The LeadingAge Nursing Home Network met on January 31 to review recent nursing home policy updates and share feedback among members. Register for the Nursing Home Network here. Check out the Nursing Homes page on the LeadingAge website here.

Policy Updates

PHE Extended The public health emergency (PHE) was extended for another 90 days on January 11. On January 30, the Administration announced that the PHE would officially end on May 11, 2023. Read here to learn how this termination impacts long-term care including regulatory waivers, COVID-era requirements and recommendations, and access to supplies including tests, vaccines, treatments, and personal protective equipment.

FDA Updates The Vaccines and Related Biological Products Advisory Committee (VRBPAC) of the Food & Drug Administration (FDA) met on January 26 to discuss the future of COVID-19 vaccines and vaccination. VRBPAC approved a recommendation to harmonize COVID-19 vaccine strain composition, meaning that individuals would receive the same bivalent vaccine whether it was the first shot or the seventh shot. Read here to learn about the recommendations VRBPAC discussed but did not vote on during the January meeting. Additionally, FDA revised the emergency use authorization (EUA) for Evusheld on January 26, limiting its use when the frequency of non-susceptible variants is greater than 90%. Read the announcement from FDA here.

Schizophrenia Audits CMS released memo QSO-23-05-NH on January 18 announcing a new initiative targeting potentially inaccurate diagnoses of schizophrenia in nursing home residents. The practice is thought to be a strategy for circumventing poor ratings on antipsychotic measures in the Five Star Quality Rating System. Nursing homes found through audits to be inaccurately diagnosing and coding schizophrenia will have Five Star ratings adjusted. More information on schizophrenia audits is available here and here.

Posting of IDR/IIDR Citations Also in memo QSO-23-05-NH on January 18, CMS announced they will begin posting citations under informal dispute resolution / independent informal dispute resolution (IDR/IIDR) on Nursing Home Care Compare. Previously suppressed until the IDR/IIDR process was complete, CMS states that posting these citations is consistent with other Administration moves to increase transparency around nursing home care and operations. Read more here. In response to feedback received from members, LeadingAge sent this letter to CMS Administrator Chiquita Brooks-LaSure stating that the new policy does not respect the nursing home’s right to IDR/IIDR process and urges CMS to work to address IDR/IIDR backlogs instead.

Staffing Standards CMS announced on a January stakeholder call that the staffing study is complete. Staffing standards have not yet been proposed but are expected in spring 2023. LeadingAge proactively initiated an Action Alert urging CMS Administrator Chiquita Brooks-LaSure to refrain from imposing staffing standards without adequate workforce investment and funding. Meanwhile, Senator John Barrasso of Wyoming sent a bipartisan letter to HHS focusing on the impact a staffing mandate would have on rural providers. Senator Barrasso cautioned that a one-size-fits-all approach is inadvisable and urged HHS to address critical workforce and funding issues.

Temporary Nurse Aides A bill was reintroduced in the House of Representatives on January 26 that would extend flexibilities from the temporary nurse aide waiver enacted by HHS beyond the public health emergency. The original nurse aide training waiver was terminated in June 2022 but widespread training and testing backlogs prompted CMS to issue additional waivers to states, individuals, and nursing homes in need. The end of the PHE will automatically terminate any TNA waivers that remain in place despite continued backlogs at this time.

OSHA Final Rule Filing / ETS Update The Occupational Safety and Health Administration (OSHA) sent a final rule to the Office of Management and Budget (OMB) on December 7 that is thought to involve the Emergency Temporary Standard (ETS) that was mostly withdrawn in December 2021. LeadingAge met with OMB in January for a listening session to reiterate concerns previously expressed in formal comments on the ETS. While the rule has not been released in the federal register yet, we know that OMB is the last stop in that process. LeadingAge will be keeping an eye out and updating members when the final rule is released. Read here for a refresher on the ETS.

OIG Report on Nursing Homes During the Pandemic The HHS Office of the Inspector General (OIG) released a report on January 19 examining COVID in nursing homes during the 2020 spring and fall surges. OIG found that more than 1,300 nursing homes had infection rates of 75% or greater. The report drew conclusions between COVID infection rates and staffing, infection control, and survey processes. More findings and resulting recommendations can be found in this fact sheet.

Surveying Hospice Services in Nursing Homes CMS has released updated guidance on hospice surveys, which includes surveying hospice services in nursing homes. The guidance, accessible here, includes a list of prompts for surveyors to interview nursing home staff about hospice services. Members may also wish to consult the Staff Competency Toolkit, Hospice Integration KSA Competency on the RoPs Tools and Resources page.

Member Feedback

LeadingAge solicited feedback from members on certified nurse aide (CNA) training and testing backlogs. With the May 11 end of the public health emergency (PHE), some states continue to experience backlogs that will have no recourse when the waivers end. Members also suggested continued advocacy on the CNA lock-out to address ongoing workforce concerns.

Members expressed concern over how the end of the PHE will impact COVID mitigation practices including CDC recommendations. Many suggested that the end of the PHE presents an opportunity to reevaluate National Healthcare Safety Network (NHSN) reporting requirements as well as validity of community transmission rate calculations.

The LeadingAge Nursing Home Network call takes place on the last Tuesday of every month. If you are a LeadingAge nursing home member and would like to join this group, you can register here. Your LeadingAge login is required to register. If you do not have a LeadingAge login, you can create one here using your work email address.