The LeadingAge Nursing Home Network met on August 30 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

Nurse Aide Training Waiver CMS has released updated guidance around transitioning staff from the terminated nurse aide training waiver by the October 2022 deadline. Recognizing barriers to nurse aide training and certification including insufficient training opportunities, limited capacity for skills demonstration, and limited capacity for written exams occurring in states across the country, CMS outlined 2 options for extending 1135 nurse aide training waivers to allow individuals currently working as temporary nurse aides to continue working in nursing homes past the October deadline while working toward certification. In situations of widespread training and certification backlogs, the state or the county may apply for a waiver to cover all affected nurse aides. In situations where state- or county-wide backlogs do not exist but other barriers prevent nurse aide certification, nursing homes may apply for facility-level waivers. All waivers are time-limited and require documentation for approval, including a plan or timeline for resolving certification issues. States, counties, and individual nursing homes can apply for waivers through the 1135 waiver portal. Read more here.

CMS Staffing Study The nursing home staffing study announced in the Biden Administration’s nursing home reform plan is underway. CMS released details of the study that includes a literature review; data analysis focused in payroll-based journal, quality measures, and Medicare claims; a cost analysis; and site visits to 65 nursing homes across all 10 CMS regions. Read more about the site visits here. CMS has also discussed feedback received through the Request for Information published in the FY 2023 SNF PPS proposed rule. Read a summary here. LeadingAge continues to advocate on the importance of recognizing the impact of the workforce crisis and supporting nursing homes to meet staffing standards.

Transitioning to iQIES In 2023, CMS will begin consolidation and transition of the QIES, CASPER, and ASPEN platforms to iQIES. In prepation for this transition, CMS will be reaching out to nursing home providers to identify Provider Security Officials for each organization. Provider Security Officials will be responsible for approving iQIES system users for the organization. CMS will be reaching out to providers by region throughout the next few months. Find out when nursing homes in your region will be contacted here. More information on Provider Security Officials and the onboarding process is available here.

FY 2023 SNF PPS Final Rule The Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule was released at the end of July. The finalized rule provides a 2.7% increase in SNF payments for FY 2023, which includes a 2.3% reduction due to the 4.6% Patient-Driven Payment Model (PDPM) parity adjustment that was finalized with a phase-in across 2 years. Read an overview of the rule here. The rule finalized changes to the SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program that are described in more detail here. The rule also provided resolution on the Fire Safety Evaluation System (FSES) issue that threatened some nursing homes. CMS has determined that nursing homes certified prior to 2016 may continue to operate using the 2001 Life Safety Code mandatory values. Background on this issue and the resolution can be found here.

PBJ Reports for Staffing Data Accuracy With the inclusion of staffing measures in the Nursing Home Care Compare Five Star Quality Rating System in July, many members saw an unexpected change in both staffing ratings and overall ratings. Nursing home providers have 45 days from the end of each quarter to review data and submit any corrections as needed. After the 45-day submission deadline, no corrections can be made, meaning that a star rating based on inaccurate data could impact a nursing home for an entire quarter. Read more here about reports that each nursing home can run to help ensure the accuracy of their staffing data.

Medicare Advantage RFI CMS issued a Request for Information on improving Medicare Advantage. The RFI comment period closed August 31. LeadingAge solicited feedback from members to inform our comments, which can be accessed here.

Member Feedback

Members discussed the CMS staffing study at length during the August call. Nearly all expressed concern with how the current workforce crisis will impact mandatory staffing standards. Many expressed interest in the separate components of the staffing study, including the site visits, and how data and information gathered from each component of the study will be considered in the development of standards. LeadingAge has participated in listening sessions with Abt Associates, the CMS contractor conducting the staffing study, and will continue to provide feedback to CMS and Abt Associates on the importance of a collaborative process that realistically addresses challenges to staffing and quality care.

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, September 27 at 2pm ET.