The Lead 10.17.24 - LeadingAge Illinois

From the Desk of Angela Schnepf, President and CEO

Member Announcements
Oak Hill Hosts State Representative for First Visit

HSBC
CMS to Allow Home Health Telehealth Services During Inpatient Stay

Nursing and Rehabilitation
IDPH Infection Control Training Opportunities
CMS Revises QSO Memo on Quality Measures
Frequently Asked Questions on Volunteers in SNF Settings
CMS Provides Updates on SNF VBP Program Performance Standards
Post-Acute and Long-Term Care Respiratory Protection Program Offering

Housing
Contact Congress on Affordable Senior Housing Funding

Other
Ask the Expert

From the Desk of Angela Schnepf, President and CEO

We look forward to seeing you soon in Nashville.

October 28-31, 2024 | Nashville, TN

The 2024 LeadingAge Annual Meeting is just around the corner! Join over 5,000 aging services professionals for four days filled with valuable insights, innovative ideas, and endless networking opportunities. Together, we’ll shape the future of aging services. Learn more and register:https://buff.ly/3L6WyAM

LeadingAge Illinois State Night

Sunday, October 27, 2024
5:30 p.m. – 7:00 p.m.
OMNI Nashville Hotel
250 Rep. John Lewis Way South, Nashville

This event is complimentary for LeadingAge Illinois provider members. Kindly RSVP here.

Business members are required to register as an event sponsor to attend. For attendee sponsorship details, click here.

Kindest Regards,

Angela

Member Announcements

Oak Hill Hosts State Representative for First Visit
Oak Hill in Waterloo hosted State Representative David Friess (R-115th District; Red Bud) for his first visit to the community. He is a member of the House Judiciary-Civil Committee, which is a key committee we monitor.

George Green, chair of the county commission, Alicia Emerich, interim administrator, and Mindy Hanna, clinical services director at Oak Hill, did a terrific job of hosting the legislator. Jason Speaks, director of government relations at LeadingAge Illinois, also attended.

During the visit, the staff and Jason met with the representative in the conference room, discussing several issues in the field and educating him on the community and service lines. Oak Hill has skilled nursing, rehab, independent, supportive living, and memory care. They have 144 long term care beds and 178 staff.

During his tour of the community, he got the opportunity to watch residents in dementia care attend daily activities and learned their daily activities schedule. One of the recent activities was deer hunting in which staff act as the deer. The memory care residents routinely enjoy live music and staff indicated it really opens up their vocabulary and movement.

If you would like to host your legislators, contact Jason Speaks.

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Top Stories

Workshop for All-Hazards Preparedness Training
The Illinois Department of Public Health (IDPH) Office of Preparedness and Response (OPR), in conjunction with Texas A&M Engineering Extension Service announced the Senior Officials Workshop for All-Hazards Preparedness Training. This workshop provides an interactive forum to better understand roles and responsibilities of community leaders as related to all-hazard disaster preparedness, share proven strategies and best practices, and enhance coordination among community partners.

The Senior Officials Workshop for All-Hazards Preparedness Training is planned for December 17 from 9 a.m. – 4 p.m. at 1 Natural Resources Way, Springfield, IL 62702. You can register for this training here.

IDPH Adopts CNAI Rules
The Illinois Department of Public Health (IDPH) recently adopted rules for Long-Term Care Assistants and Aides Training Programs Code on the Certified Nursing Assistant Intern (CNAI) program for long-term care facilities.

This rulemaking reflects statutory requirements for CNA Interns, who may perform limited duties under the direction of a supervisory nurse while working toward full certification as a CNA. The intern must first complete at least eight hours of classroom training and 24 hours of on-the-job training at the employing facility, provided by a nurse certified as a nursing assistant instructor, or an advanced practice registered nurse or registered nurse with at least a bachelor’s degree plus three years of continuous experience in geriatric care.

Tasks to be included in the intern’s training include, but are not limited to:

first aid and CPR certification;
performing the Heimlich maneuver;
infection control, including washing residents’ hands;
performing oral hygiene (e.g., tooth brushing, denture cleaning) on residents;
feeding, dressing, shaving (with an electric razor) and giving partial baths to residents;
making a bed while it is occupied;
transferring residents from bed to wheelchair or helping them walk with a gait or transfer belt;
calculating residents’ food/water intake and output; and adjusting a resident’s bed position.

Tasks that cannot be performed by a CNA Intern include

shaving with a non-electric razor; nail or perineal care;
transfers with a mechanical lift; and passive range of motion exercises or movements.

CNA Interns are subject to background checks and will be included in the IDPH Health Care Worker Registry. Persons who completed Temporary Nursing Assistant (TNA) training between April 21, 2020 and September 18, 2020 may be accepted as CNA Interns after their competency in the required skills has been confirmed by an APRN or registered nurse educator.

CNA Interns must enroll in a Basic Nursing Assistant Training Program (BNATP) within six months after completing CNA Intern training and will receive one hour credit for every hour employed as a CNA Intern or as a TNA, up to a maximum of 30 hours credit. Facilities that employ CNA Interns must be in good standing with IDPH and the federal Medicare/Medicaid program, and must not have applied for or received a waiver from registered nurse staffing requirements or have had CNAs removed from the Health Care Worker Registry for abuse, neglect or exploitation of residents within the past two years. There is a repeal date of November 1, 2027 for these provisions.

Upcoming LTC HAI Webinars
The Illinois Department of Public Health (IDPH) Healthcare Associated Infection (HAI) team announced several upcoming webinar opportunities for infection prevention in long-term care settings. You can register for the series or individual webinars by clicking the links below. The webinars are held from 1 – 2 p.m. CT on the dates indicated.

To register for the entire series click here.

October 18 – Risk Assessment
November 1 – Risk Assessment Part 2
November 15 – Training/Audit/Feedback
November 22 – Enhanced Barrier Precautions
December 6 – Interesting Cases in the Field

Attendance is limited, if you cannot register or get into the webinar, please contact Michael Moore at IDPH. The webinars will be recorded, and links can be sent out.

Intravenous Solution Shortages
According to the Federal Drug Administration (FDA), they are aware of the devastating impact Hurricane Helene had to Baxter International’s North Cove manufacturing in Marion, North Carolina. This is one of the largest manufacturers of intravenous (IV) and peritoneal dialysis solutions in the United States. The FDA is actively working with Baxter and colleagues in the Department of Health and Human Services (HHS) to confirm how much product was recently released for distribution or may be available at wholesalers, and provide any resources and assistance they can. This could include reviewing temporary imports and expediting reviews of the cleaned and restored manufacturing lines. As of October 1, the FDA has not declared any shortages related to products produced in this building as they are working with alternative suppliers, and Baxter to discuss increase supply and reduce the risk of shortages.

LeadingAge posted a resource document from the American Society of Health-System Pharmacists and the University of Utah for Suggestions for Management and Conservation of Fluid Shortages in the event that conservation strategies are necessary.

Implementation Dates Approaching on Nondiscrimination in Health Programs and Activities Final Rule
On May 6, the Department of Health and Human Services (HHS) along with the Centers for Medicare & Medicaid Services (CMS) published the Nondiscrimination in Health Programs and Activities final rule in the Federal Register. The final rule incorporates several nondiscrimination acts and prohibits discrimination along with several other provisions outlined below in health programs and activities. While the rule was effective on July 5, 2024, many provisions have staggered implementation dates which are included in the outline below.

Included Entities

The final rule includes:

Every health program or activity, any part of which receives Federal financial assistance, directly or indirectly from HHS;
Every health program or activity administered by HHS such as Medicare and Medicaid;
Every health program or activity administered by a title I entity;

The final rule does not apply to any employer or other plan sponsor of a group health plan, including but not limited to, a board of trustees (or similar body), association, or other group, with regard to its employment practices, including the provision of employee health benefits. Note that this includes health care providers who accept Medicare and/or Medicaid funding, not because they have a group sponsored health plan.

While skilled nursing homes are included in the applicability of the final rule, assisted living, independent living, or residential care will not be, unless they receive any funding under Medicaid/Waiver services.

Discrimination Basis

The following are included in the discrimination basis to ensure they are included in all notices and policies and procedures:

Race
Color
National Origin including limited English proficiency and primary language
Sex including sex characteristics, including intersex traits, pregnancy or other related conditions, sexual orientation, gender identity, and sex stereotypes
Age
Disability

By November 2, 2024:

Designation of a Coordinator:

Covered entities as identified above with 15 or more persons covered must designate a “Section 1557 Coordinator”. The Section 1557 Coordinators’ responsibilities must include coordinating effective implementation of:

Receipt, review and processes grievances filed under the grievance procedures in the rule.
Recordkeeping requirements
Language access procedures
Communication procedures
Reasonable modifications procedures
Training of relevant employees including maintaining documentation of training

Notice of Nondiscrimination:

A notice of nondiscrimination must be provided to participants, beneficiaries, enrollees, and applicants of the health program and activities, and members of the public.

The notice of nondiscrimination must be:

Provided on an annual basis to all participants, beneficiaries, enrollees, and applicants of the health program or activity.
Provided upon request
Posted at a conspicuous location on the covered entity’s website, if it has one.
Posted in a clear and prominent physical location in no smaller than 20-point sans serif font, where it is reasonable to expect individuals seeking service from the health program or activity is able to read or hear the notice.
The notice may be combined with notices required under civil rights, so long as it includes each of the elements required.

This notice must include:

The entity does not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), sex (consistent with the scope of sex discrimination outlined in this rule), age, or disability.
The entity will provide reasonable modifications for individuals with disabilities, and appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, such as braille or large print, free of charge and in a timely manner when these aids and services are necessary to ensure accessibility and equal opportunity to participate to individuals with disabilities.
Language assistance services, including written and electronic translated documents and oral interpretation will be provided, free of charge and in a timely manner when such services are a reasonable step to provide meaningful access to an individual with limited English proficiency.
How to obtain reasonable modifications, appropriate auxiliary aids, services, and language assistance.
Contact information for the Section 1557 Coordinator.
The availability of a grievance procedure and how to file a grievance if applicable.
Details on how to file a discrimination complaint with the Office of Civil Rights (OCR).
How to access the entity’s website, if there is one, that provides information outlined in this final rule.

No Later than 30 Days After Implementation:

Employee training must be provided on the civil rights policies required in this final rule, as necessary and appropriate for the employee to carry out their functions within the covered entity. Each employee must receive training no later than 30 days following implementation of the P&P and no later than May 1, 2025.

By July 5, 2025:

Implement written policies and procedures (P&P) on the following activities that are designed to comply with the final rule. Each policy and procedure by include an effective date, be reasonably designed taking into account the size, complexity, and type of health program or activities undertaken by a covered entity. These policies and procedures include:

A Nondiscrimination P&P:

At a minimum states the covered entity does not discriminate based on race, color, national origin (including limited English proficiency and primary languages), sex (consistent with the scope of sex discrimination outlined in this rule), age, or disability.
Language assistance services and auxiliary aids and services must be provided free of charge when necessary.
Reasonable modifications must be provided for individuals with disabilities.
Provides contact information for the Section 1557 Coordinator.

A Grievance P&P:

The grievance P&P must provide prompt and equitable resolution of grievances alleging any action that would be prohibited based on discrimination.
Retains grievances filed for no less than three calendar years from the date the grievance was resolved.
- The records must include the grievance, name and contact information of complainant (if provided), alleged discrimination action, alleged basis or bases of discrimination, date filed, date resolved, the grievance resolution and any other pertinent information.
The identity of the individual filing the grievance must be kept confidential as required by law or to the extent necessary to carry out purposes of this final rule, including conducting investigations.

Language Access P&P:

Include contact information for Section 1557 Coordinator.
How an employee identifies whether an individual has limited English proficiency.
How services of qualified interpreters and translators are obtained to communicate with individuals with limited English proficiency.
Names of any qualified bilingual staff.
A list of electronic and written translated materials the covered entity has, the languages they are translated into, date of issuance, and how to access them.

Communication P&P:

Describes the process for ensuring effective communication for individuals with disabilities.
Must include current contact information for the Section 1557 Coordinator.
How an employee obtains the services of qualified interpreters that the entity uses to communicate with individuals with disabilities.
Names of any qualified interpreter staff members.
How to access appropriate auxiliary aids and services.

Reasonable Modification P&P:

Describes the process for making reasonable modifications to policies, practices, or procedures when necessary to avoid discrimination on the basis of disability.
Current contact information for the Section 1557 Coordinator.
Description of the process for responding to requests from individuals with disabilities for changes, exceptions, or adjustments to a rule, policy, practice, or service of the covered entity.
Process for determining whether making the modification would fundamentally alter the nature of the health program or activity, including an alternate modification that does not result in a fundamental alteration to ensure the individual with a disability receives the benefits or services in question.

Covered entities may combine the content of policies and procedures required with any policies and procedures required pursuant to title VI, section 504, title IX, and the Age Act if section 1557 and the provisions in this part are clearly addressed therein.

Policies must be reviewed and revised as necessary to ensure they are current and incompliance with section 1557 and this rule. Changes may be made at any time to the policies required to the extent they are in compliance with section 1557 and this rule.

Notice of Language Assistance Services:

Covered entities must provide a notice of availability of language assistance services and auxiliary aids and services that:

States the covered entity provides language assistance services and appropriate auxiliary aids and services free of charge, when necessary.
Must be provided in English and at least the 15 languages most commonly spoken by individuals with limited English proficiency of the relevant State or States in which a covered entity operates and must be provided in alternate formats for individuals with disabilities who require auxiliary aids and services to ensure effective communication.
Must be provided on an annual basis to participants, beneficiaries, enrollees, and applicants of the health program or activity.
Must be provided upon request.
Posted at conspicuous location on the covered entity’s health program or activity website, if it has one.
Posted in clear and prominent locations, in no smaller than 20-point sans serif font, where it is reasonable to expect individuals seeking service will be able to read or hear the notice.
Included in electronic and written communication when these forms are provided by the covered entity:
- Notice of non-discrimination,
- Notice of privacy practices,
- Application and intake forms,
- Notices of denial or termination of eligibility, benefits or services, including explanations of benefits, and notices of appeal and grievance rights,
- Communications related to individual rights, eligibility, benefits, or services that require or request a response from participant, beneficiary, enrollee, or applicant,
- Communications related to a public health emergency,
- Consent forms and instructions related to medical procedures or operations, medical power of attorney, or living will (with an option of providing only one notice for all documents bundled together),
- Discharge papers,
- Communications related to the cost and payment of care with respect to an individual, including medical billing and collections materials, and good faith estimates required by section 2799B-6 of the Public Health Service Act,
- Complaint forms,
- Patient and member handbooks
A covered entity shall be deemed in compliance with respect to an individual if they exercise the option to:
- Opt out of receipt of notice if provided the option in their primary language and through any appropriate auxiliary aids and services.
- Opting out does not condition the receipt of any aid or benefit on the individual’s decision.
- Informs the individual the have a right to receive the notice upon their request in their primary language and through the appropriate auxiliary aids and services.
- Informs the individual that opting out is not a waiver of their right to receive language assistance services and any appropriate auxiliary aids and services.
- Documents, on an annual basis, that the individual has opted out of receiving these notices for that year.
- Does not treat a non-response from an individual as a decision to opt-out
A covered entity shall also be in compliance if they document the individual’s primary language and any appropriate auxiliary aids and services, and
- Provides all materials and communications in that individual’s primary language and through any appropriate auxiliary aids and services or
- Provides the notice required in that individual’s primary language and through any appropriate auxiliary aids and services in all communications.

Training

Following training of employees upon initial implementation of the P&P, each new relevant employee must be trained within a reasonable period of time after the employee joins the workforce.
Each relevant employee of the health program or activity whose functions are affected by a material change in the P&P and any other civil rights P&P must be trained within a reasonable period of time after the change has been made.
Relevant employees includes both permanent and temporary employees whose roles and responsibilities entail interacting with patients and members of the public, making decisions that directly or indirectly affect patients’ health care, including executive leadership and legal counsel, and performing tasks and making decisions that directly or indirectly affect patients’ financial obligations, including billing and collections.
Documentation of training must be maintained in written or electronic form and retained for no less than three calendar years.

Here are a couple of resources that we have developed with more to come!

Notice of Nondiscrimination Posting (note in word format for you to customize)
Notice of Nondiscrimination Form (note in word format for you to customize).

CDC Releases New Data Tool to Guide ICPC Practices
The Centers for Disease Control & Prevention (CDC) recently released a new Respiratory Illnesses Data Channel that can be used to help providers strategize practices in health care settings to prevent respiratory virus transmission based on prevalence of respiratory viruses in the community.

This website provides several datapoints including overall respiratory illness activity in the United States, wastewater viral activity levels, emergency department visits and a weekly national summary. The information is displayed for COVID-19, influenza, and RSV. As numbers increase, providers may enhance infection control practices such as implementing source control.

Impending Deadlines: TODAY:

Home Health CAHPS Submission Deadline. The next data submission deadline is Thursday, October 17, 2024 for Quarter 2 of calendar year 2024 (CY24,Q2). For each sample month a home health agency has no eligible patients, agencies must send an email to their CAHPS vendor documenting that they had no eligible patients or submit a blank monthly patient information file. As a reminder, home health agencies should sign into their CAHPS account to make sure their CAHPS vendor is properly submitting data in a timely manner.

HSBC

CMS to Allow Home Health Telehealth Services During Inpatient Stay
On October 10, the Centers for Medicare and Medicaid Services (CMS) released a Change Request (CR 13812) and Medicare Learning Network Article (MLN 13812) announcing that as of April 1, 2025, home health agencies will not have claims rejected telehealth G codes (G032, G0321, and G0322) are included in billing that overlaps with an inpatient, skilled nursing, or swing bed claim. There is currently an edit that will reject any home health claim if billed with dates of services that fall within the dates of an inpatient stay (not including admission, discharge or any leave of absence dates). However, since telehealth services are non-payable reporting items they do not create a duplicate payment. CMS has been interested in better understanding home health agency use of telehealth and this adjustment to billing practices will allow home health agencies to continue to use these codes when communicating with the patient and caregiver during an inpatient stay that interrupts the home health period.

Nursing and Rehabilitation

IDPH Infection Control Training Opportunities
The Illinois Department of Public Health (IDPH) announced a Regional Workshop on Antibiotic Stewardship which will assist long-term care health care professionals implement and improve your antibiotic stewardship program. Part one will be held on October 16 focusing on Infection Prevention and Antibiotic Stewardship: From Policy to Practice and part two on November 20, focusing on Tracking Antibiotic Use and Health Outcomes. Both sessions will be held in-person in Springfield, or you can register for virtual access if necessary. Registration for this and many other free educational opportunities can be found here.

IDPH is also hosting several in-person Infection Preventionist Trainings in partnership with the Hektoen Institute of Medicine. You can register for a session by clicking on the training below. There is a small fee to register for the in-person Infection Preventionist Trainings.

CMS Revises QSO Memo on Quality Measures
The Centers for Medicare & Medicaid Services (CMS) released QSO-25-01-NH on October 4. This QSO memo revises previously issued QSO-23-21-NH related to Updates to Nursing Home Care Compare Staffing and Quality Measures. Previously the memo indicated that the short stay functionality quality measure would be replaced with the new cross-setting functionality measure used in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) as of October 2024. However, CMS notes in the memo that measures will continue to be frozen until January 2025, while the date for the equivalent measures is collected.

In addition to the quality measure indicated above, the following quality measures are currently frozen also to allow for the data collection from transitioning from Section G to Section GG in the MDS.

Percentage of residents who made improvements in function (short stay).
Percentage of residents whose need for help with activities of daily living has increased (long-stay).
Percent of residents whose ability to move independently worsened (long-stay).
Percent of high-risk residents with pressure ulcers (long-stay).

Frequently Asked Question on Volunteers in SNF Settings
LeadingAge Illinois is pleased to offer a new resource for members! The Volunteer Program FAQ document outlines frequently asked questions regarding volunteers in long-term care settings such as is a background check required for volunteers? Is a TB screening test required? This document cites Illinois Rules and Federal regulations that includes volunteer requirements all in one handy resource!

CMS Provides Updates on SNF VBP Program Performance Standards
Due to technical updates in the Skilled Nursing Facility (SNF) Nursing Staff Turnover Measure included in the Fiscal Year (FY) 2025 SNF Prospective Payment System (PPS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) have updated performance standards for the FY 2026 SNF Value Based Purchasing (VBP) threshold. The technical updates include revising the turnover from 60-day to a 90-day lapse in worked hours as reported in the payroll-based journal (PBJ) system.

The original performance standards published in the FY 2024 SNF PPS Final Rule included a benchmark of 0.72343 and an achievement threshold of 0.35912. These performance standards have been updated beginning with the FY 2026 VBP year to a benchmark of 0.75149 and achievement threshold of 0.38365.

The performance standards published in the FY 2025 SNF PPS Final Rule included a benchmark of 0.72959 and achievement threshold of 0.38000 and the performance standards were updated for the FY 2027 VBP year to a benchmark of 0.75655 and an achievement threshold of 0.40230.

Any questions on these updates should be directed to the SNF VBP Program Help Desk at SNFVBP@rti.org.

Post-Acute and Lone-Term Care Respiratory Protection Program Offering
CIMPAR, a Chicago-based medical group specializing in community health is offering a free program to help protect employees, ensure compliance with OSHA standard 1910.134, and promote a safer workplace by supporting the development of a comprehensive Respiratory Protection Program. The final cohort of this project will begin November 5 and includes five virtual webinars, continuing education for RNs and Administrators, supplies, fit-test medical evaluations, multiple HEPA air purifiers, and a professional survey of your building’s air quality all at no-cost to providers located in central and southern Illinois based on a grant from the Illinois Department of Public Health (IDPH).

You can learn more about this program or sign up for the final cohort here.

Housing

Contact Congress on Affordable Senior Housing Funding
Contact U.S. Congress and urge them to increase and adequately fund HUD affordable senior housing programs in fiscal year 2025. See the action alert here.

Other

Ask the Expert
A number of member questions come in daily to the association. In this article we will feature unique or recent questions of interest to members.

Q. Do all hospitalizations in assisted living have to be reported?

A. If it is a change in a resident’s condition that is due to health or medical decline, then is not a reportable incident or accident. If the resident has additional diagnoses outside of chronic condition, then it would need to be reported. Example: CHF Exacerbation by itself – No. The Resident also found to have a UTI – Yes.

Have a question? Email yours now.