LeadingAge Nursing Home Advisory Group - April 2021

Regulation | April 30, 2021 | by Jodi Eyigor

David Hood, Principle at RPA, a Jensen Hughes Company, presented on emergency preparedness on the monthly Nursing Home Advisory Group call on Tuesday, April 28.

David Hood, Principle at RPA, a Jensen Hughes Company joined the Nursing Home Advisory Group call on April 28, 2021 to discuss emergency preparedness compliance and answer questions from LeadingAge nursing home members. Mr. Hood’s presentation was then followed by policy updates from LeadingAge staff and a short, facilitated discussion with group participants on vaccine acceptance and personal protective equipment.

Life Safety Code and Emergency Preparedness

Mr. Hood focused on 2 key components of Life Safety and Emergency Preparedness: resuming normal inspection, testing, and maintenance and annual emergency preparedness testing requirements.

Inspection, Testing, and Maintenance. Mr. Hood reviewed the 1135 federal blanket waiver currently in effect related to inspection, testing, and maintenance (ITM). This waiver alleviates providers of certain ITM requirements, though not all. The following requirements remain in effect, despite 1135 waivers:

  • Fire pump monthly/weekly churn testing
  • Fire extinguisher monthly inspections
  • Monthly elevator firefighter service testing
  • Monthly 30-minute generator / automatic transfer switch testing
  • Daily means of egress inspections in construction/renovation areas

As CMS has recently noted, 1135 waivers are available for providers, but are intended to be used only when truly needed due to emergency. Mr. Hood recommends considering the following factors in determining when to resume inspection, testing and maintenance:

  • Nursing home COVID status (outbreak status)
  • Vaccination rates of residents and staff
  • State-specific guidelines or requirements
  • Community positivity rate
  • Time elapsed since last inspection, testing, and maintenance
  • Any system issues/troubles since last inspection, testing, and maintenance

More information on these and other 1135 waivers can be found here.

Emergency Plan Testing. Nursing homes are required to conduct 2 testing exercises annually on the emergency plan. One exercise must be either a full-scale, community-based exercise or an individual facility-based functional exercise. The second exercise must be an exercise of choice, which could include another full-scale community-based exercise or individual facility-based functional exercise or one of the following: a mock disaster drill, a table-top exercise, or a workshop.

Recall that the rule allows that if an actual emergency has occurred that required activation of the provider’s emergency plan, this actual emergency can qualify as the required full-scale community-based or individual facility-based functional exercise and the provider would be exempt from completing the next full-scale community-based or individual facility-based functional exercise following the onset of the emergency.

If the emergency plan was activated in response to COVID-19, it can qualify for the “actual emergency” exemption. The provider would be exempt from completing the next required full-scale community-based or individual facility-based functional exercise following the initial activation of the emergency plan, but would still be required to complete the second required exercise of choice. Additionally, we have clarified from CMS that the actual emergency exemption only applies once for a given emergency. The provider is not exempted from a second year’s full-scale community-based or individual facility-based functional exercise for the same emergency, even if the emergency plan remains activated.

Mr. Hood recommends documenting your pandemic response through an After Action Report that focuses on key areas or response such as: preparation, personal protective equipment (PPE), response and recovery, communication, media interactions, altered operations, COVID-19 screening and testing, staffing, visitation, and cohorting. Mr. Hood also offered the following tip on PPE storage: when creating a new hazardous area (storage), a 1-hour enclosure is not necessary provided the building is fully-sprinklered, the area is less than 250 feet, and the door(s) are self-closing, positive-latching, and restrict the passage of smoke.

To hear more from Mr. Hood on Life Safety Code and Emergency Preparedness compliance, check out the new recorded webinar on the LeadingAge Learning Hub, which includes a template to help in documenting your pandemic response to satisfy emergency preparedness testing requirements.

Policy Updates

FY 2022 SNF PPS Proposed Rule. The FY 2022 SNF PPS proposed rule was released on April 8. In addition to payment rates for FY 2022, this rule proposes changes to SNF consolidated billing, ICD-19 code mappings and lists for the patient-drive payment model (PDPM), a PDPM parity adjustment, and changes to the SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program. An overview of this rule is available here. LeadingAge will host a special advisory group call on Friday, April 30 to discuss the rule in greater detail and solicit member feedback. Comments on the rule are due June 7.

Lobby Day 2021. LeadingAge Virtual Lobby Day took place on April 21. We had more than 420 LeadingAge members participating in close to 300 meetings. Of those 300 meetings, 60 included a member of Congress despite Congress being in session at the time. This year’s Lobby Day broke all previous records, including participation across more provider settings than in years past, and we will continue to build on this momentum. Visit our Advocacy Action Center to find out how you can participate in advocacy efforts all year long.

Congressional Activity. President Biden has now introduced all 3 parts of his Build Back Better plan. Part 2, the American Jobs Plan was introduced on March 31 and included $400 billion for home and community based settings (HCBS). Senate republicans have introduced an alternative that defines “infrastructure” much more narrowly, notably excluding the care infrastructure. LeadingAge released the Blueprint for a Better Aging Infrastructure advocating for support around workforce; HCBS; expanding and improving affordable senior housing; strengthening nursing home staff, quality, and physical structures; reforming long-term care financing; and providing funding to support aging services providers in COVID recovery.

Additionally, President Biden signed the Medicare Sequester bill on April 14 to extend the suspension of the 2% Medicare reimbursement cuts through December 31, 2021.

Ensuring Access to Vaccination in Long-Term Care. The Johnson & Johnson / Janssen COVID-19 vaccine was placed on temporary hold this month due to reports of rare occurrences of thrombosis with thrombocytopenia syndrome (TTS). During this pause, long-term care pharmacies participating in the federal Retail Pharmacy Program were supplemented with the Moderna vaccine in order to avoid any disruptions to vaccine access in long-term care. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) recommended on April 23 that use of the vaccine resume. The vaccine continues to be recommended for individuals over the age of 18. Women under the age of 50 should be aware of the very rare risk of TTS and adverse events should be reported through the Vaccine Adverse Event Reporting System (VAERS).

1135 Federal Blanket Waiver Terminations. CMS released memo QSO-21-17-NH on April 8 announcing termination of 4 federal blanket waivers. These waivers, which will be terminated effective May 10, include the notice of discharge/transfer, notice of room/roommate change, submission of Minimum Data Set (MDS), and timely completion of care plans. All other waivers remain in effect at this time thanks to the extension of the public health emergency, extended for another 90 days effective April 21.

The memo also addressed the nurse aide training waiver. This waiver remains in effect at this time and CMS recommends that states begin now to review their Nurse Aide Training and Competency Evaluation Program (NATCEP) requirements to determine the on-site work completed by temporary nurse aides that can count toward training requirements. Nurse aides will have 4 months from the date of the end of the waiver to complete all training and certification requirements.

CDC Guidance on Nursing Homes and International and Domestic Travel. CDC released updated guidance on April 27 impacting nursing homes in a variety of ways. Updated guidance on travel may impact when staff are permitted to return to work following travel.

Updated infection prevention and control guidance for healthcare settings recommends greater flexibilities for fully vaccinated residents during dining and activities and during visits with fully vaccinated visitors. The guidance also allows for reduced testing for fully vaccinated healthcare personnel. More information on these updated recommendations from CDC and revised requirements from CMS is available here.

Member Feedback

Following policy updates, members engaged in open discussion on topics to include vaccine acceptance and PPE supply, use, and optimization. While many participants on the call reported conventional capacities of PPE, consistent with CDC’s analysis of data from the National Healthcare Safety Network (NHSN), providers report continued barriers such as availability of sizes, availability of fit-testing, and soaring prices.

A significant incentive to increase vaccine acceptance among staff may be relaxing guidance around PPE use. Eye protection seems to be a particular challenge. It would seem that some states have requirements in place for staff to wear eye protection such as goggles and face shields even outside of providing resident care. Providers note that relaxing this requirement for eye protection outside of resident care for fully-vaccinated healthcare workers would likely incentivize staff to accept the vaccine.

Our next monthly call will take place on Tuesday, May 25 at 2pm ET. If you would like information on how to join this group, please email jeyigor@leadingage.org.