The Lead June 25, 2021

Top Stories:
IDPH Updates
HFS/IAMHP Vaccination Resources
Medicaid Rates Update
Weekly TANs and Pendings Update

Supportive Living:
Supportive Living Update

Nursing and Rehabilitation:
NHSN Reporting Data
Top CMS F-Tags

Home and Community Based Services:
Illinois Department on Aging Budget

Value First Announces Supplier Agreement with Edward Don & Company
New OSHA Workplace Standards Are Effective July 5
Member Spotlight: Presbyterian Homes

Top Stories:

IDPH Updates
We have about a handful of updates gleaned from the Illinois Department of Public Health (IDPH) this week.  They include:

  • Involuntary Discharge Prohibition to be Terminated at End of July
  • Inactive CNAs Executive Order Ends
  • Staffing Reporting
  • State Guardian Access
  • Assisted Living

Involuntary Discharge Prohibition to be Terminated at End of July:
In our meeting with the Illinois Department of Public Health (IDPH) yesterday, the Department reported that the Governor will not renew his moratorium on involuntary discharges for lack of payment and the corresponding rules will expire at the end of July.  A SIREN notice will be issued with full details.  George Logan, general counsel for IDPH reported that they have already worked to end the emergency rules at the same time as the end of the executive order and that is in motion to expire at same time.

Inactive CNAs Executive Order Ends:
Section 1 of the Governor’s Executive Order 2020-12 suspended the provisions in the Healthcare Worker Background Check Act, 225 ILCS 46/33(g), that prohibit an individual from being hired to work as a certified nursing assistant (CNA) if they have been inactive on the Health Care Worker Registry if the individual (1) has been in inactive status for a period of no more than 5 years, (2) was in good standing at the time they became inactive, and (3) completes and submits any forms required by the Department of Public Health. As a result, CNAs who met these qualifications could be reinstated without taking the CNA exam again.  Section 1 of EO 2020-12 will expire on June 26, 2021. The Department will continue to process applications for reinstatement of CNAs until June 26, 2021. After June 26, 2021, CNAs whose certifications are inactive will be required to go through the normal recertification process, which involves undergoing a manual skills assessment and taking the CNA exam. 77 Ill. Adm. Code 395.173; 42 CFR 483.156(c)(2).

The Department has reinstated certifications for over 1,000 CNAs under the provisions of this Executive Order since March 2020.  For the CNAs who were reinstated under the Executive Order, their certifications will remain active until the CNA has an employment gap of more than 24 months.  As long as a CNA continues to work at least once every 24 months, the certification will remain active.

Staffing Reporting:
IDPH has no timeline for the training on submission of PBJ data to the State.  They are still reviewing how changes from the Budget Implementation Bill (BIMP) will impact their planning. The associations advocated for language that was included in the BIMP on the staffing data reporting that says that “the manner in which the Department requests payroll-based journal information to be submitted shall align with the federal Centers for Medicare and Medicaid Services’ (CMS) requirements that allow providers to submit the quarterly data in an aggregate manner.”  Language was also added stating that “no monetary penalty may be issued for noncompliance during the implementation period, which shall be July 1, 2020 through December 31, 2021 (instead of September 30, 2020)” and “monetary penalties shall be imposed beginning no later than January 1, 2022 (instead of January 1, 2021).”

State Guardian Access:
IDPH is receiving reports of state guardians having difficulty accessing long term care facilities.

Assisted Living:
The Department plans a reorganization of the assisted living division, which will include more surveyors in the regions.  LeadingAge Illinois had previously submitted a proposal with changes to the assisted living regulations.  The Department has been meeting internally on rule revisions and future meetings are to be set to discuss proposed changes with stakeholders.  The Department also continues to discuss internally potential fee increases.

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HFS/IAMHP Vaccination Resources
We continue to receive additional vaccination resources and information.  The Illinois Department of Healthcare and Family Services (HFS) and Illinois Association of Medicaid Health Plans (IAMHP) has provided some additional tips this week.

  • Be sure that all staff who communicate with family members by phone, online or in person incorporate into their interactions, the question:  “Have you gotten your COVID-19 vaccination?”  If the answer is no, ask if they’d like to speak to qualified staff who can answer questions and encourage residents to call their MCOs with questions or for help.
  • Remind the Medicaid resident that transportation to a vaccine appointment is free under Medicaid.
  • When staff are making reminder calls or sending emails, include COVID-19 vaccine information in message or when speaking to residents, ask if they’ve been vaccinated or need additional information.
  • Refer residents and families to gov and provide a link to the website on your website.
  • Add a reminder on voice messages or call waiting messages on where to go to register for an appointment, who is eligible, etc.
  • Check out IAMHP’s Toolkit on Recharging Routine Immunizations for regular and COVID-19 Vaccination support.

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Medicaid Rates Update
The Illinois Department of Healthcare and Family Services (HFS) has posted an Updated Medicaid Rate List, Effective July 1, 2021. The Supportive Living rates can be accessed here. They also recently posted a new Public Notice regarding 3.5% Reduction – Sunset.

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Weekly TANs and Pendings Update
Matt Werner, LeadingAge Illinois Medicaid Consultant, has provided the latest report on Transaction Audit Numbers (TANs) and Medicaid Pendings. Click here for the TANs Report and here for the Pendings Report.

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Supportive Living:

Supportive Living Update
Kara Helton from the Illinois Department of Healthcare and Family Services (HFS) presented in the Supportive Living Policy Forum at the LeadingAge Illinois Virtual Annual Meeting on Convention yesterday.  On behalf of the Department, she thanks providers for their work to safeguard residents during the emergency.  She covered several areas related to supportive living.

COVID-19 Considerations for Findings (Specific to Staff):

  • CPR Certification with in-person return demonstration. Many providers opted for online training during the public health emergency (PHE).  HFS expects that providers will begin obtaining training with in-person return demonstration.
  • Use of Temporary Nurse Assistants (TNAs) during the PHE was acceptable. TNAs are no longer allowed.
  • Out-of-state nurses approved by the Illinois Department of Professional and Financial Regulation will be accepted.

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Nursing and Rehabilitation:

NHSN Reporting Data
CMS updated the data reporting site today to display NHSN reporting for the week ending June 13, 2021.  Find the new data set here. Recall that enforcement of this requirement was delayed to June 21.  However, you may have received a warning letter from CMS in your CASPER folder on June 14 if no data or incomplete data was submitted by June 13. Remember, in order to be compliant with this requirement, you must submit data every week on all required fields. Be sure you are reporting vaccination data in the long-term care COVID-19 vaccination module, and if a given required field does not apply, enter “0” rather than leaving it blank.

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Top CMS F-Tags
Here are the top CMS F-Tags:

F564-Inform Visitation Rights

F644-Coord. PASARR & Assessment

F645-PAARRfor MD & ID

F636 (RAPS)-Comp Assessment & Timing

F656-Baseline CP

F578-Request/Refuse/Discontinue Treatment; Formulate Advanced Directives


F679-Activities Meet Interest/Needs of Residents

F686-Treatment/Services to Prevent/Heal Pressure Ulcers

F688-Increase/Prevent Decrease in ROM/Mobility

F689-Free of Accident Hazards/Supervision/Devices

F697-Pain Mamangement

F744-Treatment/Service for Dementia

F758-Free from Unnecessary Psychotropic Meds/PRN Use (Increase in Psychotropics)

Under CFR 483.80 Infection Control:
F880-Infection Prevention and Control

F881-ABT Stewardship

F882-(PHASE-3) Infection Preventionist Qualifications/Role (See CMS QSO Memo November 22, 2019re: LTC Infection Control Worksheet/LTC Facility Self-Assessment Tool: Section B. outlines qualifications/examples of specialized training for an Infection Preventionist.)

F883Influenza & Pneumonia

“New” May 6, 2020:
F884-Reporting-National Health Safety Network (NHSN)

F885-Reporting-residents, Representatives and Families

“New” August 26, 2020:
F886-COVID-19 Testing-Residents & Staff

Common IJs:
F684, F689, F880, F74

Illinois Top 10 IJs (Cited by Both State and Federal 2020 and still current):
F684 J,K-Quality of Life  (Cited 6x)

F660 J -D/C Planning Process (Cited 1x)

F600 J,K-Free from Abuse/Neglect  (Cited 11x)

F678 J,L-CPR  (Cited 3x)

F689 J,K-Free from Accidents Hazards/Supervision/Devices  (Cited 9x)

F880 L,K-Infection Prevention & Control  (Cited 19x)  IMP *Due to Cares Act Funding 20% of Surveys in each State Nationally must be Focused Infection Control Surveys-these are also done/counted during Annual, Complaint (COI) and through Focused IC Surveys

F607 L-Dev/Implement Abuse/Neglect policies  (Cited 1x)

F610 L-Investigate/Prevent/Correct Alleged Violations  (Cited 1x)

F695 J-Respiratory, Trach Care & Suctioning  (Cited 1x)

F609 J-Reporting of Alleged Violations   (Cited 1x)

F886 L-(PHASE-3) QUAPI/QAA Data Collection & Monitoring  (Cited 3x)

F602 K-Free from Misappropriation/Exploitation -Abuse, Neglect, Exploitation  (Cited 1x)

F803J-Menus meet Res needs/Prep in Advance/Followed  (Cited 1x)

Recommended Survey Readiness Tools for Focused Infection Control and All survey(s) Readiness include:
Long Term Care (LTC) Infection Control Worksheet/LTC Facility Self-Assessment Tool

CMS COVID-19 Entrance Conference Worksheet

COVID-19 Focused Survey Protocol

Federal Regulatory Groups FTags for LTC

IDPH LTCF Assessment COVID-19

CMS, MedPass, Briggs have COVID-19 Preparedness Checklists and Focused Survey Checklists

*CMS 672 and CMS 802, CASPER Reports, Critical Element Pathways Review for Focused areas should be part of a Facility’s systems/operations management Tool kit for “survey readiness” always for oversight of systems/operations and most importantly resident quality outcomes.

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Home and Community Based Services (HCBS):

Illinois Department on Aging Budget
The Illinois Department on Aging (DoA) recently announced the highlights from the recently passed Fiscal Year 2022 Budget that addresses the needs of older Illinoisans and the opportunity through State and Federal funding to assist in re-building the Aging Network.

A combination of increased state and federal funding resulted in an additional $33.6 million to support continued access to the Department’s nutrition programs. Additionally, the enacted budget provides $5 million for continuing to support emergency senior services, including transportation, home modifications, and assistance with providing ethnic meals. The FY 22 budget includes $2 million to expand the Illinois Care Connections Program to additional older adults and the American Rescue Plan provided $16 million to our 13 Area Agencies on Aging to expand services to address social isolation.

The federal Elder Justice Act along with the American Rescue Plan provided critical funding to support our Adult Protective Services (APS) Program. The additional $6.3 million funding is targeted to workforce stabilization for the Departments 40 APS agencies.

Older Americans Act Services:
The FY 2022 budget maintains support with:

$6.3 million increase addresses the importance of food insecurity and maintaining the current levels of Home Delivered Meals that meets the increased demand as a result of COVID-19 and the elimination of waitlists. Support the congregate meal sites while maintaining adequate nutrition critical to health, function, and quality of life as an important component of home and community-based services for older adults.

Minimum Wage:
$2.6 million increase will allow for the continuation for the Senior Employment Program at the proper wage of $15/hour and address the minimum wage increase within Older American services programming reducing pressure on community vendors.

Foster Grandparents Program:
$135,000 increase will assist with providing increased legal services, assistive devises, home modifications, transportation, short-term emergency caregiver coverage and gap filling services.

APR Funding:

COVID Vaccination Assistance:
$1.9 million will assist with increasing access to COVID-19 vaccinations.

Title IIIB Social Services:
$16.7 million improve services that promote or support social connectiveness and reduce negative health effects associated with social isolation.

Title IIIC1 Congregate Meals:
$10.9 million will assist in meeting the 2020-2025 Dietary Guidelines

Title C2 Home Delivered Meals:
$16.3 million will assist in meeting the 2020-2025 Dietary Guidelines as well as the Dietary Reference Intakes.

Title IIID Preventive Health:
$1.6 million will improve health care outcomes for older adults with chronic health conditions.

Consolidated Appropriations Act (CAA) for HDMs:
$6.1 million will increase access to home delivered meals and elimination of waiting lists.

Title IIIE Family Caregiver:
$5.2 million will promote healthy aging and social integration.

Adult Protective Services:
Aging Clients Rights Division budget includes $23.9 million in General Fund Revenue to operationalize and support the program in FY22. In FY21 and into FY22, Adult Protective Services received $6.3 million grant in federal funding from the Administration for Community Living to support the program in and through COVID while developing a long-range plan for the program.

Division of Planning, Research, Development and Training:

Assistive Technology:
$2 million will allow IDoA to continue the highly successful IL Care Connections program that provides iPads, tablets and WIFI hotspots to older adults experiencing social isolation or loneliness as a result of COVID. This funding will allow over 1,000 older adults to continue to stay connected and it will provide additional access to Community Care Program (CCP) participants to expand the program.

Aging Disability Resource Center / No-Wrong Door Vaccine Access Supplemental Funding:
Over $886,000 was received to develop an outreach campaign targeted to vulnerable populations to address equity in access to vaccines and vaccine hesitancy. In collaboration with IDHS’ Division of Developmental Disabilities and Division of Rehabilitation Services, this will include training modules developed to address specific feedback around vaccine hesitancy from older adult and persons with disabilities.

Emergency Senior Services (ESS):
$5 million was allocated to continue the ESS program. ESS funds are distributed to the Care Coordination Units throughout Illinois for the purposes of meeting the increased and widespread needs of older adults stemming from COVID-19 and the ongoing Public Health Emergency. ESS dollars are used to fill funding gaps for goods and services that assist older Illinoisan’s to remain safe and at home in community settings.

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Value First Announces Supplier Agreement with Edward Don & Company
Value First and HPSI Purchasing Services are pleased to announce the addition of Edward Don & Company to our growing portfolio of suppliers.  Since its founding in 1921, Edward Don & Company has been a family owned and operated leading distributor of foodservice equipment and supplies, serving a vast network of businesses across a variety of segments.  Edward Don products are sourced globally from over 3,000 “DON-Approved” suppliers with over 12,000 items in stock and nationwide distribution strength supported by seven full-service distribution centers.  Check here for more details. DON is Everything but the Food®. Questions?  Please contact your Value First consultant Terry Romin at 224.230.7265.

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New OSHA Workplace Standards Are Effective July 5
A new Emergency Temporary Standard (ETS) specific to COVID-19 in the workplace was published today in the Federal Register. The ETS was issued on June 10 by the Occupational Health and Safety Administration (OSHA). Most of the provisions require employers to be in compliance within 14 days (July 5), while all other provisions require compliance within 30 days of publication (July 21). The OSHA Healthcare Emergency Temporary Standard applies to you if you have more than 10 employees (if you belong to a larger corporation it’s the number of employees the corporation has on payroll.

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Member Spotlight: Presbyterian Homes
Presbyterian Homes was founded in 1904 to serve older adults without resources.  The Geneva Foundation of Presbyterian Homes was established and during the last 30-plus years, Presbyterian Homes has spent between $4 million and $6 million annually to support residents who have outlived their assets.  In the 1960’s, they built Westminster Place, their first Life Plan Community.  Since then, they built Lake Forest Place (1998) and acquired The Moorings of Arlington Heights (2000), both Life Plan Communities. Today, Presbyterian Homes serves more than 1,400 residents, is in the Ziegler top 50, and enjoys an A- rating with Fitch.

Alpana Patel, vice president of clinical services joined Presbyterian Homes in 2018. She is an alumna of the University of Illinois where she earned her Bachelor of Science degree in Nursing. She also earned a Master’s degree in Business Administration with a certificate in health care management in addition to her Master’s degree in Nursing from the University of Phoenix.  She is a licensed nursing home administrator, certified restorative nurse, and holds AANAC’s QAPI Certified Professional (QCP) and Resident Assessment Coordinator (RAC-CT) credentials. She is also a graduate of the LeadingAge Illinois Leadership Academy and a current member of the Nursing Facilities Cabinet.

Today, we visit with Alpana and get to know her a little more:

How long have you been in the industry and what made you select it?
“I have had the pleasure of working in senior living since graduating high school. I left senior living to work in a hospital, and quickly realized that I was more enthusiastic about providing care and services to seniors. I returned to senior living and have not looked back. I appreciate the opportunity to work with people in this industry; I learn something every day and every day is different. What started as a job has become a lifelong passion and I have been touched deeply by the people I have met.”

What is one of your proudest moments in your career?
“My proudest moments have been growth opportunities, allowing me to advance my career and make a difference in people’s lives at the same time. My first position in health care was as a resident care assistant at an assisted living community. I was fortunate to have the opportunity to advance to charge nurse and through the ranks, putting in my time and gaining experience.  Now, with all of the experience and knowledge gained, I serve in my current role as a Vice President of Clinical Services. Every position I held has been rewarding and brought new challenges and new opportunities. Graduating from the LeadingAge Illinois Leadership Academy was a capstone experience, as it reinforced everything I’ve learned.

What is your vision for the future of aging services?
“My vision for the future of aging services is that every senior receives high quality health services. To accomplish this, we will need to build and sustain a care model that focuses on well-being, while providing medical and nursing care for chronic and complex diseases. In addition, I envision going beyond a typical care model to one that supports peoples’ changing social, emotional, and spiritual needs. Adoption of emerging technology and providing fewer structured and more community-based services will be key to achieve this worthwhile future goal.”

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