The LeadingAge Nursing Home Network met on April 26 to review recent nursing home policy updates and share feedback among members. Register for the Nursing Home Network here. Check out the updated Nursing Homes page on the LeadingAge website here.

Policy Updates

White House Nursing Home Reform Initiative The Biden Administration announced a nursing home reform initiative, Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes, on February 28. Reforms cover 21 initiatives across 5 goals aimed at improving quality, enhancing oversight, increasing transparency, boosting workforce, and ensuring pandemic and emergency preparedness. While timelines for implementation will vary, we are beginning to see some movement on this plan already. For example, many reforms are reflected in the Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule released on April 15. Read more about the White House initiative here.

NASEM Report The long-awaited nursing homes report from the National Academies of Sciences, Engineering, and Medicine (NASEM) was released on April 6. The Committee on the Quality of Care in Nursing Homes began its work in fall 2020 to examine how the United States delivers, finances, measures, and regulates the quality of nursing home care. The report identified recommendations across 7 goal areas addressing person-centered care, workforce, transparency and accountability, financing, quality assurance, quality measurement, and health information technology. There are several overlaps between the NASEM report and the White House nursing home reform initiative, though the recommendations in the NASEM report go into much greater detail and include an imperative for financing of reforms. The NASEM report is available here and a high-level summary from LeadingAge is available here.

OSHA In early March 2022, the Occupational Safety and Health Administration (OSHA) announced that it would be conducting focused inspections over the next 3 months in hospitals and skilled nursing facilities (SNFs) that treat COVID-19 patients. Inspections will target those locations that were previously inspected and received citations from OSHA related to COVID-19. Read more about these inspections here.

Additionally, LeadingAge submitted comments to the Federal Register on the OSHA Healthcare Emergency Temporary Standard (ETS) for a comment period that reopened on March 22 and closed April 22. Comments were consistent with those previously submitted by LeadingAge during the initial comment period that closed in August 2021 and urged OSHA to follow recommendations from the Centers for Disease Control & Prevention (CDC) in any rulemaking. An informal public hearing on the ETS was held on April 27, with another comment period reopened from May 2 to May 23. Information on the latest extension is available here.

FY 2023 SNF PPS Proposed Rule The Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule was released on April 11 and published in the Federal Register on April 15. The comment period on this rule closes on June 10. The rule proposes a 3.9% payment update for FY 2023 that is off-set by a proposed 4.6% payment reduction due to the recalibration of the patient-driven payment model (PDPM). The rule additionally requests feedback on minimum staffing standards with 17 prompts for stakeholder consideration. Consistent with the White House initiative and the NASEM report, this request for information represents one of the most comprehensive opportunities for members to contribute to forthcoming minimum staffing standard policies.

Additional proposals of note in the rule include infection isolation coding on the minimum data set (MDS), proposed measures for both the SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program, a revised data collection period for certain SNF QRP measures, measure suppression for FY 2023 for the SNF VBP, a new low volume policy and new scoring methodology for SNF VBP, and a request for information on validation procedures to be incorporated into the SNF VBP program.

LeadingAge strongly encourages members to take action on this rule, engaging in the LeadingAge letter writing campaign to CMS Administrator Chiquita Brooks-LaSure and submitting comments to the Federal Register including a response to the minimum staffing request for information. More information on the rule and LeadingAge advocacy and resources can be found here.

National Public Health Emergency Health and Human Services (HHS) Secretary Xavier Becerra extended the COVID-19 national public health emergency (PHE) on April 12, effective April 16, for another 90 days into July 2022. The Biden Administration stated previously that it will give at least 60 days’ notice prior to terminating the national public health emergency. LeadingAge will continue to monitor PHE renewals and alert members to any changes.

1135 Federal Blanket Waivers CMS released memo QSO-22-15-NH & NLTC & LSC on April 7 announcing termination of many of the 1135 federal blanket waivers applicable to nursing homes. Waivers will terminate in 2 waves with the first round of waivers terminating on May 7 and the second round terminating on June 6. Information on waivers can be found here. A few waivers to note: the nurse aide training waiver will terminate in the second wave on June 6, giving individuals working under that waiver 4 months, into October 2022, to meet requirements for continued employment as a nurse aide. The Qualifying Hospital Stay (QHS) waiver, or 3-day stay waiver, has not been announced for early termination and remains in effect at this time until the end of the PHE.

Quality Measure Threshold Recalibration on Care Compare The 5-Star Quality Rating System on Care Compare updated star rating thresholds for the quality measures domain with the quarterly refresh on April 27. This begins a new policy of threshold recalibration first announced by CMS in March 2019 and announced in October 2019 for an April 2020 implementation in which the star rating thresholds will update every 6 months by half the rate of improvement since the previous update. Information on this change can be found in the 2019 CMS memos and in the 5-Star Quality Rating System Technical Users Guide.

HHS Point-of-Care Test Reporting Effective April 4, providers are no longer required to report negative point-of-care testing per the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This change, announced March 8, applies to nursing homes administering point-of-care testing under a Clinical Laboratory Improvement Amendment (CLIA) waiver. Read the announcement here. Nursing homes must continue to report positive test results within 24 hours and have a number of options for reporting including reporting to a state platform, a health information exchange, or through the point-of-care testing pathway on the National Healthcare Safety Network (NHSN). Note that nursing homes must continue reporting all required data through the Long-Term Care Facility (LTCF) COVID-19 module on NHSN. This announcement relates only to COVID-19 test reporting requirements under the CLIA waiver.

NHSN Reporting Updates May will bring several updates to NHSN reporting for nursing home providers. NHSN has released a new event-level tracking form for COVID-19 vaccination. This event-level form requires SAMS level 3 access and will replace the excel spreadsheets previously available to providers. Note, however, that use of the event-level form is not required and providers who have developed an alternative method for tracking and reporting data may continue. Training on the new event-level form is available here.

Also in May, the LTCF COVID-19 module and the Healthcare Personnel & Resident COVID-19 Vaccination module will undergo significant updates. Updates are scheduled for May 30 and include streamlining of many data elements, reflecting changes in the national COVID-19 response. Changes include eliminating data breakdowns on vaccine manufacturer and test type, eliminating data elements related to co-infections and re-infections, and modifying data elements on personal protective equipment (PPE) and staffing shortages. CDC will host trainings on these changes on several dates in May.

Community Transmission Rates vs. COVID Community Levels CDC continues to recommend use of Community Transmission Rates to determine mitigation strategies for healthcare settings, despite transitioning the general public to COVID-19 Community Levels. CDC advises that, at this time, the risks remain too great to the individuals served by healthcare settings to transition away from Community Transmission Rates. Providers should ensure that they continue to access community transmission rates on the COVID-19 Data Tracker, signified by blue, yellow, orange, and red color-code levels as opposed to the blue and green color codes utilized in COVID Community Levels.

Member Feedback

As in previous Nursing Home Network calls, members discussed the difficulty of tracking and adjusting operations to be consistent with frequently changing CDC recommendations. In particular, nursing home members shared how challenging it has been to help residents and visitors understand and adhere to recommendations for healthcare settings that are based on community transmission rates when the general public follows much more relaxed measures based on COVID Community Levels. Members also expressed concern over following community transmission rates based, in part, on test positivity, when the way the nation accesses COVID-19 testing has changed so significantly. Member concerns were shared with partners at CDC.

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, May 31 at 2pm ET.