08/05/2020

Today's COVID-19 Report: Wednesday, August 5, 2020

Wednesday, August 5, 2020

Here are the latest need-to-know updates for Wednesday, August 5 regarding the COVID-19 pandemic.

ODH Releases Enforcement Reports, Complaints and Citations Rise in NF/AL

Data from the Ohio Department of Health (ODH) shows that the number of complaint surveys and citations continue to increase for nursing homes and assisted living facilities. Home health and hospice experienced a positive trend in 2019 of fewer deficiencies.

In the ODH Bureau of Survey and Certification Quarterly Report, home health agencies had a lower number of citations, averaging 1.44 compared to 1.67 in 2018. Hospice agencies also had fewer citations with an average of 1.32 compared to 2.34 in 2018. Both had more agencies receiving deficiency-free surveys. In the ODH 2019 Nursing Home Survey and Enforcement Actions report, nursing homes were reported to have 224 additional complaint surveys and complaints combined with annual surveys in 2019 compared to 2018. The number of citations from those surveys also increased with 281 additional citations resulting in 2019 compared to 2018.

Communication to families regarding changes and concerns were a consistent theme. ODH stated that many of the calls to ODH could have been prevented through better communication. Citations in quality of life specific to F584, maintenance and housekeeping, is one area that continues to see an increase in citations. Immediate Jeopardy citations also increased from 70 in 2018 to 80 in 2019. The number of deficiency-free surveys have declined overall.

In 2019, LeadingAge Ohio conducted monthly In The Know calls updating members on the citation trends and provided a monthly tool focused on exactly how the citations occurred and all relevant resources to prevent similar citations. Information on citation trends with the Focused Infection Control Surveys was also shared with members during the SNF Virtual Regional Meetings in July.

Below is the list of the top ten deficiencies in 2019. If you have a question about nursing home or assisted living enforcement concerns, email Stephanie DeWees Quality & Regulatory Specialist - Long Term Care at sdewees@leadingageohio.org. If you have any questions regarding the home health or hospice, please contact Anne Shelley at ashelley@leadingageohio.org.

The top ten nursing home deficiencies in 2019 were:

• F880 -Infection Prevention & Control (438)
• F689 -Free of Accident Hazards/Supervision/Devices (373)
• F684 -Quality of Care (373)
• F812 -Food Procurement, Store/Prepare/Serve-Sanitary (297)
• F607 -Develop/Implement Abuse & Neglect Policies (296)
• F761 -Label/Store Drugs and Biologicals (239)
• F677 –ADL Care Provided for Dependent Residents (227)
• F623 –Notice Requirements Before Transfer/Discharge (221)
• F842 -Maintain Medical Records (209)
• F609 –Reporting of Alleged Violations (208)

The top ten safety deficiencies in 2019 were:

• K353 -Sprinkler System -Maintenance and Testing (430)
• K920 -Utilities -Gas and Electric (282)
• K222 -Egress Doors -Unobstructed (222)
• K363 -Corridors –Doors, Smoke Resistant and Positive Latching (220)
• K372 -Subdivision of Building Spaces –Smoke Barrier (220)
• K712 -Fire Drills (215)
• K345 -Fire Alarm System -Testing and Maintenance (212)
• K918 -Electrical Systems –Essential Electric Systems (190)
• K761 -Maintenance, Inspection & Testing –Doors (178)
• K923 –Gas Equipment –Cylinder and Container Storage (169)

The top home health deficiencies in Quarter 4 of 2019 were:

G0572	Plan of care	7
G0536	A review of all current medications	6
G0710	Provide Services in the Plan of Care	4
G0574	Plan of care must include the following	3
G0578	Conformance with physician orders	3
G0798	Home health aide assignments and duties	3
G0682	Infection Prevention	3
G0590	Promptly alert relevant physician of changes	3
G0808	Onsite supervisory visit every 14 days	3
G0800	Services provided by HH aide	2

 

The top hospice deficiencies in Quarter 4 2019 were:

L0531	Content of Comprehensive Assessment	1
L0796	Criminal Background Checks	1
L0728	Fire Protection	1
L0719	Hospices That Provide Inpatient Care Directly	1

Hospice Respite Bill Introduced by Senator Sherrod Brown, LeadingAge Ohio Supports

Yesterday, Senator Sherrod Brown (D-OH) and Shelley Moore Capito (R-WV) introduced the COVID-19 Hospice Respite Care Relief Act of 2020 . The bill has been assigned number S. 4423. A summary of the bill is available as well.

The bill would expand Medicare’s hospice respite care benefit during a public health crisis. Specifically, the legislation would give the Secretary of Health and Human Services (HHS) the authority to allow hospice patients to receive respite care at home and for longer periods of time during any public health emergency, including the current coronavirus (COVID-19) pandemic.

The existing limitations on Medicare’s hospice respite benefit have made it difficult for family caregivers to utilize this important benefit during the COVID-19 pandemic. LeadingAge’ Director, Hospice, Palliative and Home Health Policy, Mollie Gurian played an integral role in developing the legislation, and LeadingAge Ohio was eager to support it. 

LeadingAge Ohio president and CEO Kathryn Brod had this to say on the bill:

“We are grateful that Senator Brown has seen the importance of supporting caregivers, who are the unsung heroes on the frontlines of healthcare. COVID-19 demands new flexibilities, as caregivers themselves could become exposed or contract the virus. Expanding hospice respite care shows appreciation and respect for selfless caregivers, and ultimately allows the individual to remain in their home for their final days."

The full press released from Senator Brown's office is available here. 

CMS Corrects Error in Home Health Provider Preview and Star Rating Reports 

The Centers for Medicare & Medicaid Services (CMS) shared that Home Health Agency (HHA) Provider Preview Reports and the Quality of Patient Care Star Rating Preview Reports that were posted previously on June 25, 2020 contained an error. 

The previous reports contained the HHA observed values instead of the risk adjusted values.  The reports have been corrected and are now available.  You can find both reports by selecting “My Reports” in iQIES. These reports preview data that will be displayed in the Home Health Compare website beginning around October 30, 2020.  Providers are encouraged to save a copy of their preview reports for later reference. 

Providers have until August 20 to review their performance data.  Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate.

Assisted Living Training on Testing to Begin August 14

The Ohio Department of Aging (ODA) conducted training this morning on COVID-19 testing in assisted living facilities. Information on these trainings will be posted on the ODA Assisted Living COVID-19 Testing Initiative webpage.

The Ohio Department of Health (ODH) and the Ohio Department of Aging (ODA) informed providers that they have secured a testing provider who is able to offer baseline saliva testing to all assisted living staff and residents at no cost to the providers. The training included a comprehensive overview of the testing program, a demonstration video on how the test is administered and a walk-through of the web-based test portal that has been developed to support assisted living providers. The facilities “Point of Contact” is the person designated by the facility to be responsible for inputting data, preferably an Excel CSV file, into a NOVA Dx Portal System. NOVA Dx Lab has been contracted by the state to run the tests. The results will be available to the facility through this online portal.

ODA announced that testing would begin as soon as August 14.

ODM Clarifies HCIC Rule

The Ohio Department of Medicaid (ODM) received approval for the creation of Nursing Facility Health Care Isolation Centers (HCICs) through the Governor’s Executive Order approving Medicaid’s emergency COVID rules, as well as by the Centers for Medicare & Medicaid Services (CMS) under the authority of an 1135 state plan amendment.

Ohio Administrative Code emergency rule 5160-3-80 establishes HCICs as COVID-19 community providers for the provision of services to individuals with an active or convalescent COVID-19 infection or who have other health care needs and require quarantine following exposure to COVID-19. These specialty services may be used for individuals who might otherwise seek care in a hospital due to COVID, or for individuals who cannot return home following a hospital stay due to their COVID-related health care, quarantine or isolation needs. Enhanced Medicaid reimbursement is available to approved HCIC providers who provide quarantine and/or isolation services to Medicaid individuals meeting a quarantine or isolation level of care as designated by the individual’s physician.

For individuals enrolled in hospice who are receiving services in an HCIC, hospice providers will be reimbursed based on the enhanced HCIC rate for room and board rather than the usual nursing facility per diem rate. ODM will pay hospice providers 95% of the HCIC rates for room and board. ODM has provided billing guidance for Medicaid hospice individuals who are receiving quarantine or isolation services in an ODM-approved HCIC facility. Medicaid managed care and MyCare Ohio plans will be required to cover these specialty services with the same reimbursement as fee-for-service Medicaid.

CMS Updates Medicare Payment Policies for IPFs, SNFs, and Hospices

On July 31, the Centers for Medicare & Medicaid Services (CMS) finalized three Medicare payment rules that further advance LeadingAge efforts to strengthen the Medicare program by better aligning payments for Inpatient Psychiatric Facilities (IPFs), Skilled Nursing Facilities (SNFs), and hospices.

Inpatient Psychiatric Facilities. The final rule updates Medicare payment policies and rates for the IPF Prospective Payment System (PPS) for FY 2021. In this final rule, CMS is finalizing a 2.2 percent payment rate update and finalizing its proposal to adopt revised Office of Management and Budget (OMB) statistical area delineations resulting in wage index values being more representative of the actual costs of labor in a given area. CMS is finalizing updates to allow advanced practice providers, including physician assistants, nurse practitioners, psychologists, and clinical nurse specialists to operate within the scope of practice allowed by state law by documenting progress notes in the medical record of patients for whom they are responsible, receiving services in psychiatric hospitals.

Skilled Nursing Facilities. The final rule updates the Medicare payment rates and the quality programs for SNFs. These updates include routine technical rate-setting updates to the SNF PPS payment rates, as well as finalizes adoption of the most recent OMB statistical area delineations and applies a 5 percent cap on wage index decreases from FY 2020 to FY 2021. CMS is also finalizing changes to the ICD-10 code mappings that would be effective beginning in FY 2021 in response to stakeholder feedback. CMS projects aggregate payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021, compared to FY 2020.

Hospices. For FY 2021, hospice payment rates are updated by the market basket percentage increase of 2.4 percent ($540 million). Hospices that fail to meet quality reporting requirements receive a 2 percentage point reduction to the annual market basket percentage increase for the year. The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. The final hospice cap amount for the FY 2021 cap year is $30,683.93, which is equal to the FY 2020 cap amount ($29,964.78) updated by the final FY 2021 hospice payment update percentage of 2.4 percent.

Final rule and fact sheets are available here:

• IPF Final Rule and Fact Sheet
• SNF Final Rule and Fact Sheet
• Hospice Final Rule and Fact Sheet

Coverage of Physician Telehealth Services Provided to SNF Residents

The current COVID-19 Public Health Emergency (PHE) does not waive any requirements related to Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, the Centers for Medicare & Medicaid Services (CMS) added CPT codes 99441, 99442, and 99443, to the list of telehealth codes coverable under the waiver during the COVID-19 PHE. These codes designate three different time increments of telephone evaluation and management service provided by a physician. Providers can bill for these physician services separately under Part B when furnished to a SNF’s Part A resident.

Medicare Administrative Contractors (MACs) will reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were denied due to SNF CB edits. You do not have to do anything. If you already received payment from the SNF for these physician services, return that payment to the SNF once the MAC reprocesses your claim.

Important ABN Deadline Extended for Home Health, Hospice, Others

Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers including independent laboratories, home health agencies, and hospices, physicians, practitioners, and suppliers to Medicare fee for service (FFS) beneficiaries in situations where Medicare payment is expected to be denied.

Due to COVID-19 concerns, the Centers for Medicare & Medicaid Services is going to expand the deadline for use of the renewed ABN, expiring June 30, 2031. At this time, the renewed ABN will be mandatory for use on January 1, 2021. The renewed form may be implemented prior to the mandatory deadline.  The ABN form and instructions may be found here.

Housing Happenings Recap

LeadingAge Ohio partners with LeadingAge Maryland to offer a weekly educational teleconference series designed specifically for affordable housing professionals titled Housing Happenings. Below is a recap of today's Housing Happenings call. 

Today’s Housing Happenings call began with noting the hurricane’s landfall yesterday, to ascertain which providers may have been impacted.

COVID-19 supplemental payments from CARES Act. Supplemental payments from the CARES Act for expenses incurred since end of March through end of July are due tonight midnight for requests for repayments on a per-property basis. Following tonight, they (who's they) will accept one request per entity for one further week. They are anticipating 20,000 requests, and hoping to turn them around relatively quickly, since they are already rather late, compared to other relief payments. LeadingAge has shared answers to multiple questions related to the payments.

Latest update to FAQs for multifamily housing. The latest update includes fourteen changes since the last update shared in May. It does answer the question about whether owners/operators can require residents to wear face masks, and also whether they can require testing. While testing cannot be required, owners/operators CAN require residents to wear face coverings, as long as it is rooted in state and local laws and other reasonable considerations. HUD does allow owners/operators to amend the house rules, with notice and following other requirements for amending house rules.

Attendees discussed their approach to the face masks/coverings. Several shared that they require masks in all public spaces, and they are providing education to residents and staff. Most are not changing the house rules because the situation is so fluid and ever-changing, and they’re concerned that house rules changes or lease addenda would be quickly outdated.  

Housing Happenings is a free member benefit co-hosted by LeadingAge Maryland and LeadingAge Ohio each Wednesday morning from 9-9:30am. To join next week’s call, register on the LeadingAge Ohio website.

LeadingAge Action Alert: Ask Congress to Provide Critical HCBS Support  

Leaders in Congress are negotiating the next major COVID-19 relief package. Providers can help to ensure that the critical needs of home and community-based services providers are included in the final package. This includes support for adult day services providers, PACE organizations, and providers of in-home services (personal/home care, private duty nursing, and more).

The House-passed Heroes Act recognizes the importance of home and community-based services in the continuum of care for older people. But the Senate package makes no mention of these important services. Tell Congress that the next COVID-19 relief package must include home and community-based services provisions. 

Members can send their message to Congress here.

CMS Open Door Forum Tomorrow: CMS Skilled Nursing Facilities/Long Term Care

The Centers for Medicare & Medicaid Services (CMS) will be holding an open door forum tomorrow, Thursday, August for skilled nursing facilities/long-term care providers from 2:00 – 3:00 PM. The forum will be held by phone only.

To participate by phone: Dial: 1-888-455-1397 & Conference Passcode: 9375124

The agenda has been listed as follows:

• FY 2021 SNF Prospective Payment Final Rule
• SNF Value Based Purchasing
• Payroll Based Journal Update
• Policy Questions should be sent to NHStaffing@cms.hhs.gov
• Technical Issues/Questions should be sent to iqies@cms.hhs.gov
• PBJ Website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html
• MDS 3.0 Item Sets updates
• Open Q&A

The mailbox for the forum is SNF_LTCODF-L@cms.hhs.gov.

CMS Open Door Forum: COVID-19 Surveillance to Enable Early Detection and Response to Outbreaks

The Centers for Medicare & Medicaid Services (CMS) will be holding an additional open door forum tomorrow, Thursday, August from 4:00 - 5:00 PM. The open door forum is open to nursing home leaders, clinical and administrative staff members and others interested in nursing home infection prevention in the era of COVID-19.

The call will share knowledge and approaches for remaining current in federal guidance and reporting requirements as well as the importance of conducting regular outcome and process surveillance.

During this webinar, participants will receive an overview of the following:

• Brief overview of federal reporting requirements and information on where to access the most up-to-date information and guidance
• Understand and recognize the purpose of, and key elements necessary for, ongoing COVID-19 surveillance
• Understand how a facility should use surveillance data for the prevention, early detection, and mitigation of a potential COVID-19 outbreak
• How to collect, enter, and submit data to the NHSN COVID-19 LTCF COVID-19 Module, including assigning a dedicated Infection Preventionist to conduct ongoing facility-wide surveillance
• Understand how HHS, CMS and CDC use data reported to the CDC NHSN LTCF COVID-19 Module

Advance registration is required.

Note: Once you register, you will receive an email with your individual link to join the webinar. The link you receive will only work for one user. Please forward this email to other team members if you would like them to attend so they can register.

The webinar audio will stream through your computer speakers. For the best experience, be sure to have headphones or your volume turned up. We recommend closing any other applications that may be open, especially those that use up bandwidth.

RELI Group Offers Free Home Health Agencies PEPPER Review

RELI Group has offered a free PEPPER Review for Home Health agencies. Information on the webinar is available below. 

When: September 1, 2020 at 3:00 p.m.

What: A WebEx presented by RELI Group

Topic: A review of the new release of the HHA PEPPER (version Q4CY19, scheduled for release by Aug. 12, 2020)

Registration is required. Click here to register. 

For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the HHA "Training & Resources" section within two weeks following the event. A handout be posted on the PEPPER.CBRPEPPER.org website in the HHA "Training & Resources" section the day prior to the event. It will also be available via WebEx upon joining the session.

Save the Date: Bereavement Networking Forum August 11

LeadingAge Ohio invites hospice bereavement professionals, chaplains and social workers to join its next Bereavement Networking Forum, scheduled for August 11 from 12:00-1:00 pm. The virtual event will begin with an update from Ohio Director of Mental Health and Addiction Services Lori Criss, who will outline the DeWine Administration’s strategy for supporting the mental health needs of Ohioans through the COVID-19 pandemic.

COVID-19 has drastically impacted the way Ohioans grieve, with traditional rituals like funerals and gatherings now limited, and many secondary losses, including job/income loss, loss of roles and routines, and other factors further complicating the bereavement process.  

Attendees will have the opportunity to engage in small group discussions to share ideas, concerns and best practices they are adopting to support their communities. 

Bereavement Networking Forum
August 11, 2020
12:00 - 1:00 pm
Registration is available online here. 

LeadingAge Need to Know: COVID-19 – August 5, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured information about Senator Brown's hospice respite bill and a reminder about tomorrow's webinar. 

Check out the full report here . 

                                        

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Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.