Greetings!

This update includes:

Sincerely,

April Payne, LNHA

Vice President of Quality Improvement | Director of VCAL

Virginia Health Care Association | Virginia Center for Assisted Living 

DMAS Medicaid Memo on 1135 Waiver

 

DMAS has issued a Medicaid Memo on New 1135 Waiver and Administrative Provider Flexibilities Related to COVID-19 . It includes key information for nursing facilities (NFs) related to LTSS Screening, entering level of care, PASRR, MDS, and nurse aides.

Clarifications and Changes Related to the Medicaid

Long Term Services and Supports (LTSS) Screening

 

LTSS Screening for Nursing Facilities

For individuals requesting and needing nursing facility (NF) services (including skilled, rehab, or custodial care) directly after discharge from a hospital, the requirement for a Medicaid LTSS Screening is suspended during the COVID-19 public health emergency. For admissions occurring after March 12, 2020, NFs do not need to obtain Medicaid LTSS Screening packages that would normally be required by 12VAC30-60-308, and may admit individuals without the Medicaid LTSS screening package. The individual may be admitted directly to the NF without a LTSS Screening. NFs must follow the directions below regarding the screening, evaluation and determination for specialized services for individuals who potentially have mental illness, intellectual disability or a related condition, and assure completion resident reviews. This process is known as Pre-Admission Screening and Resident Review (PASRR).

 

The same requirements that apply to the DMAS 97 Individual Choice form for HCBS screenings also apply in NFs: CBTs and HBTs may obtain verbal consent of the individual or authorized representative for the DMAS-97 when two LTSS screeners/individuals verify the response. Both witnesses should sign the DMAS-97 to indicate the individual's verbal choice, and this form should be maintained with the individual's case record.

For those individuals choosing NF care, the original DMAS-97 should be forwarded to the NF and the hospital should retain a copy.

 

Entering the Level of Care

The Medicaid Portal’s Long-Term Care tab, also referred as the Automated Enrollment and Disenrollment (AE and D) portal, will not validate whether a completed LTSS Screening has occurred for NF admissions until this public health emergency has subsided. For individuals admitted after March 12, 2020 without a LTSS Screening, and for whom no special circumstance exists, NFs and health plans should check “Yes” to the question “Approved Pre-Admission Screening.” The admission date included on the form will verify that this admission occurred during the COVID-19 emergency. For all admissions covered by a special circumstance, please continue to check “No” to the “Approved Pre-Admission Screening” question but also check the special circumstance that applies.

 

Nursing Facilities and Preadmission Screening and Resident Review (PASRR)

DMAS is temporarily suspending PASRR Level II evaluations for 30 days after an individual’s admission. During the declared COVID-19 public health emergency, all admissions to NFs may be treated as exempted hospital discharges under 42 CFR 483.106. If the individual remains in a NF after 30 days, a resident review shall be conducted as soon as reasonably possible. NFs should follow the processes for resident review, and notify Ascend, A Maximus Company, for scheduling evaluations related to mental illness, intellectual disability or related conditions.

 

Minimum Data Set (MDS)

The MDS is required for both Medicare and Medicaid NFs residents. The MDS is utilized both for care planning and determining the Medicaid Resource Utilization Group (RUG) for claim pricing. Virginia is following the Medicare waiver of 42 CFR 483.20 to provide relief to skilled nursing facilities (SNFs) on the timeframe requirements for MDS assessments and transmissions. This guidance is provided for Medicaid members and may be adjusted to comport with guidance that CMS may issue pertaining to Medicare residents.

 

NFs should continue to complete MDS assessments for new admissions. This assessment is necessary for appropriate care planning and to establish the RUG for Medicaid billing. These assessments should be completed within 30 days (rather than 14 days) of admission. For residents transitioning from Medicare covered SNF care to Medicaid covered NF care, the NF may use the Medicaid RUG from an Omnibus Budget Reconciliation Act (OBRA) assessment within 30 days of transition. Otherwise, the NF must complete an admission assessment. However, DMAS will waive the requirement for quarterly and comprehensive assessments and significant change assessments if the clinical staff is unable to submit them timely. For Medicaid billing purposes, the provider may continue to bill the RUG from the most recent assessment. DMAS encourages NFs to complete the MDS as soon as possible after a significant change as it both informs care planning and establishes the appropriate Medicaid RUG for billing. A RUG for a significant change assessment can be billed back to the significant change as long as the assessment is within 30 days (rather than 14 days) of the significant change assessment. NFs should continue to submit the correct Assessment Reference Date (ARD) associated with the assessment that generated the RUG submitted on the claim, even though the ARD will not be taken into account during claim processing. All completed assessments should be transmitted to CMS via the Quality Improvement and Evaluation System – Assessment Submission and Processing (QIES-ASAP) application as soon as possible.

This waiver will last through the end of the emergency declaration. NFs have until the end of the following quarter to reset the quarterly assessment schedule by completing assessments on a staggered based to avoid quarterly assessments due at the same time.

 

Nurse Aides in Nursing Facilities

Nurse Aides in Nursing Facilities - Temporarily suspending the four-month limitation in 42 C.F.R. §483.35(d) (except for 42 C.F.R. §483.35(d)(1)(i)) for individuals working in nursing facilities as a nurse aide on a full-time basis.

 

SNFs and NFs may temporarily employ individuals, who are not certified nurse aides, to perform the duties of a nurse aide for more than four months, on a full-time basis. These facilities still must comply with 42 C.F.R § 483.35(c) by ensuring that nurse aides are able to demonstrate competency in the provision of nursing and nursing related services and skills and techniques necessary to care for residents’ needs, as identified through resident assessments and described in the plan of care.

CARES Attestation Window Extended,

Updated Guidance, and Financial Resources

On May 22, US Department of Health and Human Services (HHS) extended the CARES Act Provider Relief Fund attestation window. This allows time to address additional questions and to offer providers time to collect necessary payment portal information. In the press statement, HHS announces that the attestation window and related acceptance of Terms and Conditions has been extended from 45 to 90 days from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds. Providers should have received emailed letters from HHS on May 22.

Members will need to identify the dates of each relief payment and identify their new attestation and Terms and Conditions acceptance date based on the extension. HHS updated the Fund FAQs twice this past week.

AHCA/NCAL has updated the COVID-Related Cost and Loss Calculator and prepared a guidance document on the CARES Act Provider Relief Fund (member login required for both resources). The guidance includes:

 

Questions about Award Amounts

If you have questions or concerns about Tranches 1, 2, 3 awards, contact the HHS Hotline at (866) 569-3522. HHS reported on Friday that the call center now has access to additional data and new HHS guidance to better answer questions. When calling have the following information ready:

Also, if questions about Tranche 3, the SNF Allocation, also have the number of SNF certified beds (Medicare, Medicaid or both) as well as the amount you received and the amount you believe you should have received.

For Tranches 1 and 2, in its May 14 FAQ update, HHS provided an explanation of why a building might not have received a Tranche 2 allocation. The FAQ provides a formula and explanation of how a Tranche 1 award may have impacted eligibility for Tranche 2. See FAQs on page 7 of the updated FAQ document. HHS added Change in Ownership (CHOW) FAQs as well as TIN FAQs. The latter FAQs are called out in the AHCA/NCAL Guidance document in addition to inclusion in the HHS FAQs.

 

Next Steps – Additional CHOW, TIN, and Other Questions

AHCA/NCAL will continue to submit questions and examples of challenging fund scenarios to HHS including CHOW, TIN aggregation, disaggregation, and additional questions about financial terminology and use of tax filing data for validation. However, HHS has verbally indicated the department’s goal is “maximum flexibility.” While AHCA/NCAL will continue work with them during the additional assentation window time, it is possible they will defer to reconciliation and reporting documentation to address all scenarios.

Updated NCAL Guidance on Reporting in

Assisted Living Communities

 

NCAL has updated its Assisted Living Notification Guidelines for Confirmed COVID-19 Cases guidance. NCAL encourages all assisted living communities to follow state and local requirements for reporting. Providers should use documented reporting information when reaching out to local county and state health departments when requesting assistance for supplies, such as personal protective equipment.

As a reminder, Virginia-specific guidance from DSS is posted on our COVID-19 Resources webpage.

NHSN Update and FAQs

Nursing facilities were required to submit their first set of data to the National Healthcare Safety Network (NHSN) by 11:59 pm on May 17, 2020 to be compliant with the new requirements. Facilities may choose to report more frequently, but at minimum must report at least once every seven days. The initial two-week grace period ends at 11:59 pm on May 24, 2020. Facilities that fail to begin reporting after the third week, ending at 11:59 pm on May 31, will receive a warning letter reminding them to begin reporting the required information to CDC/NHSN. Facilities who have not started reporting in the NHSN system by 11:59 pm on June 7, ending the fourth week of reporting, CMS will impose a per day civil monetary penalty (PD CMP) of $1,000 for one day for the failure to report that week. Each subsequent week that the facility fails to report will result in an additional one-day PD CMP imposed at an amount increased by $500.

NHSN updated the instructions for the pathway forms on May 12. When completing the data collection and upload, be sure that you are using the most current instructions. You can find the new instructions on the NHSN website. During one of the NHSN data reporting webinars, the NHSN team identified that each item question must have an answer entered or it will be counted as missing data and it will be counted as not being reported. When you enter count data, even if the answer is nothing or zero, you must enter 0 in the data field. If you leave it empty, it will be flagged as “no answer.”

According to the CDC, “to maintain consistency in reporting, if a facility is using crisis level strategies” the facility is experiencing a shortage. “In other words, PPE strategies that do not commensurate with U.S. standards of care are considered as a shortage. For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), we encourage facilities to refer to Optimize PPE Supply website.

A center can easily identify if they are missing data in the NSHN module by reviewing the calendar view page. Any pathway that is incomplete will be highlighted as a tan color. Pathways highlighted as green indicated all questions were answered. Missing pathway means the pathway has not been started. As of right now, NHSN does not send notices for incomplete data. Centers are encouraged to review the calendar view to ensure all four pathways are highlighted in green to ensure compliance with reporting to NHSN.

Centers are continuing to report a delay in being able to register and upload data to NHSN. There are also centers who are reporting significant delays in having their questions answered via NHSN help desk. Centers who are experiencing delays are encouraged to keep documentation of all attempts of contacting NHSN and any communications you have with them.

Some centers are reporting that they are not receiving the “Agreement to Participate and Consent” email. If this is happening to your center and you do not receive the “Agreement to Participate and Consent” in your inbox for whatever reason, you should follow these instructions:

If you log in to SAMS and see the “Annual Survey” alert on your facility homepage, you should follow these steps to remove the alert:

CDC Posts NHSN Training Recording and Offers Webinar for Groups

The COVID-19 Module Overview for Long-term Care Facilities recorded video presentation and slideset are now available on the COVID-19 LTCF Module webpage, as well as COVID-19 Module Enrollment Guidance for LTCF under “Training."

2020 Hurricane Season During COVID-19

In a webinar tomorrow, May 27, CDC experts will discuss possible health risks that could come from hurricanes combined with COVID-19; planning for the 2020 hurricane season while adhering to guidance on social distancing; and how community leaders, nonprofit organizations, and public health professionals can effectively communicate messages. Closed captioning will be available.

Webinar: 2020 Hurricane Season During COVID-19

May 27, 2020 | 1:00 – 2:00 pm

Senate Hearing on Caring for Seniors

Amid the Coivd-19 Crisis

On May 21, the US Senate Special Committee on Aging Committee held a hearing entitled, “ Caring for Seniors Amid the COVID-19 Crisis .” The hearing featured three non-governmental witnesses that discussed how COVID-19 is affecting seniors, especially seniors receiving care in skilled nursing facilities, as well as other topics including personal protective equipment, infection control, data collection, regular testing of residents and staff, pandemic health care provider funding, and vaccines and treatments. 

AHCA/NCAL submitted a statement for the record . You can watch a video recording of the hearing, and read the majority and minority press statements of the US Senate Aging chairman and ranking member.