04/28/2022
CMS addresses proposed rule, waiver termination on stakeholder call
The Centers for Medicare & Medicaid Services (CMS) held a national nursing homes stakeholder call on April 27 to review recent and forthcoming updates including the release of the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule for fiscal year (FY) 2023, public reporting of nursing home ownership data, and termination of certain 1135 federal blanket waivers. Officials from the Centers for Disease Control & Prevention (CDC) were on hand to discuss upcoming changes to National Healthcare Safety Network (NSHN) reporting.
SNF PPS Proposed Rule
The SNF PPS FY 2023 proposed rule was released on April 11 and published in the federal register on April 15. The proposed rule has a 60-day comment period with comments due on June 10. The rule proposes many changes impacting SNF reimbursement, as well as a request for feedback on a number of considerations related to nursing home staffing minimums. This staffing feedback request was the main focus on the national stakeholder call and CMS encourages providers and stakeholders to respond through the federal register.
CMS will host an Open Door Forum call on April 28 to review the rule. Information on that call can be found here. LeadingAge will host a special Nursing Home Network call on Thursday, May 5 to review the rule, solicit feedback, and support members in responding to the rule. LeadingAge members wishing to participate in this call should contact Jodi Eyigor jeyigor@leadingage.org.
Nursing Home Ownership Data
Nursing home and hospital ownership data are now publicly available. A data file was posted on the CMS data site on April 20 detailing transactions since January 2016 as recorded through the Provider Enrollment, Chain, and Ownership System (PECOS). Ownership information was also added to the Medicare Care Compare site. Data will be updated quarterly and CMS intends to improve the usability of this information over time, including adding an interactive user map in May.
Termination of 1135 Federal Blanket Waivers
In an April 7 memo, CMS announced termination of several 1135 federal blanket waivers ahead of the end of the national public health emergency (PHE). The PHE has been renewed another 90 days, extending into July, which becomes the new termination date for remaining waivers including, at this time, the Qualifying Hospital Stay, or 3-day stay waiver.
Waivers being terminated ahead of the end of the PHE can be reviewed here and include the nurse aide training waiver and physician visits waiver. CMS clarified that individuals working as nurse aides have 4 months from the termination of the waiver to complete a nurse aide training and competency evaluation program (NATCEP) or competency evaluation program (CEP) and become certified in their state. That is, individuals hired prior to June 7 must meet state-level requirements and pass the state exam by October 7 in order to continue working in the nursing home. Individuals hired on or after June 7 will have 4 months from the date of hire to become certified.
CMS further clarified the use of telehealth waivers. While the physician visits waiver will terminate May 7 and physicians will need to resume in-person visits for those visits specified in regulation, such as 30- and 60-day visits, other telehealth flexibilities will remain in place and physicians may continue to utilize those waivers on visits that are not required to be in-person. Refer to the LeadingAge blanket waivers chart to keep track of these and other waivers and corresponding termination dates.
Changes to NHSN Reporting
CDC previewed changes coming to the COVID-19 Long-Term Care Facility (LTCF) module and vaccination reporting module in NHSN. Beginning May 23, reporting in both modules will be significantly streamlined. CDC will be removing data elements collecting information that has become less essential as we learn more and change strategies in our national response to COVID-19.
Examples include removal of breakdowns by vaccine manufacturer on data elements related to vaccine status and positive SARS-CoV-2 testing, breakdowns by test type on data elements related to SARS-CoV-2 testing, and streamlining of questions around boosters and “up to date” status. Data elements related to co-infections and re-infections will be removed, and data elements related to personal protective equipment (PPE) capacity and staffing shortages will be streamlined into single questions with drop-down modifying questions for those indicating shortages in either PPE or staff.
CDC also reviewed the new event-level COVID-19 vaccination data tracking form meant to replace the excel spreadsheets that are set to retire in May. The new event-level form requires SAMS 3 access because vaccination status is recorded at the individual level rather than in aggregate numbers. Data on the forms carry forward week-to-week to track vaccination status over time. The forms also auto-classify and calculate aggregate numbers and vaccination status.
While CDC has not posted information on forthcoming NHSN changes yet, training webinars are planned for mid-May ahead of the changes. The event-level vaccination tracking form is available now and training can be found here.
