The LeadingAge Nursing Home Network met on February 28 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 Ending On January 30, the Administration announced that the PHE would officially end on May 11, 2023. This termination has varying impacts on nursing home operations. Most regulatory waivers will end, though telehealth waivers have been extended. Many of the interim final rules implemented during the PHE remain in place, and though one rule ends, the practices required under the rule do not. While vaccines, tests, and treatments are not tied to the PHE, the future of these supplies remains unclear. Read here for what you need to know about the end of the PHE.

 Staffing Standards CMS announced in January that the study to inform staffing standards was complete. This study included a literature review, qualitative and quantitative data analysis, and cost analysis. On a stakeholder call in February, CMS reported that they were continuing to evaluate time requirements and unintended barriers and consequences of staffing standards. LeadingAge launched the Get Real on Ratios campaign, outlining key conditions that must be met prior to imposing any staffing standards including payment rates that cover at least 95% of the cost of care, ample supplies of qualified potential employees in long-term care, flexible standards to meet current resident needs, the absence of a public health emergency, and waivers for local emergencies. Standards have not yet been proposed, but are expected in spring 2023.

Ownership Transparency CMS proposed a rule on February 15 to require nursing homes to publicly disclose nursing home ownership, management, and other information. Skilled nursing facilities will report information on the Medicare Enrollment Form 855A or through the Provider Enrollment, Chain, and Ownership System (PECOS). Non-Medicare nursing homes will disclose information through processes outlined by individual states’ Medicaid offices. Read more here. Comments on the proposed rule are due April 14. The rule will go into effect 60 days after the date of finalization, with data being made public one year after the date of finalization.

MDS Transition to iQIES The Minimum Data Set (MDS) will transition to iQIES on April 17. To facilitate this transition, there will be an MDS-submission black out beginning on April 13 at 8pm ET, at which time MDS submissions will no longer be accepted through QIES. Nursing homes must still adhere to timely submission requirements and should therefore make arrangements to ensure timely submission for assessments due during this time period. Note that submitting data through iQIES requires a Provider Security Official (PSO). Each individual nursing home must have a PSO designated, even if the nursing home is part of a multi-site organization or uses a third-party vendor for submitting the MDS. Learn more about the PSO role here.

CDC Meeting on COVID-19 Vaccination The Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) met on February 24 to discuss the future of COVID-19 vaccination. Information reviewed was similar to that discussed by the Food & Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting in January, including harmonizing vaccine strain composition and considering immunization schedules. ACIP did not vote on any recommendations during the February meeting and no recommendations have changed at this time. Advisory committees for both the FDA and CDC will meet again in June.

Congressional Updates The Senate Aging Committee released a report entitled “Left in the Dark” examining the impact of the Texas winter storm power outages of 2021 on nursing homes. This report was a companion to the 2018 report “Sheltering in Danger” that examined the impacts of Hurricanes Harvey and Irma on nursing homes in Texas and Florida. The reports made several recommendations including improving nursing home staffing and nursing home emergency preparedness. The report and associated Senate hearing signal continued focus by the Administration on nursing home emergency preparedness.

LeadingAge submitted written testimony to the Senate Health, Education, Labor, and Pensions (HELP) committee related to a February 16 hearing on workforce entitled “Examining the Healthcare Workforce Shortages: Where Do We Go from Here?” LeadingAge urged the HELP committee to consider policies that would bolster wages; offer incentives and federal grants; mitigate staffing agency price gouging; establish and retain a pipeline of foreign workers; implement common sense proposals that must be met before implementing nursing home minimum staffing standards; and enact meaningful, equitable, long-term care financing. Read the statement here.

Hospice Surveys and Nursing Homes CMS released updated surveyor guidance for hospices that includes interviewing nursing home staff on their understanding of hospice services provided in the nursing home. Nursing homes should coordinate with their hospice providers on this new guidance and check out the Hospice Integration KSA Competency in the Staff Competency Toolkit on the Nursing Home RoPs Tools and Resources page.

Member Feedback

During February’s call, members discussed experiences on recent surveys. Some states are experiencing increased attention on surveys to emergency preparedness. Others reported close scrutiny of Facility Assessments and how they are used to inform operations such as staff competencies. Many members reported that state agencies seem to be continuing to struggle to catch up with survey backlogs related to the COVID-19 public health emergency.

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. Our next monthly call will take place Tuesday, March 28 at 2pm ET.