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COVID-19 Updates: May 15, 2020
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This update includes:
- DHS: Emergency/Temporary Nurse Aide Training Programs Unavailable Until Emergency Rulemaking
- Reporting Accurately to NHSN COVID-19
- CMS Issues Nursing Homes Best Practices Toolkit to Combat COVID-19
- QIN-QIOs Targeting Assistance to Nursing Homes with Infection Control Deficiencies
- CMS Releases Additional Blanket Waivers
- Paid Feeding Assistants
- Specific Life Safety Code (LSC) for Multiple Providers
- Guidance on Documentation for Use of COVID-19 SNF Reimbursement Waivers
- Jeanna Ayers, DPH Administrator, to Leave DHS
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As of today, there are 11,685 confirmed cases of COVID-19 in the state of Wisconsin and 445 deaths caused by the virus. Click
HERE to view the latest outbreak information from the Wisconsin Department of Health Services. Click to view COVID-19 projections for Wisconsin and the United States.
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DHS: Emergency/Temporary Nurse Aide Training Programs Unavailable Until Emergency Rulemaking
WHCA/WiCAL Advocates for More Immediate Fix
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WHCA/WiCAL learned today that facilities with Emergency Nurse Aide and/or Temporary Nurse Aide training programs were notified this morning that DHS could not accept new students, nor could DHS approve new training programs, effective after Monday, May 11. This is due to the expiration of the state public health emergency, which ended on May 11. The temporary and emergency nurse aide training programs were allowed through
Emergency Order 21, which lasted for the duration of the public health emergency.
On March 12, the Governor declared a public health emergency due to the COVID-19 pandemic through the issuance of
Executive Order 72. By law, a public health emergency in Wisconsin can last up to 60 days upon issuance, unless the Legislature extends it further. The Wisconsin Legislature did not extend the emergency, so the emergency declaration officially expired 60 days after issuance, on May 11.
A DQA official has notified WHCA/WiCAL that the department will issue a Gov-D message alerting providers about the end of the public health emergency, and notifying providers that DHS is pursuing an emergency rule to continue the flexibility that had been granted through Emergency Order 21.
Please note: DQA has notified WHCA/WiCAL that those students who were enrolled in one of these two training programs as of May 11 can continue and be hired. DHS just can’t accept new students after May 11 because that’s the end of the public health emergency.
WHCA/WiCAL and LeadingAge WI
sent a letter to Governor Evers and DHS Secretary Palm requesting a more immediate fix to the issue, because an emergency rule would take weeks to complete. The associations instead requested that Sec. Palm issue an additional emergency order under DHS authority in Wis. Stat. 252.02. This statute grants DHS the authority to take emergency measures to help control the spread of communicable diseases. The letter asks for a new emergency order to include the reestablishment of the framework for temporary and emergency nurse aide training programs, along with other provisions from EMO 21, including but not limited to additional nurse aide training flexibilities, increased resident transfer and bed-hold options, and allowing 16- and 17-year-olds to serve as resident care staff in assisted living settings.
The letter notes that with the state's new push for statewide testing of nursing homes, the potential for asymptomatic staff being out of work for many weeks means that these temporary/emergency nurse aide training programs are more important than ever before.
WHCA/WiCAL President & CEO John Vander Meer has also submitted a request to the Governor's office to discuss this issue and the need for state funding through CARES Act funding sent to the states.
WHCA/WiCAL will update members on any developments on this matter and will continue to advocate for the necessary flexibilities so facilities can have necessary tools to combat the spread of COVID-19.
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Reporting Accurately to NHSN COVID-19
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In
Update #65, AHCA/NCAL provided guidelines on accurately reporting staffing and PPE shortages to NHSN COVID-19 LTC module. As stated in the update, it is important the data reported to NHSN gives an accurate picture as this data will be used by state, federal governments and other stakeholders.
They have received questions about the staffing guidance and have revised as shown below based on review of the latest CDC instruction for NHSN reporting.
NHSN asks, “Does your organization have a shortage of staff and/or personnel?” Any of the following situations support a YES response:
- Staffing less than your facility needs or internal policies for staffing ratios (despite efforts made by the facility to secure staff)
- Employing crisis strategies for staffing shortage
- Using any temporary positions per waiver allowances (such as temporary nurse aide or temporary feeding assistant) or agency staff, yet staffing ratios for facility needs and internal policies are still not met
As a reminder, keep documentation of efforts to secure more PPE as well as staffing. Report to your local and state health departments if employing contingency and crisis strategies to conserve PPE and staffing.
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CMS Issues Nursing Homes Best Practices Toolkit to Combat COVID-19
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CMS released a new
toolkit intended to serve as a catalog of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.
CMS says the toolkit provides resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings.
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QIN-QIOs Targeting Assistance to Nursing Homes with Infection Control Deficiencies
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CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.
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CMS Releases Additional Blanket Waivers
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On May 11th, CMS issued additional
waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 public health emergency (PHE). This is in addition to the waivers that were released on April 30. The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration.
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CMS is modifying the minimum timeframe requirements for feeding assistant training to allow the training to be a minimum of 1 hour in length. CMS is not waiving any other requirements related to paid feeding assistants or the required training content which contains infection control training and other elements. Additionally, CMS is also not waiving or modifying the requirements which requires that a feeding assistant must work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN).
With this waiver, AHCA/NCAL’s
Temporary Feeding Assistant training is allowable. However, additional state requirements may need to be waived to permit individuals completing this program to assist with care in your location. AHCA/NCAL encourages you to contact your state survey agencies and state occupational licensing agencies, where applicable.
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Specific Life Safety Code (LSC) for Multiple Providers
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CMS is waiving and modifying waivers under for ICF/IIDs and SNF/NFs. Specifically, CMS is modifying these requirements as follows:
Alcohol-based Hand-Rub (ABHR) Dispensers: CMS is waiving the requirements for the placement of ABHR dispensers for use by staff and others due to the need for the increased use of ABHR. 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 populations 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. In addition, facilities should continue to protect ABHR dispensers against inappropriate use.
Fire Drills: Due to the inadvisability of quarterly fire drills that move and bring staff together, CMS will instead permit a documented orientation training program related to the current fire plan, which considers current facility conditions. The training should instruct employees, including existing, new or temporary employees, on their current duties, life safety procedures and the fire protection devices in their assigned area.
Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between
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Guidance on Documentation for Use of COVID-19 SNF Reimbursement Waivers
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The CMS
waivers also consider requirements that would normally be in place for providers to receive reimbursement under Medicare or Medicaid. Most significant were the waiver of the 3-day prior inpatient hospital stay and the 60-day break in spell-of-illness requirements for SNF Part A benefit eligibility.
Documentation will be critical to demonstrate an organization’s rationale for the use of the waivers. In a
previous update, AHCA/NCAL offered visual flowchart guidance to help with coverage determinations of these 1135 waivers. AHCA/NCAL has provided key
documentation guidelines for supporting the employment of these waivers as it is foreseeable that after the emergency declaration is rescinded, CMS either through the Officer of the Inspector General (OIG) or through contractors will look to ensure that Medicare dollars were spent appropriately without fraud, waste and abuse.
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Jeanna Ayers, DPH Administrator, to Leave DHS
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Jeanne Ayers resigned her position as Division of Public Health Administrator. Stephanie Smiley, Director of the Bureau of Communicable Diseases will serve as Interim Administrator of the Division of Public Health and State Health Officer.
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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Business Partner Spotlight
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For the complete listing of WHCA/WiCAL Gold Business Partners, click
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