The Lead November 14, 2024
From the Desk of Angela Schnepf, President and CEO
Top Stories:
Save the Date and Don’t Forget us at Budget Time!
CMS Finalizes Home Health Payment Cuts, Condition of Participation Changes, and NHSN Reporting Changes
IDPH Office of Health Care Regulation Monthly Educational Webinars
New Member Benefit – Like Facility Evacuation Memorandum of Understanding
CMS Issues Quality & Safety Special Alert Memo on Revalidation Surveys & Extension for SNF Providers
CY 2025 HH PPS Final Rule Released – Includes NHSN Reporting for LTC
Upcoming LTC HAI Webinars
Impending Deadlines
Nursing and Rehabilitation:
PNA Rules Proposed
Maximus Outreach and Assessments for Williams and Colbert Class Members-Cook County Skilled Nursing Facilities
Regulatory Review – F557 – Right to Retain and Use Personal Property
Did You Receive Your Five-Star Report?
Telligen Receives Contract Extension from CMS
Upcoming IDPH Training
Upcoming NHSN Webinars on Updated Reporting Requirements
Housing:
LeadingAge to HUD: Streamline Solar Rooftop Approval Process
HUD Seeks to Serve Middle Income Housing
HSBC:
CMS Announces December Forum on HOPE Tool for Hospice
CMS Releases Hospice Preview Reports for the February 2025 Refresh/a>
From the Desk of Angela Schnepf, President and CEO
Payroll-based journal (PBJ) data for Fiscal Year 2024 Quarter 4 (July – September) are due November 14. Nursing homes must submit all PBJ data for the quarter before this date for calculation in the Care Compare Five Star Quality Rating System. Data submitted after this date will not be accepted, regardless of the reason for late submission. Providers should run the following reports prior to November 14 to identify and correct any errors:
- 1700 Employee Report
- 1702D Individual Daily Staffing Report
- 1702S Staffing Summary Report
- MDS Census Report
Providers who fail to submit PBJ data are automatically downgraded to a one-star in the Five Star Quality Rating System for staffing for that quarter and are assigned the lowest possible score for corresponding turnover measures. The lowest possible score remains in effect until the affected quarter times out.
Additionally, the Skilled Nursing daily census report for all skilled and intermediate care residents is due to the Illinois Department of Public Health (Department) on a quarterly basis. Census data for the 4th quarter (July 1 – September 30, 2024) is due to the Department no later than the close of business on December 1, 2024.
Kindest Regards,
Angela
Save the Date and Don’t Forget us at Budget Time!
This year’s event is shaping up to be our best yet, with a jam-packed agenda designed to provide you with top-level education, practical solutions for the challenges you face, and a valuable networking opportunity.
We’d love for you be there!
July 22 – 23, 2025 • Renaissance Schaumburg
As you’re finalizing your budget for the next fiscal year, be sure to set aside funds to cover the cost of attending the annual meeting.
Registration Fee: $399 per person Pricing kept at 2024 rates and includes morning coffee, lunch for both days, evening reception, up to 10 Continuing Education hours, access to over 115 educational sessions to select from
Hotel Room: $181 per night, plus 15% tax
Parking: Free
Total without hotel: $399 (plus applicable mileage and meal reimbursements)
Total with hotel: $815 (plus applicable travel and meal reimbursements)
Top Stories:
CMS Finalizes Home Health Payment Cuts, Condition of Participation Changes, and NHSN Reporting Changes
In the CY2025 Home Health Prospective Payment System Final Rule, CMS finalized a 0.5% aggregate increase (85 million dollars) for CY2025. It also finalized a -1.975% permanent prospective payment adjustment which was half of the calculated amount of -3.95%. While a smaller cut is a slight improvement over the proposed, home health agencies have still incurred 9% cuts to their base payments since 2023. Additionally., CMS has still not taken action on the outstanding temporary adjustment currently calculated at 4.5 billion dollars. CMS also finalized a new Condition of Participation that sets new requirements around posting patient acceptance to service requirements that LeadingAge opposed.
CMS also finalized provisions for nursing homes regarding respiratory virus reporting through the National Healthcare Safety Network (NSHN) system. These requirements include making NHSN reporting of resident respiratory illness data a permanent Requirement of Participation and extending this requirement to include other respiratory viruses beyond COVID-19, such as flu and respiratory syncytial virus (RSV). We note, however, that reporting was significantly streamlined through these finalized provisions, including allowing requirements for healthcare personnel data reporting to expire in December 2024 as planned. The rule additionally finalized the ability for the Secretary to increase both the frequency of reporting and the required data elements during a future public health emergency without notice and comment rulemaking, but did not finalize the proposal for these flexibilities to be applied in the event of a likely public health emergency. LeadingAge congratulates its members on their advocacy on these provisions and will be working with CMS to address the outstanding issue of duplicative reporting caused by reporting resident vaccination status through both NHSN and the Minimum Data Set (MDS).
LeadingAge’s press statement on the rule can be found here. The fact sheet, which contains a link to the rule itself, on the final rule can be found here.
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. Register Here.
New Member Benefit – Like Facility Evacuation Memorandum of Understanding
LeadingAge Illinois is pleased to offer a new member benefit! Email Kellie Van Ree if you are interested in entering into a Like Facility Evacuation Memorandum of Understanding (MOU). This is an agreement between LeadingAge Illinois members that in the event of an emergency and evacuation is necessary, you will have options of other like-minded providers that will be there to help out. The MOU will include an Appendix A that contains a list of participating members with contact information and capabilities to ensure that residents in your care will receive the care they deserve in the event you’re unable to.
Once there is enough interest, Kellie Van Ree, Director of Clinical Services will email a copy of the MOU to sign and begin collecting information. When completed, the Appendix A will be emailed out to all participating members. Don’t forget to put a copy of the MOU and Appendix A in your Emergency Preparedness Plan to ensure you are compliant!
CMS Issues Quality & Safety Special Alert Memo on Revalidation Surveys & Extension for SNF Providers
The Centers for Medicare & Medicaid Services (CMS) issued QSSAM-25-1-ALL on November 4, a Quality & Safety Special Alert Memo (QSSAM) Clarification of CMS’ Provider Enrollment Visits (all providers and suppliers) and Specific Disclosure Requirements for SNFs and NFs.
In the memo, CMS notes that there have been several questions regarding onsite visits by CMS contractors unrelated to survey and certification visits. These visits are being conducted as part of the revalidation process by National Site Visit Contractors (NSVCs) to help prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare program. There are resources available that providers and suppliers may use if they have questions regarding the revalidation process.
- Medicare Provider Enrollment MLN (enrollment tab, step 3)
- Provider & Supplier Enrollment Site Visits: CMS Has Authority to Conduct
- Provider Enrollment Site Visits (PDF) August 2024
To verify that CMS ordered a provider enrollment site visit, please contact your Medicare Administrative Contractor.
In addition, the memo reiterates the final rule implementing portions of section 6101 of the Affordable Care Act, requiring the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities (NFs). There are several links included in the memo regarding the SNF and NF disclosure requirements if providers have questions.
For SNF Providers Only:
In the Guidance for SNF Attachment on Form CMS-855A document, CMS notes that all SNF providers now have an extension in submitting the CMS 855-A form. Regardless of when the SNF received its revalidation letter from its MAC, the application due date is now May 1, 2025. LeadingAge advocated on behalf of members to CMS for an extension due to the limited time for compliance, extensive data requirements, and the expanded list of disclosable parties and CMS listened.
CY 2025 HH PPS Final Rule Released – Includes NHSN Reporting for LTC
On November 1, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Home Health (HH) Prospective Payment System (PPS) final rule. You can view the rule in it’s entirety here and a CMS Fact Sheet here. The final rule is scheduled to be published in the Federal Register on November 7 with an effective date of January 1, 2025. The final rule is also summarized below.
HH Rules:
The final rule includes an aggregate 0.5% payment increase for the CY 2025 PPS or $8.5 million, which is much better than the payment reduction included in the proposed rule. CMS is also finalizing a crosswalk to address the issue of mapping the OASIS E items back to the OASIS D to accurately determine payments under the Patient-Driven Groupings Model (PDGM). The final rule also includes a low-utilization payment adjustment (LUPA) OT add-on factor at 1.7238 to be used when that discipline is the first skilled visit in a LUPA episode that occurs as the only episode or an initial episode in a sequence of adjacent episodes and a Skilled Nursing (SN), Physical Therapy (PT), and Speech-Language Pathology (SLP) LUPA add-on to more accurately reflect current health care practices and costs. Also included in the final rule are Conditions of Participation (CoP) updates including a new standard that HH agencies must develop, implement, and maintain a patient acceptance-to-service policy, updating the HH Quality Reporting Program (QRP) and Value Based Purchasing (VBP) models. CMS also issued a request for information (RFI) on future performance measure concepts for the HHVBP model.
LTC NHSN Reporting:
Likely the largest impact to LeadingAge members is the finalization of the Acute Respiratory Illness Data Reporting. The previous National Healthcare Safety Network (NHSN) reporting rules were expected to sunset at the end of the CY 2024; however, finalization of the rule will require reporting indefinitely. However, there was a small win for nursing home members in that CMS did not include reporting of health care personnel COVID-19 vaccine status.
What will be required indefinitely is reporting (at a frequency determined by the Health and Human Services Secretary) including information on the current census, resident vaccination status for COVID-19, influenza, and RSV, confirmed resident cases of COVID-19, influenza, and RSV (including overall and by vaccination status) and hospitalized residents with confirmed cases of COVID-19, influenza, and RSV (including overall and by vaccination status). In addition, when a public health emergency (PHE) is declared, additional categories or reporting may be required which includes up to daily frequencies and additional or modified data elements such as relevant confirmed cases, supply inventory shortages, staffing shortages, and relevant medical countermeasures and therapeutic inventories.
Despite nursing homes not being required to report health care personnel COVID-19 vaccines, requirements remain for screening, educating and offering COVID-19 vaccines to all residents and health care personnel under Appendix PP – F887.
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.
- 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.
December 1:
The Skilled Nursing daily census report for all skilled and intermediate care residents is due to the Illinois Department of Public Health (Department) on a quarterly basis. Census data for the 4th quarter (July 1 – September 30, 2024) is due to the Department no later than the close of business on December 1, 2024.
Nursing and Rehabilitation:
The Illinois Department of Healthcare and Family Services (HFS) proposed rules implementing Public Act 103-102, which increases the personal needs allowance for long term care recipients (an amount they
may keep for personal use after any other income they have is applied to the cost of their care) from $30 to $60 per month for individuals and from $60 to $120 per month for couples.
Maximus Outreach and Assessments for Williams and Colbert Class Members-Cook County Skilled Nursing Facilities
Click here for the recent memo from the Illinois Department of Public Health (IDPH).
Regulatory Review – F557 – Right to Retain and Use Personal Property
Within the resident right’s subsection of Appendix PP, F557 includes the resident’s right to retain and use their personal property. The regulatory language states that resident’s property includes furnishing and clothing as space permits, unless to do so would infringe on other resident’s rights or the health and safety of others.
The interpretative guidance tells nursing home providers that resident’s belongings must be treated with respect, and they should be allowed to bring in their own items to promote a homelike environment. There are a few exceptions to this regulation including if there is not sufficient space to accommodate the residents’ belongings that they would like to have and if bringing in their own items infringes on the rights, health, or safety of other residents in the building.
This regulation also includes guidance on searching resident’s belongings and personal space. Previously, nursing homes were possibly accustomed to being able to search the resident’s items without their consent. However, when the interpretative guidance was updated by the Centers for Medicare & Medicaid Services (CMS) in 2022, they included guidance on the nursing home staff’s ability to search the residents items and limited this practice. Nursing home staff must explain to the resident (or their representative) the intention of the search and the resident (or representative) must provide consent. This was recently cited on a survey when a resident reported to the surveyor that while they were at an appointment, the nursing home staff searched their room for a roommate’s missing remote control. The staff did not explain to the resident why they wanted to conduct a search and obtain verbal consent to do so, resulting in noncompliance.
If there is suspicion that a resident is potentially utilizing an illegal substance, the nursing home must not act as an arm of law enforcement. The resident’s room is their personal space and must be treated similarly to their home. If an illegal substance is witnessed in plain site, then the nursing home staff may confiscate it and report it to law enforcement, particularly if other resident’s safety may be at risk. Staff need to use caution when confiscating illegal substances though to maintain the chain of custody. It is always best to have a witness present when confiscating items and the use of gloves to touch any items is essential to ensure the safety of the staff.
Other examples of non-compliance include failure to allow a resident to have their personal possessions when there was no evidence to support the denial, resident’s items are lost or stolen, and residents were discouraged from bringing in their personal items.
Did You Receive Your Five-Star Report?
Kellie Van Ree, Director of Clinical Services, is now sending the LeadingAge Five-Star Reports to members. The October report was sent earlier this week. If you did not receive your report, please email Kellie with the name of your SNF and she will send you the link to your report and add your name to the contact list for the future.
Telligen Receives Contract Extension from CMS
Telligen announced on November 6, a contract extension with the Centers for Medicare & Medicaid Services (CMS) on the 12th Statement of Work (SOW) to continue supporting nursing homes in Illinois, Iowa, Colorado, and Oklahoma. However, the contract extension has a limited scope through March 7, 2025. Between January 1, 2025, and March 7, 2025, nursing homes can expect:
- Access to Telligen QI Connect™ Resources: You’ll retain access to Telligen QI Connect™, which includes valuable resources, tools, and data insights to support your facility’s quality improvement efforts.
- https://www.telligenqiconnect.com/infectionpreventionandcontrol/
- https://www.telligenqiconnect.com/long-term-care-nhsn-resources/
- https://www.telligenqiconnect.com/vaxhub/
- https://www.telligenqiconnect.com/adult-vaccine-toolkit/
- https://www.telligenqiconnect.com/resource/nhsn-hcp-flu-vaccination-tracker/
- https://www.telligenqiconnect.com/resources/
- Portal Access for Nursing Home Data & LMS Trainings: You’ll continue to have access to essential data resources, along with our Learning Management System (LMS) for ongoing training and education.
- Support from Telligen: State contacts will remain available to share resources as needed. Please note, however, that our technical assistance support will be limited to CMS guidance during this extension period.
- Nursing Home Quality Essentials (NHQE) Spotlight on Infection Prevention: Our NHQE webinar series will relaunch on 11/19. Watch for announcements for Telligen’s bi-weekly 30-minute series.
Telligen is still awaiting CMS’ decision on the 13th SOW awards and expect to hear from them between December 2024, and January 2025.
Emergency Operations Plans for Rural Jurisdictions is an 8-hour management and planning course designed to provide emergency managers and rural first responders with the knowledge and skills to develop an emergency operations plan (EOP). This course is being held at 1 Natural Resources Way, Springfield, IL on November 21 from 8 a.m. – 5 p.m. You can register for this event here.
Disaster Recovery in Rural Jurisdictions is an 8-hour planning and management-level course designed for representatives in rural communities who play key roles in the disaster recovery process to assist with effective and efficient implementation of recovery efforts, thus ensuring the best possible long-term social and economic recovery of the communities from disaster. This course is being help at 1 Natural Resources Way, Springfield, IL on November 20 from 8 a.m. – 5 p.m. You can register for this event here.
Upcoming NHSN Webinars on Updated Reporting Requirements
On December 11 at 12 p.m. C.T. the National Health Care Safety Network (NHSN) will host a webinar on NHSN Long-Term Care Facility (LTCF) Component: Respiratory Pathogens and Vaccination Updates. You can register in advance for this webinar here.
Housing:
LeadingAge to HUD: Streamline Solar Rooftop Approval Process
In a November 11 letter to the Department of Housing and Urban Development (HUD), LeadingAge applauded the agency for its recognition of solar energy as a critical renewable energy source for the affordable housing portfolio and shared feedback on a draft proposal to establish and centralize the approval process for certain HUD-assisted properties to engage in rooftop solar leases that provide on-site solar energy. The letter stressed the importance of financial feasibility for affordable housing communities interested in installing rooftop solar and urged the creation of incentives for owners and benefits for residents. More information is here.
HUD Seeks to Serve Middle Income Housing
On October 29, HUD proposed a new Mortgagee Letter (ML) to create a new set of underwriting thresholds for middle income housing as part of the Federal Housing Administration’s (FHA’s) Multifamily Housing Programs’ underwriting standards and guidelines. The proposal would add a middle income option within HUD’s 221(d)(4) multifamily mortgage loan insurance program. “Many households with incomes above levels usually targeted and defined as affordable (i.e., LIHTC, Section 8, etc.) face lack of available housing affordable to them. Defining this Middle Income housing segment can help investors, lenders, governments, and other stakeholders target their activities to these challenges,” the draft mortgagee letter says. In the draft letter, HUD proposes to define, for the purposes of its Middle Income Housing new underwriting criteria, middle income housing as housing that is affordable to individuals and families with incomes from 60% to 120% of area median income (affordable is defined as housing costs not exceeding 30% of household income). Comments on the draft are due November 25. “As part of the Biden-Harris Administration’s commitment to create additional housing, both affordable and market rate, FHA is introducing specific policy changes to support expansion of Middle Income Housing. These changes respond to market need using the existing FHA 221(d)(4) loan program,” the draft letter says. under the 221(d)(4) program, HUD insured mortgages for 105 projects with 17,222 units, totaling $2.5 billion, in fiscal year 2023. Read the draft mortgagee letter here. Read more about the 221(d)(4) program here. While LeadingAge does not typically work on this mortgage insurance program, there has been a significant and growing interest in developing middle income housing over the past few years and HUD’s revision of its main multifamily housing mortgage insurance program identifying and addressing these needs is a significant federal event.
HSBC:
CMS Announces December Forum on HOPE Tool for Hospice
On December 12, 1 – 2 p.m. ET, the Centers for Medicare and Medicaid Services (CMS) will share an Introduction to Hospice Outcomes and Patient Evaluation (HOPE). There will be time for questions as time permits. To register, please visit this link.
CMS Releases Hospice Preview Reports for the February 2025 Refresh
Medicare hospice providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. Once released in CASPER, providers will have 30 days during which to review their quality measure results, the reports will continue to be available for 60 days. The preview period for the latest Provider Preview Report lasts from November 13, 2024 to December 13, 2024 and includes updates to the Hospice Item Set measures, Hospice CAHPS Survey measures and the Hospice CAHPS Star Rating. CMS encourages providers to download and save their Hospice Provider Preview Reports for future reference, as they will no longer be available in CASPER after this 60-day period. Providers can review the hospice quality reporting program tip sheet here for more information on public reporting.