Greetings!
This message includes:
- a link to the recently posted VDH COVID-19 Guidance for Nursing Homes;
- information from the Board of Nursing on conducting antigen testing;
- an invitation to join VCU’s AHRQ ECHO Nursing Home COVID-19 Network—cohorts start next week;
- information on updated NHSN reporting requirements related to POC testing; and
- details about changes to the Provider Relief Fund reporting requirements.
I have also included links to information we distributed last week that I wanted to be sure you didn’t miss:
Sincerely,
April Payne, MBA, LNHA
Vice President of Quality Improvement | Director of VCAL
Virginia Health Care Association | Virginia Center for Assisted Living
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VDH COVID-19 Guidance for Nursing Homes
VDH posted a new document, VDH COVID-19 Guidance for Nursing Homes, on the Virginia Long-Term Care Task Force webpage on October 22. The document list numerous topics (general prevention measures, hand hygiene, PPE, cohorting, etc.), summarizes the recommendations related to the topic, and specifies the recommending agency and resource links.
We are following up with VDH on several questions about the document and will relay any additional information about it.
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BON Q&A on Antigen Testing
We received the following guidance from the Virginia Board of Nursing (BON) regarding antigen testing at facilities:
Q: The federal government will be distributing point-of-care (POC) antigen tests (BinaxNOW) to states; are there any scope of practice issues with placing these assays in settings where there isn't always a licensed healthcare provider? Does a certain level provider have to administer such tests?
A: While this question cites the BinaxNOW test, other POC tests (BD and Quidel) do not alter our collective opinion.
Virginia Code allows a Board of Medicine licensee to delegate functions that are nondiscretionary and that do not require the exercise of professional judgement to trained, but unlicensed, individuals. This is the applicable Code section:
§ 54.1-2901. Exceptions and exemptions generally
A. The provisions of this chapter shall not prevent or prohibit:
6. Any practitioner licensed or certified by the Board from delegating to personnel supervised by him, such activities or functions as are nondiscretionary and do not require the exercise of professional judgment for their performance and which are usually or customarily delegated to such persons by practitioners of the healing arts, if such activities or functions are authorized by and performed for such practitioners of the healing arts and responsibility for such activities or functions is assumed by such practitioners of the healing arts;
Licensed practitioners in this case would need to have prescriptive authority as the BinaxNOW is by prescription only. Hence delegators could include MDs, DOs, Podiatrists, PAs, and NPs. The delegating authority could be a practicing provider, a local health director, or even Dr. Oliver. The keys are that the delegating authority must supervise the personnel and assure that they are trained and competent.
Non-licensed individuals (for example CNAs and MAs) could be trained on the BinaxNOW and be assessed for competency. (Abbott does provide training modules, a proficiency written test, and way to document training.)
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Join the AHRQ ECHO Nursing Home
COVID-19 Action Network
Project ECHO and Virginia Commonwealth University are actively recruiting nursing homes across Virginia to join an interactive community of practice to advance improvements in COVID-19 preparedness, safety, and infection control. Supported by the federal Agency for Healthcare Research and Quality (AHRQ), and in collaboration with the Institute for Healthcare Improvement (IHI), the AHRQ ECHO National Nursing Home COVID-19 Action Network is open to any Medicare or Medicaid-certified nursing home at no cost. Nursing homes eligible to receive funding from the Provider Relief Fund (PRF) can receive $6,000 in compensation for participating. Each nursing home must commit two staff members to actively participate in the 16-week training (60 minutes per week).
VCU would like to recruit three cohorts of 34 nursing facilities. There is a deadline of the week of November 9 for all nursing homes interested in the project to take advantage of all the financial incentives and benefits.
The Approach. The Network will operate as a 16-week interactive virtual community of practice utilizing the ECHO model. Weekly sessions are designed to create space to hear directly from nursing home staff about the challenges they are facing through discussion of real cases. All participants are encouraged to share best practices and learn from their peers, while benefiting from the guidance of nursing home and quality improvement experts. Each Network session will include a short lecture combined with case-based presentations and discussion.
Topics include:
- Infection Prevention and Management: PPE, Cohorting, Testing, Screening
- Environmental Design: Cleaning and Disinfection Practices
- Advance Care Planning in COVID-19
- Staff Return to Work
- Care Transitions
- Safe Visiting Policies
- Social Isolation and Emotional Wellbeing
The Goals. Help nursing homes implement evidence-based best practices to:
- Keep COVID-19 from entering nursing homes where it has not entered.
- Identify residents and staff who have been infected with COVID-19 early.
- Prevent the spread of COVID-19 between staff, residents, and visitors.
- Provide safe and appropriate care to residents with mild and asymptomatic cases of COVID-19.
- Ensure staff have the knowledge, skills, and confidence to implement best-practice safety measures to protect residents and themselves.
- Reduce social isolation for residents, families, and staff during these difficult times.
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Updated HHS NHSN Reporting Requirements
This week, CMS has added a new requirement that all point-of-care (POC) antigen test results conducted in a facility must be reported to NHSN. The June 4 HHS memo on laboratory testing has now been updated to state:
“#4 CMS-certified long term care facilities shall submit point-of-care COVID-19 testing data, including antigen testing data, to CDC’s NHSN”.
This new requirement goes into effect immediately. However, CMS has verbally indicated to AHCA that it will exercise enforcement discretion until November 20.
This new reporting module in NHSN requires SAMS Level-3 access. More information on this new reporting module is available here. CDC will also be holding training webinars in the coming weeks.
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Updated Reporting Requirements to the Provider Relief Fund
On October 22, HHS announced changes to the reporting requirements and expanded the types of providers who could apply for Provider Relief Funds.
Key takeaways:
- HHS is returning to its previous definition of lost revenue, a decrease from 2019 revenue, rather than using the September 19 version which would have capped funds to a facility’s 2019 net revenue.
- HHS has created new flexibility around reporting at the parent and subsidiary level.
- HHS now is allowing private pay ALs to apply for Phase 3 awards.
From the HHS press release:
“In response to concerns raised, HHS is amending the reporting instructions to increase flexibility around how providers can apply PRF money toward lost revenues attributable to coronavirus. After reimbursing healthcare related expenses attributable to coronavirus that were unreimbursed by other sources, providers may use remaining PRF funds to cover any lost revenue, measured as a negative change in year-over-year actual revenue from patient care related sources.”
All Phase 3 applicants will have until 11:59 pm on November 6, 2020 to submit their applications for payment consideration.
Learn more:
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Upcoming Events
September 29 – October 30, 2020
**Access extended to Friday!**
October 8-31, 2020
November 16 & 19, 2020
November 17-18, 2020
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