficient and Competent Nurse Staffing Review Critical Element Pathway. The critical element pathway includes various interview questions that surveyors are expected to ask staff members, residents, and families during interviews, observations that could lead to deficiencies with sufficient nurse staffing, and minimum scope and severity which was also identified in the interpretive guidance.
HUD Publishes 2025 Annual Adjustment Factors
On December 3, the Department of Housing and Urban Development (HUD) announced the Annual Adjustment Factors (AAFs) for 2025, which adjust rents for certain Section 8 housing assistance payment programs for the current fiscal year. HUD establishes the rent adjustment factors on the basis of Consumer Price Index (CPI) data relating to changes in residential rent and utility costs. AAFs are applied at the anniversary of certain Housing Assistance Payment (HAP) contracts; the amount that an owner is required to deposit to the Reserve for Replacement account is also adjusted annually by the most recently published AAF, at the HAP contract anniversary. The AAFs are distinct from, and do not apply to the same properties as, Operating Cost Adjustment Factors (OCAFs), which are used by many project-based Section 8 and Section 202/8 properties. HUD’s OCAF notice is still forthcoming for 2025. The 2023 AAFs are effective as of December 3, 2024.
In a forthcoming announcement by the Department of Housing and Urban Development (HUD), the agency will delay the effective date for a recent final rule overhauling the HOME Investment Partnerships Program. The updates in the January 6 final rule were supported by LeadingAge and were slated to take effect in early February, but have been delayed until April 20 in response to the Trump Administration’s current regulatory freeze. You can find more information from LeadingAge here.