Lead November 18, 2021 - LeadingAge Illinois

Nursing and Rehabilitation:
Nursing Home Stakeholder Call Today
CMS Issues Guidance to Surveyors to Address Survey Backlogs
HRSA Says Nursing Homes Can Wait to Report Infection Control Expenses until Second Reporting Period

Housing:
Take the LeadingAge Quarterly Affordable Housing Survey
Member Spotlight, Alina Serban, Embrace Living Communities

Other:
TANs and Pendings Update

Top Stories:

CMS Issues Changes in Revised Visitation Memo
CMS issued a revised memo that contains significant changes to nursing home operations. CMS memo QSO-20-39-NH-REVISED revises visitation, outings, dining/activities, and issues a warning that a surveyor’s vaccination status is not the business of the nursing home. Visitation changes eliminate most restrictions on visitation. Visitation is now permitted at any time for all residents, regardless of vaccination status, nursing home outbreak status, or implementation of transmission-based precautions.

Nursing homes may no longer require scheduling, limit number of visitors, limit length or frequency of visitors, or limit number of overall visitors in the nursing home at one time. Large gatherings continue to be discouraged, and all must continue to adhere to core infection control principles. This includes masking and social distancing, which is recommended or required within certain parameters.

Dining/activities and resident outings are all permitted without limitation provided core infection control principles are followed. Nursing homes may continue to offer testing and/or vaccination to visitors but may not restrict visits based on vaccination status or refusal to test. The memo explicitly states that nursing homes may not restrict surveyors’ access based on vaccination status nor is the nursing home permitted to ask for proof of vaccination as a condition of entry. Nursing homes should refer questions about the process used to ensure surveyors are safe to enter a nursing home to the state survey agency.

Read the LeadingAge article on these changes here. Visitation returns to pre-pandemic in that visitation is permitted for all residents at all times in accordance with 42 CFR Section 483.10 Resident Rights. However, many COVID-era practices, including core principles of infection control, must continue to be observed.

LeadingAge Illinois President and CEO Presents on Workforce Panel
This week, Angela Schnepf, president and CEO of LeadingAge Illinois, was a part of a panel to discuss workforce issues in the healthcare industry. The panel, which included Senator Laura Fine, was assembled by Health News Illinois. “Instead of workforce being an issue for us, workforce is now the issue,” Schnepf said.

Schnepf said robots are now being used in some facilities for tasks such as taking food from a kitchen to a room and could expand to robots taking drugs from pharmacies to rooms in community settings, which is already occurring in hospital areas. She added they are exploring ways to ease certain regulations and training requirements to get more people in the workforce faster, including certified nursing assistants.

“One of the reasons we want that is that it gives people the opportunity to start doing the work before they have put money out for an education,” Schnepf said. “Providing an opportunity for individuals to do that, under appropriate supervision, is something that is going to be able to help increase the ability to have a sustainable CNA model that encourages people that want to enter this field and hopefully what happens is the communities start funding that education.”
Source: Health News Illinois

Vaccine Update
We have a few vaccine updates today.

IDPH SIREN:
The Illinois Department of Public Health (IDPH) distributed a SIREN to long term care facilities on November 15 indicating the emergency rule requiring all facilities to require its staff who are not fully vaccinated against COVID-19 to undergo testing for COVID-19, weekly, at a minimum was renewed. All facilities must maintain a record of fully vaccinated staff, unvaccinated staff, and weekly testing. If staff who are not fully vaccinated against COVID-19 are not tested as required by this subsection, the staff shall not be permitted to enter or work at the facility.

All Federal COVID Mandates pertaining to Long Term Care facilities will be enforced by IDPH as required. Facilities that are not required to report COVID-19 aggregate vaccination and testing data into the National Healthcare Safety Network (NHSN) shall report this data to the Department weekly utilizing the online form. Failure to comply with any of the requirements set forth in this Section creates a substantial probability of risk of death or serious mental or physical harm and shall result in a Type “A” or “1” violation as defined in the Sections listed in the attached document. Violations of the requirements of this Section shall have the status of “high risk designation.

LeadingAge Member Briefing on Vaccine Mandate Rules:
LeadingAge National Policy staff presented an overview for LeadingAge members of the CMS Interim Final Omnibus COVID-19 Health Care Staff Vaccination rule and the OSHA Emergency Temporary Standard on Vaccination and Testing. Here is a link to the slides from the briefing. The recording is available in the LeadingAge Learning Hub.

COVID-19 Vaccine Policy Template:
LeadingAge has partnered with Pathway Health to offer a COVID-19 Vaccine Policy template that addresses several of the processes required by the CMS rule. This template is a members-only resource, which means one must use a LeadingAge login in order to access it. The template can be accessed with login here.

Resource for COVID-19 Vaccine Policies Required by CMS Rule:
There are 10 processes that must be addressed in organization policies. LeadingAge has developed this resource to help keep track of the processes that are required, with a few tips for developing, combining, and/or cross-referencing policies. Check out this resource here.

Nursing and Rehabilitation:

Nursing Home Stakeholder Call Today
Join the Centers for Medicare and Medicaid Services and The Centers for Disease Control and Prevention for a National Nursing Home Stakeholder today from 1-2 p.m. CST. During the call, subject matter experts will provide an overview of recently released guidance and address trending questions. Please register in advance for this Zoom Call.

CMS Issues Guidance to Surveyors to Address Survey Backlogs
CMS memo QSO-22-02-ALL includes new guidance on survey activity. Focused infection control surveys will no longer be required based on outbreak. State survey agencies are still required to conduct focused infection control surveys at 20% of the nursing homes in the state during a given fiscal year, and may conduct additional FIC surveys when a concern arises, such as outbreak in a nursing home with low vaccination rates.

Recertification surveys should continue but surveys are not required to make up those missed during survey reprioritization periods. For example, if a recert was due in April 2020 but was not conducted until August 2021, the next recert would be due no later than October 2022 (15 months after the completion of the August 2021 survey). Recertification surveys can be prioritized based on potential risk to residents (factors such as past noncompliance, allegations of noncompliance, or complaints regarding abuse, infection control, insufficient staff or staff competency, violation of transfer/discharge rights, quality of care issues, etc.). Some surveyor tasks will temporarily be discretionary (resident council observation, dining observation, medication storage).

The memo outlines levels of triage to assist surveyors in addressing back-log of complaints and facility-reported incidents. Surveyors are directed to pay special attention to certain areas such as nurse competency including assessing for change in status, inappropriate use of antipsychotics, and risks to health and safety such as unplanned weight loss, loss of function/mobility, pressure ulcers, abuse/neglect, and depression.

HRSA Says Nursing Homes Can Wait to Report Infection Control Expenses until Second Reporting Period
HRSA indicated that providers can wait to report certain expenses for future reporting periods because “all PRF payments have overlapping periods of availability.” This revelation may be of greatest interest to nursing home members who received Nursing Home Infection Control (NHIC) dollars including their incentive payments because these payments can only be used for infection control expenses, and won’t be reported upon until the second and/or third reporting periods. By waiting to report infection control expenses until the second and/or third reporting periods, a nursing home may be able to maximize use of their NHIC payments, while also using their General Distribution payments to cover lost revenues. For all providers, HRSA reinforced their PRF FAQ that indicates providers can choose during each reporting period whether to report expenses and lost revenues or enter “0” for expenses. Basically, HRSA said providers decide, how they apply their PRF funds received to their various coronavirus expenses and lost revenues.

HRSA also clarified that PRF general distribution funds can be used to cover COVID-19 staff testing costs that were not reimbursed or obligated to be reimbursed by another source. They did note that providers should document that the testing expenses were to prevent, prepare for and respond to coronavirus and that they weren’t reimbursed by other sources. This documentation just needs to be maintained by the provider not submitted as part of the reporting process.

In related news, some providers began receiving emails from HRSA stating that they had not yet submitted their first PRF report. It sounds like this email went out pretty broadly and included providers who had actually submitted their reports already. Of note in the communication, HRSA indicates in the email, “Please be aware, if you are eligible for a Phase 4 General Distribution payment, HRSA will not release your Phase 4 payment until you have met your reporting requirements.” Providers who have already submitted their reports do not need to take any additional steps. However, this email should provide extra motivation for other providers to submit their First PRF report by the November 30 deadline and sooner, if possible.

Housing:

Take the LeadingAge Quarterly Affordable Housing Survey
It’s time for the LeadingAge quarterly affordable housing survey! Please fill out this 5-minute survey on key housing issues, including internet connectivity and staff vaccine requirements at affordable housing communities. The information you provide us advances LeadingAge’s advocacy efforts with the U.S. Department of Housing and Urban Development (HUD) and the U.S. Congress, it helps them understand the materials that housing members need, and gives you insights about your housing peers. Please complete the survey by Friday, December 3.

Member Spotlight, Alina Serban, Embrace Living Communities
For 17 years, Alina Serban was a TV journalist and advocate for people with special needs in her homeland of Romania. Currently, she is chief of staff at Embrace Living Communities, taking the position just a year ago.

Alina was born and raised in Romania, a land of mystery, beauty, and wonder. For as long as she can remember, she wanted to be a television Journalist, and she says she was lucky to see the dream come true. She also has been involved heavily in philanthropic work. “Motivated by my sister’s autism, I dedicated time and passion to support the ones in need. That led me to a U.S. Department of State Fellowship with Autism Speaks Chicago and to a complete and unexpected change in my life,” said Serban.

Her journey in the new land with her husband and three-year-old son continues at Embrace. So, what are the differences between senior living here as opposed to back in Romania? “As a child in Romania, I was taught that putting your elderly in an asylum is close to committing a crime. I say asylum because this is how the government funded facilities are called, Azil pentru bătrâni” stands for asylum for elderly. As you can tell from the name, the places are institutionalized and often badly lacking any sense of home,” explained Alina. “Fortunately, privately owned housing communities, offering better services and a sense of home, are starting to emerge. However, it’s tough to break the mentality of the people, the same I was taught growing up, and often these communities are financially prohibitive for most of the population.”

Working for Embrace Living Communities, she has learned how the system is built in the United States, and has seen firsthand how senior affordable housing can also be a home for older adults. “Every time I visit one of our 30 communities I am humbled by our team’s love and passion showed to our residents,” said Alina. “The attention put into their health and wellness is beyond words. Institutionalized housing cannot be further than that. There is room for improvement in the U.S. too, with some seniors on five-year waiting lists before they find an available apartment, and others living on the streets because they can’t afford market rate homes. Therefore, we need strong, dedicated organizations to advocate for a better now and future.”

At Embrace Living Communities, their mission is to give seniors and people with disabilities the chance to live in affordable housing that follows the motto: Affordable. Welcoming. Home. “I love feeling challenged by being exposed to many different projects and for that I say a big thank you to Ralph Gaines, our CEO. We are working closely every day, and thanks to Ralph, I have not only learned a great deal, but I feel that my efforts have made an impact,” said Alina.

Other:

TANs and Pendings Update
Matt Werner, LeadingAge Illinois Medicaid consultant, has provided the latest update on Transaction Audit Numbers (TANs) and Medicaid Pendings.