May 12, 2020
KHCA/KCAL is committed to providing our members with important updates. Below is a list of the most recent COVID-19 updates. Please visit our website for a list of complete updates.  www.khca.org
1135 Blanket Waiver- Life Safety Code Requirements
The document that has blanket waivers was updated today and now includes provisions for fire drills and a few other items in the LSC. Please review and utilize the information provided by the Kansas Office of the State Fire Marshal here .

A message from KHCA Life Safety Consultant Stan Spzytek
Additional Clarification on 1135 Blanket Waiver- Life Safety Code Requirements

CMS has provided additional clarification on Life Safety code compliance. See details below. Of particular note, your SNFs can now do training instead of conducting actual fire drills during the declared emergency. Your facilities should conduct a training session on each shift during each quarter of the declared emergency and make sure that it is properly documented including a sign-in sheet. The training sessions can documented with the facilities existing fire drill forms. It will be important to include comments on the form indicating that it was a training session as allowed by CMS under the waiver instead of an actual fire drill. 
 
In a revised communication on the 1135 waivers issued May 8, 2020, CMS is modifying (and clarifying) the following requirements:
 
  • Alcohol-based Hand-Rub (ABHR) Dispensers: We are waiving the prescriptive requirements for the placement of alcohol based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area. Refer to: 2012 LSC, sections 18/19.3.2.6. In addition, facilities should continue to protect ABHR dispensers against inappropriate use as required by 42 CFR §482.41(b)(7) for hospitals; §485.623(c)(5) for CAHs; §418.110(d)(4) for inpatient hospice; §483.470(j)(5)(ii) for ICF/IIDs and §483.90(a)(4) for SNF/NFs.

  • Fire Drills: Due to the inadvisability of quarterly fire drills that move and mass staff together, we will instead permit a documented orientation training program related to the current fire plan, which considers current facility conditions. The training will instruct employees, including existing, new or temporary employees, on their current duties, life safety procedures and the fire protection devices in their assigned area. Refer to: 2012 LSC, sections 18/19.7.1.6.

  • Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between patients. Refer to: 2012 LSC, sections 18/19.3.3.2.

To review the actual revised CMS communication, click on the following link and examine pages 25 – 27:  https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf    

You may contact our Life Safety Consultant who is on a temporary engagement with KHCA for additional clarification or to answer and specific questions.

Stan Szpytek | President - Fire and Life Safety, Inc.
M: 708.707.6363 or email:  Firemarshal10@aol.com
Many Part B Therapy Code Edits Removed
As part of a recent COVID-19 related update to National Correct Coding Initiative (CCI) files, CMS announced the removal of many problematic claim coding edits related to Medicare Part B PT, OT, and SLP services. The changes are effective for dates of service beginning April 1, 2020. Medicaid and most private insurance also follow the CCI edit policies. Provider billing staff should review the updated files available on the  PTP Coding Edit webpage   and the  Quarterly PTP and MUE Version Update Changes webpage .  
Sunflower Personal Protective Equipment for HCBS and NF members and member facing staff
Get 3 ply masks free of charge on a first come, first serve basis. The instructions are included here .
White House Tells States to Test All Nursing Home Residents & Staff
Yesterday, the White House recommended to state governors to test all residents and staff in nursing homes across the country within the next two weeks. This is not an order from the federal government and as of May 12 no specific written recommendation has been made. However, we expect to see states develop plans to put these recommendations into place to the extent feasible. Members should review AHCA/NCAL’s  testing guidance .  

Providers should prepare to meet this requirement by contacting their state health department to seek information on preferred vendors, testing protocols, availability of tests and reimbursement for testing. You should also ask the state health department what to do and document if a resident or staff person refuses to be tested. Document all your communications with the state health department and the steps you take as a result. 

In absence of direction from the state health department, facilities can refer to AHCA/NCAL’s  list of vendors  who can provide testing in the long term care setting. This list is continually updated as new vendors and testing opportunities are available, so please check back frequently.

When testing residents and staff, providers must use PCR tests and should not use antibody tests in place of PCR tests unless instructed by your state officials. Antigen tests are new to the market and while we believe they can be used to comply with this new guidance, their availability is still very limited.

Residents who test positive for COVID-19 must be isolated and wear a source control mask until placed in isolation. Providers are encouraged to follow AHCA/NCAL guidance on  steps to take when COVID-19 gets in . Providers should also explore  cohorting  with other positive residents, if possible. 

Providers should review the CDC  Return to Work Criteria  guidance for considerations for permitting health care providers (HCP) to return to work without meeting all return to work criteria outlined. In addition, providers should refer to CDC’s  Strategies to Mitigate Healthcare Personnel Staffing Shortages  for information on contingency and crisis strategies should a large number of your staff test positive. 

AHCA/NCAL is also seeking  feedback  from members on COVID-19 test availability and use in both skilled nursing and assisted living settings. Information from this survey will help identify challenges and advocate for more availability and clearer guidance on how testing should be used and reimbursed on a national level. 

Please take a few minutes to complete the survey by Wednesday, May 13 (11:59 PM EDT). 
Kansas Health Care Association and the Kansas Center for Assisted Living
1100 SW Gage Blvd Topeka, KS 66604
PH: 785-267-6003 FAX: 785-267-0833