The LeadingAge Nursing Home Network met on May 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

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. A LeadingAge Nursing Home Network special call was held on May 5 to discuss the rule in greater detail and solicit feedback from members. 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. LeadingAge launched a letter writing campaign to oppose the payment cuts. You can add your voice to the more than 750 members who have taken action so far by going here to send an email directly to CMS Administrator Chiquita Brooks-LaSure. Comments on the rule are due to the Federal Register on June 10. Check out our Tips for Commenting resource here to get started (LeadingAge login required).

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 terminated in 2 waves with the first round of waivers terminating on May 7 and the second round terminating on June 6. Check out this LeadingAge article for important details on 3 specific waivers: the nurse aide training waiver, the CNA in-servicing waiver, and the temporary construction Life Safety Code waivers.

Emergency Preparedness: Actual Emergency Exemption CMS updated memo QSO-20-41-ALL on May 26 related to the actual emergency exemption in emergency preparedness requirements. This exemption allows providers who have activated their emergency plan in response to an actual emergency to be exempt from their next scheduled full-scale, community based exercise or individual, facility-based exercise. CMS has re-confirmed that the COVID-19 public health emergency qualifies as an actual emergency and providers who continue to operate under the emergency plan or who have reactivated the emergency plan in response to COVID-19 are eligible to utilize the actual emergency exemption once again. CMS notes, however, that exemptions may not be accumulated for use in future cycles. Read more on use of the actual emergency exemption here.

Second Boosters CDC strengthened recommendations on May 19 to state that individuals aged 50 and older should receive a second COVID-19 booster. This strengthened recommendation changed the definition of “Up to Date”, which CMS will uphold. This change impacts nursing home operations including source control, quarantine of new admissions and residents with close contact exposure, work restrictions of staff with high-risk exposure, and routine screening testing of asymptomatic staff. Review the definition of up to date here. Read the LeadingAge article here. LeadingAge notes that the change to “up to date” does not change vaccination status requirements under the CMS vaccine mandate. The CMS vaccine mandate continues to require that staff are fully vaccinated against COVID-19, though nursing homes must also track all staff who receive a booster (including second boosters). Nursing homes must also educate both residents and staff on vaccination, including boosters, and offer or assist with accessing vaccination as needed.

NHSN Reporting Updates CDC released updates to the National Healthcare Safety Network (NHSN) system on May 30. These updates include changes to the Long-Term Care Facility (LTCF) COVID-19 module as well as the Healthcare Personnel (HCP) and Resident COVID-19 Vaccination module. More information on these changes is available here. Access updated reporting forms and training slides on the changes on the NHSN page on the CDC website. CDC has also announced a training on June 9 on updates to the new event-level COVID-19 vaccination reporting form. Register for the training here.

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

During the May Nursing Home Network call, members expressed concern about the recent strengthening of booster recommendations and the resultant change in up to date status. While the sudden change in recommendations and definitions present challenges for compliance, a bigger concern is the impact on residents. Many members expressed concern about having to quarantine new admissions, restricting them to their rooms for the first week after admission, simply because they are over the age of 50 and have not received a second booster yet. Not only does quarantine impact a resident’s well-being and assimilation into the nursing home community, but restriction to the resident’s room may also interfere with the resident’s ability to fully participate in services such as rehab therapy.

Additionally, the change in “up to date” impacts routine staff testing based on community transmission rates. With the sudden change in definition, nursing homes must now scramble to increase routine testing to include all staff aged 50 and older who have not received a second booster. This asymptomatic screening testing is not covered by any payer source and while providers may receive test kits from state or federal programs, many members tell us at that these allocations are not sufficient to cover all required testing.

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, June 28 at 2pm ET.