COVID-19 UPDATE #292

April 19, 2023

Information Required for Continuation of Nurse Aide Waiver | SNF

The Aging and Long-Term Support Administration (ALTSA) has released critical information required to continue the Nurse Aide 1135 Waiver with CMS, which requires you to complete the waiver survey again. ALTSA is required to compile this information and send it to CMS every month.

IMPORTANT: To remain in compliance with the waiver, Washington State is required to provide CMS monthly reports. As part of the reporting process, the state must compile information from each CMS-certified nursing home each month. If ALTSA cannot provide the requested information to CMS, Washington State may lose this critically important 1135 waiver and the ability to allow NARs to continue working in a nursing home beyond four months while they complete their certification process. Please assist in this process and complete the three-question survey as soon as possible.

Coronavirus (COVID-19) Update: FDA Authorizes Changes to Simplify Use of Bivalent mRNA COVID-19 Vaccines

Yesterday, the U.S. Food and Drug Administration amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines to simplify the vaccination schedule for most individuals. This action includes authorizing the current bivalent vaccines (original and omicron BA.4/BA.5 strains) to be used for all doses administered to individuals six months of age and older, including for an additional dose or doses for certain populations. The monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized in the U.S.

What You Need to Know:

• Most individuals, depending on age, previously vaccinated with a monovalent COVID-19 vaccine who have not yet received a dose of a bivalent vaccine may receive a single dose of a bivalent vaccine. 
• Most individuals who have already received a single dose of the bivalent vaccine are not currently eligible for another. The FDA intends to make decisions about future vaccination after receiving recommendations on the fall strain composition at an FDA advisory committee in June.
• Individuals 65 years of age and older who have received a single dose of a bivalent vaccine may receive one additional dose at least four months following their initial bivalent dose. 
• Most individuals with certain kinds of immunocompromise who have received a bivalent COVID-19 vaccine may receive a single additional dose of a bivalent COVID-19 vaccine at least two months following a dose of a bivalent COVID-19 vaccine. Additional doses may be administered at the discretion of, and at intervals determined by, their healthcare provider.
• Most unvaccinated individuals may receive a single dose of a bivalent vaccine rather than multiple doses of the original monovalent mRNA vaccines. 

Read the FDA's full release.

Biden Administration Announces Executive Actions to Improve Care | SNF

Yesterday, U.S. President Joe Biden and the Administration announced what they described as “the most sweeping set of Executive Actions to improve care in history.” The White House fact sheet on these Executive Actions specifically notes the Administration’s focus in the fiscal year 2024 budget around various care services, including support for quality and affordable long term care (LTC). While Congress is considering these options, the President noted he wanted to take “immediate action to make care more affordable for American families, support family caregivers, boost compensation and improve job quality for care workers, and expand care options.”

The President’s Executive Order (EO) directs the U.S. Department of Health and Human Services (HHS) to consider issuing regulations and guidance documents to build on the planned SNF minimum staffing proposal expected to be released this Spring and condition a portion of Medicare payments on worker retention. It also lists other provisions of the EO specifically impacting LTC providers. Learn more.

CMS Corrects Guidance on Billing SNF Part A Stays for Three-Day Waiver Admissions | SNF

The Centers of Medicare and Medicaid Services (CMS) has published updated claim coding guidance related to using the DR condition code on claims after the end of the COVID-19 public health emergency (PHE) in its weekly MLNconnects newsletter. This guidance, COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency, corrects guidance previously posted on March 16. 

The updated guidance explicitly states that for benefit period and three-day qualifying hospital stay waivers, skilled nursing facility and swing bed providers should continue to submit condition code DR for Medicare Part A claims for those residents with admission dates before May 12, 2023. Learn more.