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CMS Releases Nursing Home RoPs 3 and Other Guidance
A LeadingAge Article
On June 29, CMS released the long-awaited surveyor guidance on phase 3 of the Requirements of Participation (RoPs) with an implementation deadline of October 24, 2022. Access the CMS memo QSO-22-19-NH on this release and associated attachments here. In addition, here is a link to the related CMS Fact Sheet.
Phase 3 went into effect in November 2019 and nursing homes have waited more than 3 years for the guidance for how surveyors will interpret the requirements. The lack of guidance has largely put implementation of RoPs 3 on hold, though CMS has advised that nursing homes should be working toward compliance with the elements of the rule that are more straight-forward and nursing homes have been surveyed on the requirement to designate an infection preventionist. With the release of this guidance, providers can now aim to meet compliance with all Phase 3 requirements by the new implementation deadline of October 24, 2022.
In addition to the RoPs 3 guidance, CMS also issued revisions to sections of existing guidance such as abuse and neglect, including revision of the Psychosocial Outcome Severity Guide used to determine severity level when citing abuse and neglect. Admission, transfer and discharge guidance has been revised and lessons learned from the COVID-19 public health emergency have been integrated into sections on Resident Rights (visitation) and Infection Prevention. Continuing their work on unnecessary psychotropic medications including antipsychotics, CMS updated Pharmacy Services, and new information was added to direct surveyors in using data from the payroll-based journal (PBJ) to identify staffing issues and enforce compliance with PBJ reporting requirements.
Additionally, CMS released guidance on the use of arbitration agreements relative to the September 2019 requirements, and revised Chapter 5 of the State Operations Manual that relates to investigations of complaints and Facility Reported Incidents (FRIs). Training on new guidance is now available for surveyors and providers on the Quality, Safety, and Education Portal (QSEP) site. CMS is working to update the Critical Element Pathways, which will be released ahead of the October implementation date. LeadingAge will release more detailed information, tools, and resources for compliance on each of the revised sections in coming days.
Nursing Home Acuity Rates Effective July 1
The long-anticipated nursing home Medicaid acuity rate system will go into effect tomorrow, July 1, 2022. Nursing homes have been preparing for this transition which will be implemented over a three-year phase-in period. DSS and Myers and Stauffer personnel were available on today’s member CFO Roundtable Call to answer last minute questions and up to date information on the rate system can be found on the designated DSS webpage.
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The July 1 rates will also include a scheduled 4.5% rate increase that will need to be passed through to wage and salary increases. Nursing homes should follow the same guidance as the July 1, 2021 4.5% rate increase.
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For those nursing homes that applied for enhanced health benefit and pension funding, the final file has been posted to the DSS webpage.
Temporary Nursing Home Rate Increase Expires on June 30
The 10% temporary rate increase for nursing homes is expected to expire today, although the two associations have requested a continuation of the relief. Additionally, as you may recall, the 10% temporary rate increase for the month of June is to be paid utilizing federal ARPA funds. As a result, nursing homes will need to sign an attestation that they will abide by the conditions of the ARPA funding before they will be paid the lump sum amount for June. The attestation forms are not yet available, but will be posted soon and we will notify our membership when they become available.
Update on RCH State Funding
DSS is finalizing the distribution methodology for the $3.7 million in ARPA funding that was appropriated to the residential care homes (RCH). The distribution will give 3% to all RCHs or $2.1 million of the $3.7 million. The remaining $1.5 million will then be distributed to the RCHs that are still below their 2019 costs after the application of the 3%. A stop-gain of 7% is applied to the $1.5 million so that more of the funding is distributed across the RCHs with rates below cost. The funding will be distributed quarterly in lump sum payments. However, since it is ARPA funding, RCHs will need to sign an attestation document before they can receive the funding. The attestation document will be available soon and we will notify members as soon as it becomes available.
Connecticut’s Minimum Wage Is Scheduled to Increase on Friday
The state’s minimum wage will increase from the current rate of $13.00 per hour to $14.00 per hour beginning July 1, 2022. The change is the result of legislation signed into law three years ago that scheduled several increases in the minimum wage over a five-year period. The final increase will occur on July 1, 2023 when the rate will become $15.00 per hour. Then, beginning on January 1, 2024, that same law requires the minimum wage to become indexed to the employment cost index, which is calculated by the U.S. Department of Labor.
Temporary Nurse Aide Update
We are anticipating additional guidance from DPH on the use of Temporary Nurse Aides (TNA) after the expiration of the state’s TNA program. As you know, in April the state of Connecticut had extended the state’s TNA program to June 30, 2022, with CMS then terminating the permissive waiver for the program on June 6, 2022 and allowing TNAs to transition to full CNAs up to October 6, 2022. DPH is expected to now clarify how the Connecticut and CMS rules and deadlines will be applied and we will notify the membership as soon as we receive the clarification. However, DPH has already clarified that a TNA who has completed their CNA training and is just awaiting their examination date may practice as a CNA within the nursing home or assisted living community for up to 120 days while awaiting the exam.
Presentation on Aging Services and Housing Laws Effective July 1
Here is the link to our recent presentation by Wiggin and Dana on new state laws that go into effect on July 1. (Please note that providers seeking permission to share an infection preventionist on one campus will need to wait until mid-July to apply as that is when DPH will make available the form to be used to request permission.) The Office of Legislative Research has also released the following report on 2022 Acts Affecting Seniors.
Governor Issues Declaration Enabling Federal Support for COVID-19 Response to Continue for Several More Months
Governor Lamont has signed a declaration that will enable federal support Connecticut has been receiving throughout the COVID-19 pandemic to continue through December 28, 2022, or until the federal public health emergency ends, whichever is earlier. The governor specifically stated in the declaration that he does not intend to issue any executive orders under this declaration, but rather wants to ensure that his administration has the authorities necessary to apply for and receive federal assistance in response to the pandemic.
Medicaid Provider Bulletins
Medicaid Continuous Enrollment Unwinding Plans
Despite not knowing if the federal Public Health Emergency (PHE) will conclude in mid-October or next year, the CMS message, as detailed in this LeadingAge article, is for states, their partners and stakeholders to prepare and act now, so that beneficiaries maintain coverage. Connecticut DSS is actively preparing for the end of the PHE and presented on their plans at the latest Medicaid Oversight Committee meeting. Here are the links to this informative presentation:
Medicare Enrollment Details
CMS released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). As of March 2022, 64,361,274 people are enrolled in Medicare. This is an increase of 92,795 since the last report.
- 34,891,994 are enrolled in Original Medicare.
- 29,469,280 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
- 49,957,572 are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.
Over 11.9 million individuals are dually eligible for Medicare and Medicaid, so are counted in the enrollment figures for both programs. Detailed enrollment data can be viewed here.
“Up to Date” Status of Individuals Over 50
What does it mean to be “up to date” and how does that impact nursing homes?
There has been a great deal of confusion about what it means to be up to date with COVID-19 vaccination, and for good reason. The following LeadingAge article describes how the confusion came about and what it means for nursing homes. LeadingAge article.
Reminder of DPH Offer of Free Fit Testing for Connecticut Nursing Homes
DPH recently sent out Blast Fax 22-25 to Connecticut nursing homes outlining an opportunity for free fit testing.
County Rates of Transmission Are High or Substantial
The state's eight counties remain classified as having either a high transmission rate or substantial transmission rate by the CDC. The appropriate CMS and CDC guidance should be followed for these conditions
Election Guidance for Non-Profits
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CMS, CDC and State Covid-19 Links and Resources |
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The NFP HR Compliance Corner
LeadingAge Connecticut's Diamond Partner, NFP, is pleased to provide our members with access to their Human Resource Compliance Corner
Executive and Commissioner Orders-Blast Faxes
A complete listing of Executive and Commissioner Orders can be found
here. A listing of DPH Blast Faxes can be found here. Practitioner and Facility Guidance documents can be found here.
LTC-MAP July Duty Officers
Dave Bouchard (July 1 - 15)
860-207-9270
CT LTC-MAP Duty Officer: Vinnie DeSanti (July 16 - 31)
860-207-9270
Back-Up Duty Officer: Andy McGuire
(On vacation July 24 - July 31)
Cell - 203-648-7116
Office - 860-390-1949
Back-Up Duty Officer: Jim Garrow
(Covering July 24 - July 31)
Cell - 860-944-2803
Office - 860-793-8600
Value First GPO: A Resource for Affordable Products and Supplies
Value First is the LeadingAge owned GPO and a trusted resource for your purchasing department. Our contact for Value First is Den Miciletto, Value First Sales Liaison. Mobile 917.370.6518, Office 518.867.8383 ex.160, Fax 518.867.8384
Schedule for Member Calls
Nursing Home Tuesdays and Thursdays at 2 p.m.
CCRC/Assisted Living Community Every other Thursday at noon
Nursing Director Tuesdays at Noon
Affordable Housing Third Wednesday of the month at 9 a.m.
Human Resource Second Thursday of the month at 10 a.m.
Social Work Second Wednesday of the month 11:30 a.m.
Building Engineering Last Wednesday of the month at 9 a.m.
Recreation Second Tuesday of the month at noon
CFO Roundtable TBA
Mission Roundtable TBA
LeadingAge national Monday and Wednesday at 3:30 p.m.
The Benefits of Your LeadingAge Connecticut Membership
Please Keep Us Up to Date on Your Major Staffing Changes
In an effort to keep our contact information current with our members and their staff, we request that you notify our office manager, Nurka Carrero, as soon as possible when you have significant staffing changes. Thank you!
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LeadingAge Coronavirus Update Calls on Monday and Wednesday
If you have not registered for LeadingAge Monday and Wednesday 3:30 pm Update Calls, you can do so here. You can also find previous call recordings here. Note that to access recordings of the calls you need a LeadingAge password. Any staff member of any LeadingAge member organization can set up a password to access previous calls and other “members only” content.
National Coronavirus News, Tools and Resources
Larry Minnix National Leadership Academy Applications Open
Developing your own leadership style and approach requires self-reflection and uncovering your unique leadership attributes. Embark on this journey alongside your aging services peers through the 2023 LeadingAge Leadership Academy. Applications are due August 1 and the program begins in February 2023. Learn more and start your application.
Letter to HHS on Nursing Home Recommendations
LeadingAge sent a letter to HHS this week advocating for revision of nursing home recommendations including quarantine, work restriction, and routine screening testing of staff. Read the letter here.
LeadingAge Statement on CMS Home Health Prospective Payment System Rate Update
LeadingAge issued a statement on the CY2023 Home Health Proposed Rule released earlier this month. The proposed $810 million annual Medicare payment reductions, considered alongside recent payment proposals for nursing homes and hospice providers, stand in stark contrast to the Biden Administration’s stance on the importance of long-term care.
LeadingAge Home Health Member Network Call on Home Health Proposed Rule
Join LeadingAge on Tuesday, July 19, at 2pm ET, for the Home Health Member Network call to discuss the newly released Home Health Proposed Rule. Any LeadingAge member can join the Home Health Member Network here or by emailing Katy ([email protected]) or Mollie ([email protected]).
HUD Clarifies Property Risk Classification for MOR Schedules
Following HUD's June 27 final rule implementing a new performance-based schedule for Management and Occupancy Reviews (MORs), HUD has clarified how it determines a property's risk rating classification. More information about HUD's risk rating classification is available for LeadingAge members here, and more information about HUD's new performance-based MOR schedule is available here.
LeadingAge Asks USCIS to Fix Long Delays in Immigrant Petition Processing
On June 27, 2022, LeadingAge joined eight long-term and post-acute providers in a letter to the U.S. Citizenship and Immigration Services (USCIS), raising concerns about problems health care employers are experiencing when utilizing the I-140 Immigrant Petitions for Registered Nurses. The letter highlights four- to six-month delays in transferring I-140 Immigrant Petitions from the Texas Service Center to the National Visa Center. You can access a copy of the letter here, along with the referenced enclosure, here.
Provider Relief Reporting Period 3 Starts Friday, July 1
Providers who received PRF from January 1 – June 30, 2021 (last year) will need to submit reports on the use of those funds no later than September 30, 2022 at 11:59 p.m. The reporting portal will open for reporting on these funds on Friday, July 1. Providers have until June 30, 2022 to spend the funds received. HRSA has indicated that it will not be updating the reporting guidance for Reporting Period 3. Its resources can be found here.
Provider Relief Fund Page on LeadingAge Website
LeadingAge has co-located all articles, tools, letters and resources on Provider Relief Funds on a single web page to make it easier for members to find the key dates and information they need. Members can find a link to the page on the Coronavirus Resources page under Provider Resources in the left-hand column.
LeadingAge Member Resources
Get Connected with LeadingAge
LeadingAge offers a variety of ways for members to engage with one another and get involved from listservs and networks to advisory groups, committees and board service. We encourage you to take advantage of your membership and connect with your peers to learn, share and grow. Get connected!
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Defending Your Decisions: Managing Post-Pay Audits
Wednesday, July 13, 9:00 - 11:00am
Presented by Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, RAC-MTA, President/CEO, Celtic Consulting
Leading With Confidence Virtual Webinar Series
A 7 Week Virtual Management Skills Course
Beginning Thursday, July 14, 2022
Two Session Times Available! 9am to 11 am or 1pm to 3pm
Featuring Del Gilbert, Accelerating Excellence
The Dynamic DON Webinar Series
Eight Consecutive Wednesdays beginning August 3
12:30 PM - 1:30 PM
This 8-week webinar series runs August-September 2022 and focuses on skill
building for serving effectively as the Director of Nursing with emphasis on
effective leadership and staff engagement, nursing operations and systems
of care for common conditions treated in the LTC setting.
Annual Dementia Symposium with Teepa Snow
Focus: Fall Prevention and Communication Strategies
Presented by National Dementia Expert: Teepa Snow, MS, OTR/L, FAOTA
Thursday, August 4
9:00am – 3:30pm
Program will be at the Aqua Turf Club
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CMS Website Resources
National Government Services News
National Government Services shares important Part A information on their website. Click on www.NGSMedicare.com, determine your Medicare contract. On the Provider Specific Portal Home Page, under Latest Part A News Articles click on the View All News Articles link. Note: you may have to accept the CPT Point and Click Agreement in order to access this information.
NGS Medicare Educational Sessions and Training Events Calendar
Visit the National Government Services Web site for details at NGS Medicare.
Medicare University Computer-Based Training Course Listings
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McKnight’s June 24
Long-term care residents who get a fourth dose of the COVID-19 vaccine are at a reduced risk of being hospitalized or dying from the disease during an omicron-related surge, Israeli researchers say.
New State Laws Impacting Connecticut Employers
CBIA, June 28
Captive audience, workers’ compensation changes
New Fiscal Year, New Laws on Friday
CT News Junkie, June 28
New legal protections designed to expand access to abortion services and a $1 increase in the state’s minimum wage are among the changes to Connecticut law taking effect on Friday with the beginning of the new fiscal year.
LeadingAge Chastises HHS For ‘Devastating’ Home Health Rule
McKnight’s, June 30
Lamont Says CT State Worker Retirement ‘Tsunami’ Was Milder Than Feared
CT Mirror, June 30, 2022
Although more than 4,400 state employees will have retired since January, the state has hired more than 6,000 this fiscal year.
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