The Lead October 31, 2024 - LeadingAge Illinois

From the Desk of Angela Schnepf, President and CEO

Member Announcements:
Member Announcements – What’s happening at your Organization?

HCBS:
CMS to Allow Home Health Telehealth Services During Inpatient Stay

Nursing and Rehabilitation:
HFS Reports
NHSN Reporting Annual Healthcare Personnel Influenza Vaccination Data Webinar
Heads Up on SNF MDS Submission Changes in 2025
ASPE Prepares Report on Medicaid Reimbursement Rates in Nursing Homes
LeadingAge Article on SNF Ownership Reporting Questions
Regulatory Review – Enforcement Action

Housing:
HUD Posts Advance Notice of HOTMA Forms, Model Lease

Other:
Ask the Expert
LeadingAge Members-Only National Policy Pulse Call

From the Desk of Angela Schnepf, President and CEO

The Fall Veto Session dates have been released. The session will be November 12-14 and 19-21. LeadingAge Illinois’ policy team will be actively involved and keep you abreast of anything impacting our field.

Kindest Regards,

Angela

Member Announcements – What’s happening at your Organization?

For our LeadingAge Illinois member providers, we’ve created a new feature highlighting members’ updates such as: promotions, retirements, announcements, and any changes you’d like to share with the member network. We will be including these shout-outs each week in The Lead and on our social media channels. Please send your announcements to info@leadingageil.org.

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.

Flu and Shingles Vaccination Information

Click here to view information.

IDFPR Licensing Update

The Illinois Department of Financial and Professional Regulation (IDFPR) announced the launch of the Comprehensive Online Regulatory Environment (CORE), its new online licensing system, for the first set of IDFPR-licensed professionals. The new online process eliminates the need for paper applications, gives applicants more control over their application materials, and helps prevent deficient applications from being submitted. In addition to creating a streamlined online application process, CORE features a simplified review process for all license applications received by IDFPR.

The launch of CORE marks the first completed step of a planned, multiphase approach by IDFPR over the next two years that will ensure applications for more than 300 license types and records for more than 1.2 million professionals are properly transitioned.

New applicants seeking initial licensure for three license types (clinical psychologists, nail technicians, and music therapists) will submit their applications online using CORE. IDFPR selected these three license types to test and ensure CORE’s functionality, while preparing to add all other professions licensed by IDFPR across five additional phases over the next two years.

LeadingAge Illinois Presents at ANFP-IL Conference

LeadingAge Illinois presented at the recent conference of the Association of Nutrition and Food Service Professionals-Illinois Chapter (ANFP-IL). Jason Speaks, director of government relations at LeadingAge Illinois presented on dining trends and data for seniors in senior living. He has been invited to present at the ANFP-IL Spring Conference as well.

OIG Exclusion List – New Resource Available

Have you wondered how frequently you should check the Office of Inspector General (OIG) Exclusion list? Or What happens if someone provided services for Medicare/Medicaid reimbursement while on the exclusion list? This resource is for you! The OIG Exclusion Resource describes what the exclusion is, how someone is placed on it, consequences if they provide services for you, and how someone can apply for reinstatement.

Is there something you would like to see as a clinical or regulatory resource? Email Kellie Van Ree, Director of Clinical Services, with any ideas you have.

CMS Issues Final Rule on Observation Status Appeal Processes

On October 11, the Centers for Medicare & Medicaid Services (CMS) issued Medicare Program: Appeal Rights for Certain Changes in Patient Status which was filed in the Federal Register on October 15. This rule is based on a proposed rule issued in December 2023 which requires CMS to establish an expedited appeals process when a patient is classified as observation status during hospitalization as well as a retrospective appeals process back to January 1, 2009. The final rule is CMS’ effort to comply with court orders included in Alexander v. Azar, 613 F. Supp. 3d 559 (D. Conn. 2020) and Barrows v. Becerra, 24 F 4^th 116 (2d Cir. 2022).

The final rule indicates an effective date of October 11, 2024; however, CMS stated that they will announce when the appeals processes have been established and implemented in 2025. The appeals processes will consist of the following:

Expedited appeals process for certain beneficiaries who disagree with the hospital’s decision to reclassify their status from inpatient to outpatient receiving observation services (resulting in a denial of coverage for the hospital stay under Part A). This expedited appeals process will provide the patient a decision prior to release from the hospital and will be conducted by a Beneficiary & Family Centered Care – Quality Improvement Organization (BFCC-QIO).
Standard appeals process for those who do not file an expedited appeal due to filing outside of the expected timeframes regarding the hospital’s decision to reclassify their status from inpatient to outpatient receiving observation services (resulting in a denial of coverage for the hospital under Part A). The standard appeals will follow a similar procedure to the expedited appeals process but without the expedited timeframes.
Retrospective appeals process for certain beneficiaries to appeal denials of Part A coverage of hospital services (and certain SNF services, as applicable), for specified inpatient admissions involving status changes that occurred prior to the implementation of the prospective appeals process, dating back to January 1, 2009. Consistent with existing claims appeals process, Medicare Administrative Contractors (MACs) will perform the first level of appeal, followed by a Qualified Independent Contractor (QIC) reconsiderations and Administrative Law Judge (ALF) hearings, review by the Medicare Appeals Council, and judicial review. Eligible beneficiaries will have 365 calendar days from the implementation date of the rule to file a request for retrospective appeal.

A fact sheet on the final rule can be found here.

CMS Releases Annual Health Equity Confidential Feedback Reports for Post-Acute Care Providers

On October 15, the Centers for Medicare & Medicaid services (CMS) updated the two annual post-acute care (PAC) Health Equity Confidential Feedback Reports. This includes the Discharge to Community (DTC) Health Equity Confidential Feedback Report and the Medicare Spending Per Beneficiary (MSPB) Health Equity Confidential Feedback Report. These reports are available to Home Health (HH) and Skilled Nursing Facility (SNF) settings. The updated 2024 Health Equity Confidentiality Reports are based on data from calendar year (CY) 2022-2023 for HH providers and fiscal year (FY) 2022-2023 SNF settings.

These reports provide insight on DTC and MSPB measure outcome differences across social risk factors. They stratify these two PAC Quality Reporting Program (QRP) measure outcomes by Medicare-Medicaid dual-enrollment status (duals and non-duals), and by patient’s race and ethnicity. The data is meant to provide information to providers about their performance for certain populations who may have been historically disadvantaged. This information can be used to focus internal quality improvement initiatives aimed at increasing opportunities for all individuals to achieve optimal health outcomes. Earlier in October, CMS also released the new Screen Positive for Health-Related Social Needs (HRSN) Indicator Confidential Feedback Report to HH agencies and anticipates releasing a similar report for SNF in October 2025.

Medicare Open Enrollment: Top 5 Things to Know

LeadingAge members can use the Top 5 Things to Know About Medicare Open Enrollment flyer to support older adults as they choose how to receive their Medicare benefits during Medicare Open Enrollment (October 15-December 7).

REMINDER – New CMS ABN Form Must be Used October 31

As a reminder, providers were able to implement the revised Centers for Medicare & Medicaid Services (CMS) Advanced Beneficiary Notice (ABN) form when it was released. However, beginning October 31, this new form MUST be used.

FDA Approves New Antibiotic for Uncomplicated UTIs

On October 24, the U.S. Food & Drug Administration (FDA) approved Orlynvah (sulopenem etzadroxil and probenecid) which is a new antibiotic treatment option for uncomplicated urinary tract infections (uUTIs) caused by certain bacteria including Escherichia coli (e-coli), Klebsiella pneumoniae, or Proteus mirabilis in adult women who have limited or no alternative oral antibiotic treatment options. This antibiotic is intended to be prescribed as a twice daily oral tablet over a five day duration.

An uUTI is a bacterial infection of the bladder in women with no structural abnormalities of their urinary tract. The effectiveness of Orlynvah was evaluated in two phase three controlled, randomized, double blind clinical trials which enrolled adult women with uUTI. In the first trial, 2214 adult women with a uUTI were randomized and treated. Orlynvah demonstrated efficacy in patients with amoxicillin/clavulanate-susceptible pathogens with a response rate of 62% compared to 55% response rate when treated with amoxicillin/clavulanate group. In the second trial, 1660 adult women with uUTIs were randomized and treated and Orlynvah demonstrated efficacy in patients with ciprofloxacin-resistant pathogens with a composite rate of 48% compared to 33% when treated with a ciprofloxacin group antibiotic.

Contraindications for treatment with this new antibiotic include potential exacerbations of gout when given to patients with a known history, hypersensitivity reactions to components in the medication or other beta-lactam antibacterial drugs, known history of blood dyscrasias, uric acid kidney stones and those who are taking ketorolac tromethamine. The most common side effects experienced including diarrhea, nausea, vaginal yeast infection, headache, and vomiting.

CDC Updates Recommendations for COVID-19 and Pneumonia Vaccines

On October 23, the Centers for Disease Control and Prevention (CDC) endorsed the Advisory Committee on Immunization Practices’ (ACIP) recommendations on COVID-19 and Pneumonia vaccines. The following changes are now recommended:

COVID-19 – Individuals 65 years and older and those who are moderately or severely immunocompromised should receive a second dose of the 2024-2025 COVID-19 vaccine six months after their first dose. In addition, flexibility for additional doses based on immunocompromised status and shared clinical decision making may determine additional doses are indicated. LeadingAge IL now has a template COVID-19 policy and procedure available for members to personalize and use.
Pneumonia – The CDC lowered the recommended age to receive a Pneumonia vaccine from 65 years to 50 years and children younger than 5.

Department of Public Health and Association Monthly Meeting

On October 24, the Illinois Department of Public Health (IDPH) Regulatory Affairs hosted a monthly call with health care associations to discuss questions sent by the associations. Here are some Q&As that were discussed:

It is the impression that all abuse allegations result in a deficiency, regardless of the provider following their policy.

IDPH indicated that they only cite approximately 15% of providers for abuse. If there are specific situations that individual providers have when they feel this has been cited inappropriately, IDPH is willing to look at the circumstances. Please contact Jason Speaks or Kellie Van Ree to facilitate communication if you would like to have the department review individual circumstances.

Is there clarification to what is considered a serious injury in the Assisted Living Code?

IDPH stated they tried to clear this up the best they could but has still created a lot of questions and programs continue to report several things that are not necessary. This may be an area that is addressed during the next Legislative session.

Is the informed consent form available for psychotropic medications?

Not at this time as there have been IT issues.

Is it possible to increase the LLCS Portal users from three to five?

This has already been implemented. A SIREN notice will be released soon with further details.

Do C.N.A. interns count as Direct Care Worker hours in the staffing formulas and how do you code them in the Payroll Based Journal (PBJ)?

No, they do not count as you’re unable to code them as a C.N.A. when reporting PBJ hours.

Can the department begin focus groups or regional townhall meetings again to address provider questions?

Beginning November 13, 2024, from 1 – 2 p.m. CT IDPH will host virtual townhall meetings to discuss providers questions and survey trends. A SIREN notice will be released soon including registration information.

When will IDPH update COVID-19 guidance to reduce employee return to work criteria and resident isolation periods?

This was recently updated, however, IDPH included all acute respiratory viruses in the same guidance. The COVID-19 guidance is based on current CDC recommendations. Assisted Living guidance is still being reviewed/updated and will be released when complete.

Are nursing homes required to complete the redcap survey linked in the acute respiratory guidance as well as a facility-reported incident (FRI) and NHSN weekly reporting?

Yes, nursing homes are required to report outbreaks via redcap survey and complete a FRI. In addition, nursing homes are required to report to NHSN weekly as outlined by the Centers for Medicare and Medicaid Services (CMS).

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.

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.

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.

Impending Deadlines

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.

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.

HFS Reports

Click here for the staffing add-on report.

Click here for the Medicaid Rate List for Nursing Facilities, County Nursing Facilities, Effective October 1, 2024

Click here for the SLP rates.

NHSN Reporting Annual Healthcare Personnel Influenza Vaccination Data Webinar

NHSN is hosting a webinar on Reporting Annual Healthcare Personnel Influenza Vaccination Data through NHSN for nursing home providers. The initial webinar is scheduled for November 19 at 12 p.m. CT pre-registration is required. A replay webinar will be held on December 3 at 12 p.m. CT pre-registration is required.

Heads Up on SNF MDS Submission Changes in 2025

During the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility Open Door Forum (SNF ODF) on October 17, CMS announced a couple changes for the October 1, 2025 Minimum Data Set (MDS) effective date.

First, CMS will no longer support the Optional State Assessment (OSA) option. If a state elects to conduct OSA MDS’, the state will need to support the development and submission of these assessments. Iowa does not currently require an OSA MDS.

Finally, CMS also announced that MDS submission will no longer occur in iQIES. Providers will be expected to submit the MDS’ in an XML format which will need to be completed through a vendor software program. If you’re not currently using a vendor to submit MDS data, you may want to begin discussions with these companies to ensure on October 1, 2025, you are still able to submit MDS data. CMS does not have anything posted on their MDS 3.0 Technical Information website, so there will likely be more information available in the future.

ASPE Prepares Report on Medicaid Reimbursement Rates in Nursing Homes

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) prepared a report titled “Assessing Medicaid Payment Rates and Costs of Caring for the Medicaid Population Residing in Nursing Homes”. The report outlines the purpose of the study was to understand the relationship between state Medicaid payment rates to nursing homes costs of providing care to Medicaid residents by using pre-pandemic (2019) cost report data for freestanding nursing homes in 44 states. The report outlines the median nursing home Medicaid reimbursement rate was about 82 cents per dollar of costs incurred for Medicaid residents. Not-for-profit nursing homes had the lowest Medicaid payment-to-cost ratio compared to for-profits and government owned nursing homes. In addition, the study noted that nursing homes with total nursing staff levels below 3.00 hours per resident day (HPRD) had the highest average Medicaid payment-to-cost ratio of 0.85, whereas nursing homes with nursing staff levels above 4.0 HPRD had the lowest average Medicaid payment-to-cost ratio at 0.77.

In Appendix 3, the report includes State-by-State results including Illinois which reported a mean Medicaid reimbursement of $155 while costs were reported at $282 per day or 66 cents per dollar spent and Median reimbursement of $153 with $228 in costs per day or 70 cents per dollar spent.

LeadingAge Article on SNF Ownership Reporting Questions

LeadingAge developed an article titled SNF Open Door Forum Addresses Ownership Reporting Questions related to the subregulatory guidance developed by the Centers for Medicare & Medicaid Services (CMS) and ownership reporting during revalidation surveys.

Regulatory Review – Enforcement Action

For this month’s regulatory review, we will focus on the various types of enforcement action that can be imposed on skilled nursing providers certified with the Centers for Medicare & Medicaid Services (CMS), which are included in Chapter 7 of the State Operations Manual (SOM).

CMS or the State may impose one or more remedies in addition to, or instead of, termination of the provider agreement when the State or CMS finds that a nursing home is not in substantial compliance with federal requirements. When determining what (if any) enforcement remedies are selected, the State and/or CMS must identify the scope (number of residents impacted by noncompliance) and the severity (level of harm to the residents impacted by noncompliance) which are represented by letters A-L on the 2567. CMS notes the purpose of enforcement actions is to address the nursing home’s responsibility to promptly achieve, sustain, and maintain compliance with federal requirements. The State and CMS Regional Office (RO) must consider the extent to which noncompliance exists such as the result of a one-time mistake, larger systemic concerns, or an intentional action of disregard for the resident’s health or safety.

In addition, the State and/or CMS must consider which and/or how many remedies to impost based on:

The relationship of one deficiency to other deficiencies.
The prior history of noncompliance in general, and specifically with reference to the cited deficiencies.
The likelihood that the selected remedy(ies) will achieve correction and continued compliance.

An example is provided in the SOM indicating that noncompliance exists because of the nursing home’s failure to spend money, then any civil monetary penalty (CMP) that is imposed should at least exceed the amount saved by not maintaining compliance.

There are three remedy categories that survey agencies and/or CMS has the option to select from based on the deficiencies and scope and severity (S/S) cited during the survey.

Category 1 remedies are used when there are isolated deficiencies that constitute no actual harm with a potential for more than minimal harm but not immediate jeopardy or there is a pattern of deficiencies that constitutes no actual harm with a potential for more than minimal harm but not immediate jeopardy (S/S = D or E).

Directed plan of correction
State monitoring
Directed in-service training

Category 2 remedies are used when there are widespread deficiencies that constitute no actual harm with a potential for more than minimal harm but not immediate jeopardy or one or more deficiencies (regardless of scope) that constitute actual harm that is not immediate jeopardy (S/S = F, G, H, or I). CMS notes that the State Medicaid Agency does not have the statutory authority to impose to impose denial of payment for all Medicare and/or Medicaid residents.

Denial of payment for all new Medicare and/or Medicaid admissions.
Denial of payment for all Medicare and/or Medicaid residents, imposed only by the CMS RO.
Lower range per day CMP
Per instance CMP

Category 3 remedies are used when there are one or more deficiencies that constitute immediate jeopardy to resident health or safety. A CMP of $3,050 – $10,000 per day or a CMP of $1,000 per instance may be imposed in addition to the remedies of termination and/or temporary management. Temporary management is also an option when there are widespread deficiencies constituting actual harm that is not immediate jeopardy. (S/S = I, J, K, L).

Temporary Management
Termination
CMPs as indicated in the description.

Termination of the provider agreement may be imposed by the State Medicaid Agency or the RO at any time. Transfer of residents or transfer or residents with closure of the nursing home will be imposed by the State as appropriate. Although temporary management must be imposed when there is a finding of immediate jeopardy and termination is sought, it may also be imposed for lesser levels of noncompliance.

Descriptions of enforcement actions:

A directed plan of correction (DPOC) is a plan that the State, CMS RO, or temporary manager develops to require the nursing home to take action within specified time frames. Achieving compliance is ultimately the nursing home’s responsibility, whether or not the DPOC is followed. A directed plan of correction must be dependent upon causes identified. As you may recall, DPOC enforcement actions were utilized heavily during the pandemic when a nursing home received more than one infection control related deficiency and generally required the nursing home to work with the Quality Improvement Organization (QIO) to understand the root cause and also directed staff to complete training from the Centers for Disease Control & Prevention (CDC).
Directed In-Service Training is used when the State, CMS, or the temporary manager believes that education is likely to correct the deficiencies cited and help achieve substantial compliance. The nursing home should use programs developed by well-established geriatric health services education such as schools, centers for aging, and area health education centers. When directed in-service training is implemented, the nursing home bears the expense of the training.
State monitoring is implemented when a nursing home was identified to have substandard quality of care on three consecutive standard surveys and is optional in other situations such as a poor compliance history, concern by the survey agency that the situation has the potential to worsen, immediate jeopardy exists and no temporary manager can be appointed, the nursing home refuses to relinquish control to a temporary manager, or the nursing home seems unwilling or unable to take corrective action. The frequency of monitoring visits is determined by the survey agency and can occur periodically or 24 hours per day/7 days per week based on the nature and seriousness of the deficiencies and timing and frequency of when the problems occurred. State monitoring is discontinued when the provider agreement is terminated or when they have demonstrated substantial compliance and it is determined they will remain in substantial compliance.
Discretionary denial of payment for new Medicare and Medicaid residents may be implemented anytime the nursing home is found to be out of substantial compliance, as long as the nursing home is given written notice at least 2 calendar days before the effective date in immediate jeopardy situations and at least 15 calendar days before the effective date in non-immediate jeopardy situations. The Medicare Administrative Contractors (MACs) will be notified of the denial of payment remedy and will deny payment to the nursing home for all new Medicare admissions after the effective date until substantial compliance is achieved. The State Medicaid Agency will also deny payment to all new Medicaid admissions until substantial compliance is achieved.
Mandatory denial of payment for new Medicare and Medicaid residents is imposed when the nursing home is not in substantial compliance three months after the last day of the survey identified deficiencies or when the nursing home has been found to furnish substandard quality of care on the last three consecutive standard surveys. Similar to the discretionary denial of payment above, the MAC will deny all Medicare payments for new admissions and the State Medicaid Agency will deny all Medicaid payments for new admissions. The duration generally lasts until substantial compliance is verified and payments will resume prospectively from the date that substantial compliance was achieved. When this is implemented for repeated instances of substandard quality of care, the remedy may not be lifted until substantial compliance is achieved and CMS/State believes that the nursing home will remain in substantial compliance.
- Note: section 7506.5 provides several scenarios of residents being admitted and/or readmitted while a nursing home is under denial of payment and whether they are included in the sanction or not.
Denial of payment for all Medicare and Medicaid residents is imposed only by CMS. CMS notes that denial of payment for all Medicare and Medicaid residents may be imposed for any instances of noncompliance but due to the severity of the sanction consider factors such as the seriousness of the current survey findings, noncompliance history, and the use of other remedies have failed to achieve or sustain compliance. The duration of this denial of payment is similar to the mandatory denial of payment for new admissions.
Civil Monetary Penalties (CMPs) may be imposed for the number of days the nursing home is not in substantial compliance or for each instance of noncompliance, regardless of immediate jeopardy determinations. The per day and per instance CMP cannot be imposed simultaneously during a specific survey, but can be imposed during the same survey cycle if multiple surveys with noncompliance are identified and the per day CMP was not the initial enforcement action imposed. CMS or the State Medicaid Agency may impose CMPs between $3,050 and $10,000 per day of immediate jeopardy or between $50 and $3,000 per day of non-immediate jeopardy. Per instance CMPs can range from $1,000 to $10,000 for each deficiency. CMS and States are encouraged to develop methods for ensuring consistency when issuing CMPs.
Temporary Management may be imposed at anytime for noncompliance but when deficiencies constitute immediate jeopardy or widespread actual harm and a decision is made to impose an alternative remedy to termination, the imposition of temporary management is required. The temporary manager’s responsibility is to oversee correction of the deficiencies and assure the health and safety of the resident’s are maintained while the deficiency is being corrected. Temporary managers may also be imposed to oversee the orderly closure of a nursing home. The temporary manager has the authority to hire, terminate, or reassign staff; obligate funds; alter the procedures; and otherwise manage the nursing home to correct the operations. The State is responsible for selecting temporary managers for the nursing homes. The nursing home must agree to relinquish control to the temporary manager and pay their salary. In addition, the nursing home cannot retain authority to approve changes to personnel or expenditures when agreeing to a temporary manager. If the nursing home refuses to relinquish control, they will be provided with a termination notice with an effective date 23 calendar days of the last date of the survey if the immediate jeopardy is not removed.
Termination of provider agreement is imposed within 23 days of the last day of the survey which found the immediate jeopardy if the immediacy is not removed by then. In addition, if no immediate jeopardy exists, a provider agreement may be terminated when the nursing home has not achieved substantial compliance within six months of the date of the survey to which they were found to be out of compliance.

HUD Posts Advance Notice of HOTMA Forms, Model Lease

On October 24, the Department of Housing and Urban Development (HUD) posted advance notice of draft forms that reflect changes made by the Housing Opportunity Through Modernization Act (HOTMA). The updates reflect owner certifications of tenant eligibility and rent procedures, as well as brochures that help Section 202 residents understand how their rent is determined. HUD announced that it will soon post a formal 30-day comment period for the forms; in the meantime, the forms are available on HUD’s drafting table for review. LeadingAge will work with members to provide input to HUD on the forms once the formal comment period opens. The forms are available for review here.

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.

LeadingAge Members-Only National Policy Pulse Call

LeadingAge is excited to launch a new members-only briefing and analysis call with our experts, “National Policy Pulse,” every Monday at 2:30 p.m. CT. LeadingAge members will still have timely and important updates from LeadingAge experts on policy, workforce, and more—just once on Monday and for members only. Also, you will have access to resources, handouts, and recordings of recent calls on the new landing page so you can always keep the Pulse on national policy!