The Lead January 23, 2025 - LeadingAge Illinois

From the Desk of Angela Schnepf, President and CEO

Nursing and Rehabilitation:
NHSN Reminder on “Up to Date” Definition
CMS Revises QSO Memo on Surveyor Guidance
Regulatory Review: Resident’s Right to Share a Room with Another Resident of Their Choosing
CMS Responds to LeadingAge Advocacy Letter on Duplicative Reporting to NHSN

Housing:
HUD Publishes 2025 Annual Adjustment Factors

HCBS:
CMS Proposes Changes to Home Health CAHPS Measures

Other:
Ask the Expert

From the Desk of Angela Schnepf, President and CEO

LeadingAge Illinois & Iowa is pleased to offer members a 2025 list of special celebrations that may be incorporated into activity programming and staff recognition. Click here to view.

Kindest Regards,

Angela

IDPH Adopts Rules for SNF and Sheltered Care Updates

The Illinois Department of Public Health (IDPH) recently adopted rules for to Skilled Nursing that went into effect December 31, 2024. They combine two separately proposed rulemakings and implement several Public Acts.

These amendments implement the Latex Glove Ban Act, which generally prohibits use of latex gloves in food service or in direct care of residents unless the facility is experiencing a shortage or supply interruption of non-latex gloves, in which case non-latex gloves will be prioritized for use upon residents who have known latex allergies or who are unable to communicate whether they have a latex allergy.

The rulemaking also:

Give IDPH greater flexibility in scheduling inspections during a statewide public health emergency;
Require closed captioning to be activated at all times on TV sets in common areas and residents’ rooms (unless a resident or visitor specifically requests that it be turned off);
Require the following information to be conspicuously posted in a nursing home for viewing by residents, employees, and visitors:

o Phone numbers and websites for services that protect and defend residents’ rights;

o a statement that the Illinois Long-Term Care Ombudsman Program is a free resident advocacy service available to the public;

o and the name, address and phone number of the appropriate State governmental office to which complaints may be directed, plus notice of the facility or program’s grievance procedure.

State information on how to file complaints or grievances must be provided to residents in a language and format they can understand.
Implement statutory language concerning residents’ rights to be treated with courtesy and respect, have their basic needs accommodated in a timely manner, maintain their autonomy as much as possible, and choose whether or not to perform labor or services for the facility.
If a resident chooses to perform services for a facility, these services must be part of the resident’s plan of care and the resident must be compensated at or above the prevailing wage rate.
Facilities must also have internal grievance procedures that state the process to be followed, set time limits for the facility to respond, inform residents of their right to have an advocate, and provide for a third party (which may include the State Long- Term Care Ombudsman) to respond within 25 days if a grievance cannot be resolved by the facility.
Records of grievance proceedings must be kept for at least 3 years and made available to IDPH upon request.
IDPH also adopted amendments to Sheltered Care Facilities Code implementing the Latex Glove Ban Act gives IDPH greater flexibility in scheduling inspections during a statewide public health emergency.

These amendments also add statutory provisions for IDPH surveyors to conduct an exit conference with facility management after having investigated a complaint and update provisions for probationary licenses and transfers of ownership; and update incorporations by reference.

2025 COLA Increase and File Download through MEDI

The Illinois Department of Healthcare and Family Services (HFS) recently distributed a that a cost-of-living adjustment (COLA) has been approved for all persons receiving Social Security Administration (SSA) benefits effective January 2025.

The COLA is 2.5% for 2025. The maximum Supplemental Security Income (SSI) for a single person is increased from $943 to $967. The maximum SSI for a couple is increased from $1,415 to $1,450. Additionally, as part of the COLA update, the 2025 Supportive Living Program (SLP) room and board amount and the 2025 Medicare premium will be updated for LTC cases. Eligibility will run to update the group care credit for 1/2025 and a 360C will be generated.

Based on this increase, the budgeting process has been automated to achieve timely processing of the increased SSA benefits for Medical Assistance residents. Updates to the patient credit amount in the HFS payment system based on the COLA increase have also been automated. The updates were completed on 01/17/2025. The HFS 2449A LTC Transaction Report will reflect the updated amounts. The report was issued on 01/17/2025. Providers may download the report by following the instructions below.

Login to MEDI
Select Internet Electronic Claims (IEC)
Select Download File(s)
Choose the “Entity” from the drop-down box
Select the file you wish to download from the “Available Files” listed
Enter a “Local Directory Location” (a folder created on your computer or network) to accept the downloaded file
Click “Download Files” button
Go to your designated directory location
Open the downloaded file (recommended program is WordPad)

Note: The patient credit amount listed in the HFS payment system, which can be viewed via the MEDI LTC Inquiry, should be considered the source of truth. If you disagree with the patient credit amount listed in the HFS payment system, an LTC Income Change transaction should be submitted in MEDI. The proper verification documents should be submitted to the appropriate LTC Medical Field Operations (MFO) office via fax, mail, or ABE Managed My Case (MMC). For more information on sending documentation.

Falls Prevention Grants for Community Based Organizations

The National Council on Aging (NCOA) announced it will award up to 18 community-based organizations with up to $290,000 each over two years to test a new approach that aims to increase access to falls prevention interventions for underserved older populations and communities. Nonprofit organizations, including housing providers, are eligible to apply. A Letter of Interest, which is required, is due by February 10, 2025, at 10:59 p.m. CT. The application deadline is March 21, 2025, at 10:59 p.m. CT. NCOA will host an information session for this funding opportunity on January 30, 2 – 3 p.m. CT and you can register here. You can view additional information here on this funding opportunity and the application process.

LeadingAge Submits Comments on OSHA Proposed Heat Standard

On January 14, LeadingAge submitted comments to the Occupational Safety and Health Administration (OSHA) concerning the agency’s notice of proposed rulemaking concerning Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings. As summarized in this LeadingAge article, OSHA is proposing to create a federal standard setting requirements employers must meet to protect employees from hazardous heat in indoor and outdoor work settings, including the creation of a plan to evaluate and control heat hazards in the workplace.

The comments emphasized the importance of acknowledging that not all work settings are the same and identified challenges the standard would create for an organization working to implement in the course of home and community-based services, for example. LeadingAge further commented on aspects of the proposed standard that are more prescriptive than necessary and called on OSHA to provide flexibility and scalability for employers. LeadingAge will track the progress of the proposed rule and update members on future developments, including information that may suggest how the incoming Administration views the proposal

CMS Releases 2025 Updates to Poverty Guidelines

Via an informational bulletin issued on January 16, the Centers for Medicare & Medicaid Services (CMS) outlined their process for updating the poverty guidelines for 2025. The bulletin contains charts for each category of dually eligible individual and couple. Updates reflect small price increases over recent calendar years. You can review the informational bulletin or seek more information in the full posting on the Federal Register

Illinois Control of Tuberculosis Code Updated

Section 696.100 – 696.190 was recently updated outlining procedures for health care settings to screen, protect, and identify tuberculosis. The effective date of the revised requirements was December 18, 2024 and include the following updates.

Testing and screening for health care and residential workers previously was required within seven days of hire and required a two-step testing process. With the revisions, an Interferon Gamma Release Assay (IGRA) or Mantoux Tuberculin Skin Test (TST) is now required preplacement, and a second step is not required.

When a health care worker is exposed to someone with suspected or confirmed tuberculosis, their symptoms must be evaluated to determine if they are experiencing symptoms consistent with active tuberculosis and then have an IGRA or Mantoux TST. If negative, a repeat IGRA or Mantoux TST shall be completed 8-10 weeks after the most recent exposure.

In addition, patients in non-acute residential health care settings previously required a two-step testing process if their stay was longer than 30-days. This requirement was revised to include an entry tuberculosis screening process according to the written protocol with routine periodic screening determined by completed a Department approved Risk Assessment tool and in cooperation with the local tuberculosis control authority. The risk assessment form identifies when the patients do and do not require testing for tuberculosis.

You can connect with your local health jurisdictions by location on this map. You can also access forms from IDPH on tuberculosis here.

In addition, LeadingAge Illinois created a Tuberculosis Resources website, including a

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.

Upcoming IDPH Education

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

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.

January 24: Occupational Health

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.

CMS Proposes 4.33% Medicare Advantage Rate Increase for CY2026

On Friday, January 10, the Centers for Medicare and Medicaid Services (CMS) released its required, annual Advance Notice of Medicare Advantage (MA) and Part D payment policy updates including a proposed average plan rate increase of 4.33% and continuing policy adjustments to the Effective Growth Rate and the calculation of risk scores. CMS also proposes to begin the process to transition Programs of All-Inclusive Care for the Elderly (PACE) organizations to the 2024 CMS-HCC risk adjustment model.

The notice also includes information on Part D risk adjustment changes and seeks input on future measures to be included in the MA Star Rating program that focuses on clinical care, outcomes, and patient experience. The Better Medicare Alliance has already asked for swift action from the Trump Administration to make sure that the Calendar Year (CY) 2026 rate increase is aligned with increases in medical costs. You can read the CMS Fact Sheet here. Comments on the Advance Notice are due by February 10, 2025, 10:59 C.T. and the final payment notice will be published no later than April 7, 2025.

Prepare for the TEAM Model which Begins in 2026

The Centers for Medicare & Medicaid Innovation (CMMI) finalized a new episode-based model called Transforming Episode Accountability Model (TEAM) that will replace current CMMI bundled payment models – such as the recently ended Comprehensive Care for Joint Replacement and the Bundled Payment for Care Improvements that will end in 2025. The new model will be implemented in areas that are currently participating in a bundled or episodic models, but it will also be expanding into new geographies that have had little exposure to these risk-based models that can markedly transform care delivery across the continuum. Now is the time to learn about this new model and begin preparations. LeadingAge in partnership with ATI Advisory has a free on-demand spotlight in the Learning Hub entitled “An Overview of the Transforming Episode Accountability Model” to help members understand the basics of the model, the risks and opportunities, and how to begin preparing. Members can check this list to see if one of their area hospitals will be required to participate.

Now is the time to collaborate with required TEAM hospitals to ensure your post-acute services are the choice provider!

Send us your MCO Issues

LeadingAge Illinois is working with the Illinois Department of Healthcare and Family Services (HFS) and the MCOs to resolve MCO billing issues. If you have a pattern of claims issues (not single claims) that you have not been able to resolve using the normal channels, such as working with your provider relations representative or through the use of the complaint portal, we can help by raising attention to these issues.

If you have issues, please contact Jason Speaks.

NHSN Reminder on “Up to Date” Definition

The National Healthcare Safety Network (NHSN) sent a blast email to users on January 17 with a reminder that the “up to date” definition for reporting COVID-19 vaccination status changed for 2025 Quarter 1 reporting (week beginning on December 30, 2024). To be up to date with COVID-19 vaccination, individuals aged 65 years and older need two doses of the 2024-2025 COVID-19 vaccine or one dose in the past six months. Recalling that the 2024-2025 COVID-19 vaccine was only available in September and the CDC recommends the doses are spaced six months apart. Most nursing home residents who have received one dose of the 2024-2025 vaccine will remain “up to date” until March 2025. More information on the definition of up to date 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.

This information and so much more will be included in the upcoming webinar What You Need to Know Regarding the Updated Surveyor Guidance. The webinar will be hosted on January 30, 10:30 a.m. and Jodi Eyigor from LeadingAge will join Kellie Van Ree as a co-presenter! Members can register for this webinar for FREE!

Regulatory Review: Resident’s Right to Share a Room with Another Resident of Their Choosing

Continuing on with the resident’s rights regulations, F559 in Appendix PP states that the resident has the right to share a room with another resident they choose with a few limited exceptions. This right includes the resident’s spouse when married residents live in the same nursing home with spouse including opposite and same sex married couples. The resident must be afforded the opportunity to share a room with others even if they are not married such as a domestic partnership, siblings, or friends. The limited exceptions to this right include:

When one of the residents does not agree to share a room, including a spouse. Both residents must be in agreement to sharing a room.
If a resident has a roommate already, they cannot demand that the roommate be displaced to accommodate the other resident moving in. In this situation, the nursing home could offer a different room choice to accommodate the desire such as moving into the other resident’s room or moving both residents into an unoccupied room. The nursing home staff can approach the current roommate about moving rooms but cannot demand that the resident do so.
If areas of the nursing home are not certified or licensed for the type of care the resident is receiving they could not move to this area. This is typically only relevant when the nursing home has distinct composite units such as Medicare-only designated units.
- If the resident is receiving care or service under Medicare in the distinct unit, the nursing home should discuss with them the options to remain in the distinct unit and receive Medicare services or move to a different unit within the building and pay privately for services.
- In the situation where a nursing home has a dementia-specific unit, a resident without dementia could move into the unit based on the nursing home’s specific policies regarding admission to the dementia-specific unit. According to life safety code regulations, if this resident is alert and oriented they must be provided with the code or instructed how to exit the unit.

Residents or their representative must receive a written notice prior to a room or a roommate change. The resident should be provided with the opportunity to see the new location, meet the new roommate, and ask questions about the move. When a resident is receiving a new roommate, they should be afforded as much notice prior to the new roommate moving in as possible. In addition, if the change is due to a former roommate passing, the resident should be provided an appropriate period of time to adjust to the passing of their roommate and provided with necessary social services for grieving.

Whenever a resident’s roommate changes, the nursing home should consider the resident’s preferences as much as possible.

CMS Responds to LeadingAge Advocacy Letter on Duplicative Reporting to NHSN

On January 13, the Centers for Medicare & Medicaid Services (CMS) responded to a December letter from LeadingAge. The December letter sent to CMS on behalf of LeadingAge members was the third in a series of advocacy efforts on nursing home reporting requirements. LeadingAge has repeatedly called on CMS to streamline reporting requirements and eliminate duplicative reporting. You can read the letter by LeadingAge as well as CMS’ response here.

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.

CMS Proposes Changes to Home Health CAHPS Measures

On November 25, the Centers for Medicare and Medicaid Services (CMS) released the 2024 Measures Under Consideration (MUC) List in partnership with Battelle. This list includes all the quality and efficiency measures CMS will consider adopting, through the federal rulemaking process, in the next calendar year. Included in the 41 new measures are five measures for the Home Health Quality Reporting Program, specifically changes to five CAHPS composite measures. Two of the proposed measure changes, Care of Patients and Communications Between Providers and Patient, if adopted could have significant impacts on the Expanded Home Health Value Based Purchasing model. As part of this yearly process, CMS makes the measures publicly available and will seek input through public comments by the CMS Consensus Based-Entity (CBE), Battelle. Comments are due by December 30, 2024. LeadingAge is honored to have Jodi Eyigor representing the post-acute care and long-term care community as part of the Pre-Rulemaking Measure Review advisory groups.

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: Since the pandemic has ended, do we still need to complete fit testing on staff?

A: Yes. Fit testing must be completed under the OSHA Standards for Respiratory Protection Program for any staff that use an N95 or higher-level respirator. Fit testing must be completed prior to the individual using an N95 or higher-level respirator and annually. During the pandemic, only the requirement for completing annual fit testing was waived.

Have a question? Email yours now.