The LeadingAge Nursing Home Network met on October 25 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

RoPs Guidance Implementation The Centers for Medicare and Medicaid Services (CMS) released updated surveyor guidance for the Requirements of Participation (RoPs) in June 2022. Updates included changes to phase 2 and 3 requirements and tightening of investigation timelines and procedures for facility-reported incidents and complaints. LeadingAge has been working with partners at Pathway Health to create resources to assist members as they implement these changes. Resources are available on the Nursing Home RoPs Tools and Resources page. LeadingAge has also worked with partners to update the Trauma-Informed Care Resources, adding the Trauma-Informed Care Addendum. All resources are an exclusive member benefit and require LeadingAge login to access.

Nurse Aide Training At the start of the pandemic, CMS enacted a number of 1135 federal blanket waivers of requirements to streamline operations during the public health emergency (PHE). Though the PHE continues at this time, many waivers have been terminated, including the nurse aide training waiver that was terminated in June 2022. Due to notable backlogs among state nurse aide training and competency evaluation programs (NATCEPs), CMS has made additional waivers available in circumstances where training and testing backlogs prevent individuals from completing training or testing within the regulatory 4-month window as required to continue full-time employment in the nursing home. Waivers are time-limited and efforts must continue to address backlogs and/or complete required training and testing. LeadingAge has been tracking state actions related to these waivers. View this information here.

Flu Vaccination Reporting Nursing home providers must begin reporting flu vaccination coverage of staff in the 2022/2023 flu season as part of the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Providers must submit at least one report that covers staff working at least one day during the flu season (October 1 – March 31 each year) to meet SNF QRP requirements. Data is reported through the National Healthcare Safety Network (NHSN) system in the Healthcare Personnel Safety component. More information is available here.

Point-of-Care Testing CMS issued a memo in early October 2022 rescinding previous enforcement discretion for providers utilizing point-of-care COVID-19 tests. The rescission meant that providers must refrain from using point-of-care tests outside the parameters of the Food & Drug Administration (FDA) authorization or emergency-use authorization (EUA). CMS noted at the time that 31 point-of-care tests were authorized for use in serial screening of asymptomatic individuals. However, the point-of-care test most often distributed to nursing homes by the Department of Health & Human Services (HHS) was not authorized for such use and CMS ultimately reversed the decision to rescind enforcement discretion. As of this time, providers may continue to utilize all point-of-care tests available.

Special Focus Facility Program CMS announced policy changes to the Special Focus Facility program in October. While changes do not expand the number of nursing homes served in the Special Focus Facility program, program policy changes are aimed at improving effectiveness of the program, transitioning nursing homes through the program efficiently, and preventing quality regression in the years following completion of the program, also known as “yo-yo compliance”. Read on for more information on these program changes.

Quality Measure Threshold Recalibration Star rating thresholds in the Quality Measures domain of the Five Star Quality Rating System on Nursing Home Care Compare recalibrated with the quarterly refresh on October 26. As previously announced by CMS, quality measure thresholds now recalibrate every six months, changing by 50% of the rate of improvement from the previous period. The recalibration methodology, adopted to prevent substantial and unpredictable changes in the future while encouraging continuous quality improvement, may impact the star ratings of nursing home providers in both the Quality Measures domain and the overall star rating.

Upcoming Webinar on MDS Changes LeadingAge will host a webinar on November 9 to review upcoming changes to the Minimum Data Set (MDS). Expert consultants from Zimmet Healthcare Services Group will take an in-depth look at the changes and help providers examine assessment and documentation strategies for the interdisciplinary team. Register for the webinar here.

LeadingAge Annual Meeting 2023 Call for Sessions LeadingAge Annual Meeting 2023 will be held in Chicago, Illinois November 5 – 8, 2023. The call for sessions will close December 5, 2022. Learn more and submit your session proposal here.

Member Feedback

Members discussed the September 2022 changes to CDC recommendations for healthcare settings related to COVID-19, with several participants reporting that they have opted not to relax masking guidelines for staff at this time. Participants reported working with long-term care pharmacies to offer updated COVID-19 boosters and flu vaccination to staff and residents and noted that while resident uptake of boosters is consistent, staff acceptance of boosters appears to be impacted by factors such as vaccine fatigue and uncertainty about the necessity of additional boosters. Uncertainty is influenced by staff observations of individuals contracting COVID-19 despite being up to date with COVID vaccinations and the relative lack of severe illness caused by currently circulating variants.

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, November 29 at 2pm ET.