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Virtual Spring Conference Live Session Schedule:
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May 13th
@ 10 AM:
Assessments and ISP Development in Assisted Living
May 13th
@ 2 PM:
Health Monitoring & Resident Condition
May 14th @ 10 AM:
Results of Wisconsin Study on Light's Effect on the Elderly
May 14th @ 1 PM:
Common ICD-10 Coding Errors and the PDPM Impact
Don’t worry, if you are unable to attend a live session, it will be recorded and added as an on-demand session, that you may view in accordance with your own schedule.
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COVID-19 Updates: May 12, 2020
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This update includes:
- White House Tells States to Test All Nursing Home Residents & Staff
- Coronavirus-Mandated SNF Staffing, PPE Reporting Starts
- LTCAC Holds Virtual Meeting to Provide Brief Update, Conduct COVID Roundtable
- Many Part B Therapy Code Edits Removed
- Letter from CMS Administrator Seema Verma Shares Letter to Nursing Homes
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As of today, there are 10,611 confirmed cases of COVID-19 in the state of Wisconsin and 418 deaths caused by the virus. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services. Click
HERE
to view COVID-19 projections for Wisconsin and the United States.
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White House Tells States to Test All Nursing Home Residents & Staff
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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.
As reported last week, Governor Evers announced testing for all residents and staff in every nursing home in Wisconsin during the month of May
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.
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 (10:59 PM CST).
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Coronavirus-Mandated SNF Staffing, PPE Reporting Starts
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The Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN) COVID-19-mandated reporting for nursing centers has started, according to the latest update from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).
AHCA/NCAL recommends that providers accurately report the staffing and personal protective equipment (PPE) situation at their facilities based on normal standards and guidance for PPE and staffing, not conservation guidance.
“Federal and state governments will use these data to hold nursing homes accountable for care and services provided and to identify who needs additional resources,” AHCA/NCAL said. “It is important that the data reported to NHSN give an accurate picture of staffing and PPE, as well as the other areas collected in NHSN.”
Given the instructions on NHSN, providers reporting that they have what they need tells the Centers for Medicare & Medicaid Services (CMS) that providers possess enough PPE and employ enough staff to follow conventional and normal practices, which will likely be used by surveyors when comparing what they find during their surveys.
AHCA/NCAL recommends using these guidelines.
Staffing: NHSN asks, “Does your organization have a shortage of staff and/or personnel?” Answer YES if any of the following are occurring during the time period of reporting.
- Staffing less than the facility needs or internal policies for staffing ratios prior to COVID or based on increased needs since COVID
- Employing contingency or crisis strategies for staffing shortage
- Using more agency staff than used before the pandemic
- Using volunteers for staffing needs more than what the facility may have used prior to the pandemic
- Using any temporary positions per waiver allowances (such as temporary nurse assistant or temporary feeding assistant)
PPE: NHSN asks, “Do you have enough for one week?” each for N95 masks, surgical masks, eye protection, gowns, gloves, and alcohol-based hand sanitizer. Answer NO if any of the following are occurring during the time period of reporting.
- Employing any conservation strategies for PPE use; if you are not able to use PPE per conventional transmission-based precautions in place before the pandemic you should answer NO
- Using alternative PPE such as cloth masks or other types of face coverings, clothing, or other types of coverings instead of surgical gowns, or glasses for eye protection
- Reusing any single-use supply item such as gown or masks
- If additional residents in the next week will need to be placed on precautions, it will compromise your PPE supply
- If additional staff in the next week will need to use PPE when returning to work, it will compromise your PPE supply
- If visitors or contractors in the next week need to visit, it will compromise your PPE supply
As a reminder, skilled nursing facilities (SNFs) should keep documentation of their efforts to secure more PPE as well as staffing. “You should report to your local and state health departments that you are employing contingency and crisis strategies to conserve PPE and staffing,” AHCA/NCAL said.
In other developments, CMS said it will fix a glitch in the new Patient-Driven Payment Model (PDPM). AHCA/NCAL said SNF PPS Part A claims were not being paid day-1 variable per diem rates when a beneficiary switched from Medicare Advantage (MA) to fee-for-service Medicare Part A during a stay.
AHCA/NCAL said it reported to CMS that this was inconsistent with current policy.
CMS agreed and on May 8 published a
change request to the Medicare Administrative Contractors (MACs) to update the claims processing systems retroactive to Oct. 1, 2019. A summary of the changes is posted in this
MLN Matters article. Although this is retroactive, the systems changes will not occur until Oct. 5, 2020.
Providers should notify billing staff that the MACs will adjust any improperly adjusted SNF PPS claims related to a beneficiary switch from MA to fee-for-service during a stay only if brought to their attention, so that the prior days count is corrected to exclude the MA days, AHCA/NCAL said.
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LTCAC Holds Virtual Meeting to Provide Brief Update, Conduct COVID Roundtable
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The Wisconsin Long-Term Care Advisory Council today held a virtual meeting via Zoom to conduct limited business and to hear from LTCAC members about how the COVID pandemic has impacted the members and/or consituencies each Council member serves.
See the agenda
here
and documents
here
.
Heather Bruemmer of the Board on Aging and Long-Term Care called the meeting to order. Brenda Bauer, DHS Program Analyst, provided a brief review of COVID funding via the federal Families First COVID Response Act, passed on March 18 to provide local county aging units, ADRCS, and other entities with resources to help facilitiate meal delivery to elders; and the CARES Act, which passed on March 27 and provided money to state governments and additional funding for local units, as well as direct funding for providers. Bauer said the state had two priorities: 1) distributing the money as quickly as possible, and 2) to ensure compliance with the requirements included within the legislation to secure the funding at the state level.
Next, Betsy Genz discussed EVV updates. Genz said that DHS is working with MCOs, HMOs, and fiscal employer agents to test some aspects of the EVV system ahead of the Jan 1, 2021 implementation deadline. Genz said there has not been any delay in the EVV implementation date, so Jan 1, 2021 appears to still be the implementation deadline.
Genz also discussed HCBS implementation for non-residential settings. Genz said nonresidential settings still must ensure compliance with HCBS by March 17, 2022. Therefore, the department continues to work toward that goal. DHS is not currently conducting on-site visits, but staff are beginning to contact those settings to request documentation in order to prepare for those site visits down the road.
Genz said the Department is working to draft an amendment to the DHS-MCO contract, which will include revised language on direct care workforce and Room & Board.
Genz said that the legislature's Joint Finance Committee has approved the department's IRIS waiver request, and DHS should be posting it by the end of May for public comment. Genz said the department anticipates submitting the waiver request for approval by the end of November 2020.
Next, Jie Gu, Program and Policy Analyst, Bureau of Adult Programs and Policy, provided a slide show on results from the department's Pay for Performance survey results. See the full
presentation slide deck
here.
The meeting concluded with 20 of the Council's members providing their perspective on how the COVID-19 public health crisis has impacted their members/constituencies. The conversations ranged from operational issues for providers to new challenges for members/participants, such as deaf participants not being able to read lips when masks are used during care.
The next scheduled meeting of the LTCAC is Tuesday, July 14.
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Many Part B Therapy Code Edits Removed
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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.
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Letter from CMS Administrator Seema Verma Shares Letter to Nursing Homes
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Today, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma penned a letter to nursing home management and staff. Administrator Verma shared her gratitude for the unwavering dedication and commitment of nursing home management and staff in keeping residents safe and for continuing to compassionately care for those who rely on them during this unprecedented time. The letter also provides links to previously shared infection control resources.
Click
HERE to view the letter.
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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