WHCA/WiCAL today participated in the first of a new regularly-scheduled call with DQA officials about pressing issues facing long-term care.
Present on the call from DHS were Otis Woods, DQA Administrator; Shari Klessig, DQA Deputy Administrator; Ann Angell, BNHRC Director; Alfred Johnson, BAL Director; and Nikki Andrews, Bureau of Education Services and Technology Director.
Present on the call from WHCA/WiCAL were John Vander Meer, President/CEO, Jim Stoa, Director of Government Relations and Regulatory Affairs; and Brian Purtell, Legal and Regulatory Advisor.
Items discussed included:
CMS Memo QSO-20-31-All
Providers again raised concern and frustration over the new survey and enforcement structure found in this
. WHCA/WiCAL reiterated that this is a 180-degree turn from the previous collaborative approach to COVID involving providers and regulators.
Providers asked for clarification on several issues found in the memo, and DQA officials plan to report back after review.
Vander Meer asked if the DHS Secretary or DQA officials would publicly raise concerns about these new penalties. We are waiting on feedback on this matter.
WHCA/WiCAL continues to raise serious concerns about this memo and the new survey/enforcement environment it creates. We have already had several conversations with DQA and have elevated concerns to AHCA. We are also working with AHCA to communicate a need to significantly alter this new approach with Wisconsin’s Congressional delegation, urging them to contact CMS and HHS to make needed changes.
WHCA/WiCAL requested that the NHSN grace period should be extended, because we have heard from members facilities who have submitted completed data, but they are still getting CMPs.
WHCA/WiCAL also asked for any more information on the IIDR system in place for these CMPs. The IIDR reviewer is Health Care Management Solutions, based out of West Virginia. WHCA/WiCAL emphasized that providers are relieved that Maximus is not the IIDR review firm for these CMPs due to Maximus’s 91% upholding rate of IDRs/IIDRs in 2019.
Additional questions were: Where do facilities go to make complaints about the accuracy of the data? What happens when NHSN indicates that facilities have positives when they don’t?
WHCA/WiCAL has been in contact with AHCA about the need to address the significant failures of the NHSN reporting system, and AHCA has been in regular contact with federal officials about these concerns.
How to get off the state’s public list of nursing homes with COVID investigations
Vander Meer raised this question, but there is still no clear answer at this time. Ann Angell indicated she would look into it.
DQA officials indicated that guidance is nearing completion, and that we should see new guidance within a week. DQA plans to share a draft with stakeholders for a final review before publication.
WHCA/WiCAL noted that DQA should make clear to surveyors that they can’t be second-guessing decisions related to compassionate care visits – that if facilities are allowing them in certain compassionate care situations in good faith, they should be give the benefit of the doubt.
Angell said that we will also see guidance on beauticians in the near future. The guidance will address proper protocol for allowing a beautician on-site if strict precautions are taken, including PPE use, sanitizing practices, and use of physical space.
Angell also said she would look into the possibility of CNAs or other essential workers being able to fulfill some basic beautician-like services during their shift, as time allows.
Date of July 11 – Liability Protections
WHCA/WiCAL asked if there have been any discussions about extending the liability protections, which will expire on July 11. 2019 Act 185 includes statutory language which says the provision expires 60 days after the expiration of the state’s public health emergency, and the public health emergency expired May 11.
Woods said he would speak to the Secretary’s office and the Governor’s office about any potential for extending those protections.
Status of Emergency Rules
Stoa asked about the current timing for several emergency rules which will reinstate many of the waivers and flexibilities included in Emergency Order 21, which expired in Mid-May. Klessig indicated that the rules could be published and in effect as early as next week.
Federal Emergency Declaration/1135 Waivers
Woods noted that the federal health emergency is set to expire on July 26, and there are some conversations at the federal level whether to extend the declaration by an additional 90 days. Woods questioned whether the expiration of the federal emergency would impact (and potentially end) the CMS 1135 waivers. He said he will provide more information on the implications of the federal health emergency expiring.
Weekly SNF Calls – Thursdays
Woods indicated that next week’s call will be 1.5 hours, instead of 1 hour. They plan to evaluate the usefulness of the additional 30 minutes, and potentially make this a permanent change.