The LeadingAge Nursing Home Network met on March 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

Ownership Transparency CMS proposed a rule on February 15 to require nursing homes to publicly disclose nursing home ownership, management, and other information. Of note, skilled nursing facilities and nursing homes will begin reporting “additional disclosable parties” and status as private equity and real estate investment trusts. Read more here. LeadingAge will be submitting comments on the proposed rule by the April 14 deadline.

PHE Ending The May 11 end of the COVID-19 public health emergency (PHE) is drawing closer. All 1135 and 1812(f) regulatory waivers, with the exception of telehealth, will end with the end of the PHE. Most interim final rules implemented during the PHE will remain in effect for a period of 3 years after the date of finalization. The one exception is the rule on COVID-19 testing, which will end with the PHE, though nursing homes will continue to adhere to CDC recommendations on COVID-19 testing and mitigation strategies as nationally accepted standards per infection control requirements. More information on the impact of the end of the PHE can be found here.

Continuing CDC Recommendations for COVID-19 Infection Control Despite the impending termination of the PHE, nursing homes will continue to follow CDC recommendations for COVID-19 infection control in healthcare settings. Rather than announcing changes to the recommendations, CDC is encouraging providers to examine how the mitigation strategies of the past few years have had positive impacts on nursing home infection control and the mitigation of other respiratory illnesses. CMS continues to refer to CDC recommendations and is unlikely to issue separate guidance to contradict the accepted standards set forth by CDC.

Potential Changes for NHSN Reporting When the Biden Administration announced the end of the PHE, LeadingAge spoke with CMS and CDC about COVID-era operations to re-evaluate as we transition. One such area was NHSN reporting and LeadingAge has learned that changes to NHSN reporting data elements are currently under review with plans for release in June 2023. Changes are mostly aimed at streamlining NHSN reporting – removing or changing data elements that no longer yield meaningful data or trigger administrative support and resources for nursing homes. Changes have not yet been finalized but are tentatively projected for a June 2023 release.

3-Day Stay LeadingAge continues advocacy with the Administration and Congress to eliminate the 3-day stay requirement for Medicare A coverage of Skilled Nursing Facility (SNF) services. Recognizing that the 3-day stay waiver ends with the end of the PHE, LeadingAge has been advocating to CMS to implement a permanent waiver of requirements until such time as Congress eliminates the requirement altogether. LeadingAge met with CMS in March and encourages members to participate in the Action Alert to Congress.

Workforce Advocacy LeadingAge continues advocacy to Congress related to workforce shortages in aging services. LeadingAge submitted written testimony for the Senate Committee on Health, Education, Labor, and Pensions (HELP) hearing in March and continues communications with the committee on challenges faced by our members. LeadingAge conducted an informal snap poll on workforce in March in which 92% of nursing home respondents reported “significant” or “severe” workforce shortages. Read toplines of the snap poll here. Read a related blog post on workforce shortages here. The results of the snap poll will assist LeadingAge in continued advocacy.

COVID-19 Test Kits from HHS HHS continues to supply free rapid COVID-19 tests to assist aging services providers at this time. These allocations are not tied to the PHE and are supplemental to the regular allocations from HHS to nursing home providers. LeadingAge members can order additional test kits here.

Flu Vax Reporting for SNF QRP Nursing home members participating in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) will soon submit reports on flu vaccination coverage among healthcare personnel for the 2022 – 2023 flu season. Flu season is defined as October 1 – March 31 and providers must submit at least one report capturing the flu vaccination status of all healthcare personnel who worked in the nursing home at least one day during the flu season. Reports must be submitted through the NHSN Healthcare Personnel Safety (HPS) component, a different component than the one through which COVID-19 reporting is submitted. Read more here on requirements for submitting this data prior to the May 15 deadline.

Schizophrenia Audits CMS continues audits to identify potentially inaccurate diagnosis and coding of schizophrenia on the Minimum Data Set (MDS). Believed to be a strategy for preserving quality measure ratings, these audits are CMS’s latest effort to address inappropriate and unnecessary use of antipsychotic medications in nursing homes. During audits, nursing homes are requested to provide documentation to substantiate schizophrenia diagnoses, such as comprehensive medical and psychiatric assessments, documentation of symptoms and behaviors associated with schizophrenia, or documentation of required attempts at gradual dose reduction. LeadingAge welcomes feedback from members who have been selected for schizophrenia audits. Please email Jodi Eyigor jeyigor@leadingage.org.

MDS Transition to iQIES The Minimum Data Set (MDS) will transition to iQIES on April 17. To facilitate this transition, MDS submission through QIES will be disabled April 13 at 8pm ET. Timely MDS submission is still required during this time, so nursing homes will need to make arrangements to submit all necessary assessments prior to the April 13 blackout. Nursing homes must have a Provider Security Official (PSO) approved by CMS to begin submitting through iQIES on April 17. Information on changing the PSO is available here. Once approved by CMS, the PSO is responsible for assigning all other iQIES users within the nursing home, including any additional PSOs.

GAO Report on Infection Control The Government Accountability Office (GAO) released a report on March 20 on nursing home infection prevention and control. The report is based on the work of an expert roundtable convened by GAO and includes 14 recommendations. Recommendations are consistent with those issued in the past by GAO in a September 2022 report, the National Academies of Sciences, Engineering, and Medicine (NASEM) report released in April 2022, and the 2020 report from the Coronavirus Commission on Safety and Quality in Nursing Homes. Among them, the experts recommended that HHS continue requirements for NHSN reporting, the emphasis on infection control, and utilization of strike teams; enhance requirements around emergency preparedness, infection prevention and control training, and the use of non-monetary enforcement actions; and discontinue extended use of limitations on visitation and group activities.

Emergency Preparedness Emergency preparedness continues to receive heightened attention. The HHS Office of the Inspector General (OIG) added emergency preparedness to its work plan in March 2023, focusing on how state survey agencies enforce adherence to emergency preparedness requirements and what more is needed to support survey agencies in enforcing requirements. LeadingAge participated in a call with CMS in March that was convened by Jensen Hughes to initiate regular communication between the provider associations and CMS on emergency preparedness issues. CDC featured inclusive emergency planning in their monthly EPIC Exchange, noting that individuals with disabilities or mobility challenges and individuals identifying as LGBTQIA+ are among those most likely to face increased risk during emergencies.

Dialysis Surveys in Nursing Homes CMS revised memo QSO-18-24-ESRD on March 22 related to surveying home dialysis services in nursing homes. The revised guidance states, “The primary goal of the on-site visit is to evaluate the care and management of patients requiring dialysis, including adherence to infection control procedures, knowledge of the nature and management of ESRD [end-stage renal disease], as well as the ability to detect, report, and manage potential dialysis complications.” During the on-site visit to the nursing home, ESRD surveyors will evaluate the written agreement between the nursing home and the ESRD facility, the qualifications and training of staff caring for residents receiving in-home dialysis in the nursing home, and the coordination of care between the nursing home and the ESRD facility. LeadingAge notes that similar guidance was issued related to surveying hospice services in the nursing home in January 2023. LeadingAge members may wish to consult the Staff Competency Toolkit on the Nursing Home RoPs Tools and Resources page, which contains knowledge-skills-abilities (KSA) competencies on dialysis and hospice integration.

Congressional Updates Senators Bob Casey (D-PA) and Ben Cardin (D-MD) introduced the Medicare and Medicaid Dental, Vision, and Hearing Benefit Act on March 16. The legislation would allow Medicare to cover dental, vision, and hearing services and increase the federal investment in Medicaid, incentivizing more states to provide these comprehensive services.

President Biden’s budget proposal in March included a nearly 40% increase in spending for nursing home survey and certification. The Administration further detailed plans for continued focus on ownership transparency, addressing the backlog of complaint surveys, securing adequate funding for inspections, increasing Special Focus Facility oversight, and expanded use of penalties for nursing home noncompliance.

Medicare Advantage LeadingAge published a white paper on Medicare Advantage that describes the challenges providers face in assuring beneficiaries access to quality care and outlines actions CMS can take to address these barriers. Read more here.

LeadingAge Leadership Summit Leadership Summit will take place April 16 – 19 in Washington, DC. Nursing home members won’t want to miss the nursing home policy update with CMS on Wednesday morning, followed by LeadingAge Lobby Day on Wednesday afternoon when members have the opportunity to meet with members of Congress and congressional staff on Capitol Hill. Register for Leadership Summit and Lobby Day here.

Member Feedback

During our March call, members provided feedback on the ownership transparency proposed rule. Many expressed concern about the vagueness of the requirement to report on “additional disclosable parties” and wondered if this would result in CMS receiving significantly more information than was useful. Members shared experiences of recent surveys and of experiences updating account information within the National Healthcare Safety Network (NHSN) system.

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, April 25 at 2pm ET.