You're receiving this email because of your relationship with the Office of Inspector General, Division of Health Care. Thank you for your continued commitment to serving the citizens of our Commonwealth!
Cabinet for Health and Family Services
Office of Inspector General
Division of Health Care
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Long Term Care Provider Newsletter
January 2023
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A Letter from the Public Health Commissioner
Dear Long Term Care Facility (LTCF) Partners,
We want to share information about some recent changes by the federal government to increase access to COVID-19 vaccine and boosters for your residents and staff. COVID-19 cases and hospitalizations are increasing across the United States. The updated (bivalent) COVID-19 boosters are the best protection against the COVID-19 variants causing illness right now.
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LTC facilities that are not directly enrolled in the CDC COVID-19 Vaccination Program can access COVID-19 vaccine through enrolled pharmacy providers for direct administration by the LTCF to their residents and staff under a new CDC COVID-19 vaccine sub-provider agreement. See Long Term Care Facilities Enrolling in CDC COVID-19 Vaccination Program | CDC for planning, vaccine administration, and enrollment information.
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Single-dose vials of Pfizer-BioNTech COVID-19 vaccine are now available for order.
- Review the storage and handling guidance for Pfizer-BioNTech COVID-19 vaccine (gray cap, single-dose vial) for persons 12 years of age and older.
- The single-dose vials can be stored at ultra-cold temperatures (-130°F to -76°F (-90°C to -60°C)) up to the expiration date or they can be stored at refrigerator temperatures (36°F to 46°F (2°C to 8°C)) for up to 10 weeks.
- Ancillary supplies will not be provided. You must use your existing inventory of syringes and needles for administration. The single-dose vials do not require the use of the low dead-space syringes.
- LCTFs and/or pharmacies serving LTCF who are enrolled with the Kentucky COVID-19 Vaccine Program, can order single-dose vials through the KYIR vaccine ordering page. Contact DPH.KVP@Ky.gov if assistance is needed.
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A 90-day temporary waiver of COVID-19 vaccine administration data reporting requirements to the Kentucky Immunization Registry (KYIR) has been granted by the U.S. Department of Health and Human Services.
- KDPH requests facilities still report all vaccine administration data to KYIR.
- Immunization data may be reported electronically to KYIR. Please visit the Kentucky Health Information Exchange website for additional information on how to begin the process of reporting directly from your electronic health record.
- CMS-certified nursing homes are still required to report resident and staff vaccination data to CDC’s National Healthcare Safety Network each week. More information related to this reporting can be found at: LTCF | Weekly HCP & Resident COVID-19 Vaccination |NHSN | CDC.
Additionally, several resources are available to assist in providing COVID-19 vaccine to your residents and staff:
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This sample letter can be shared with your residents and their families to provide information about COVID-19 vaccination and to promote your facility’s efforts to provide access to the vaccine (e.g., onsite vaccination or driving residents to a vaccination site).
- The Centers for Medicare and Medicaid Services will allow Medicare-enrolled immunizers, including but not limited to pharmacies working within the U.S., to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare skilled nursing facility residents. This means that vaccinators such as EMTs or home health agencies may be available to provide onsite vaccinations at LTC facilities, helping provide much needed access to residents.
- The KDPH Nurse Strike Team remains available to provide emergency staffing support for patient care and vaccination. Contact Ruth Belflower Midkiff at Ruth.belflower@ky.gov or 502-991-1712 for more information or to request assistance for your facility.
During this difficult influenza season, it is especially important for residents and staff to be vaccinated with both flu and COVID-19 vaccines to reduce the spread of these respiratory illnesses. Thank you for your efforts to increase vaccination among this critical population who are at great risk of severe illness and death from COVID-19 and flu.
Thank you for your service to the people of Kentucky.
Sincerely yours,
Steven J. Stack, MD, MBA
Commissioner
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Provider and Supplier Compliance Education
Through Quality in Focus
CMS has developed a series of short (10–15 minutes), Quality in Focus (QIF) interactive videos tailored for specific provider types. These trainings highlight both specific citation patterns as well as compliance solutions to incorporate into a facility’s operational practices. Each video focuses on a specific health or safety citation, with the goal of helping facilities to proactively identify and prevent these deficiencies in the future.
QIF interactive videos are currently available for:
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Ambulatory Surgical Center (ASC) - Infection Control Citations;
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Intermediate Care Facility for Individuals with Intellectual Disabilities (IICF/IID) - Program Implementation Citations;
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Community Mental Health Center (CMHC) - Local, State, Tribal Collaboration Process Citations;
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Hospice - Plan of Care Citations;
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Psychiatric Residential Treatment Facility (PRTF) - Post-Intervention Debriefing Citations;
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Skilled Nursing Facility/Nursing Facility (SNF/NFs) - Treatment and Prevention of Pressure Ulcer Citations; Free of Accident Citations; Medication Error Citations;
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Outpatient Physical Therapy (OPT) - Equipment, Buildings, and Grounds Maintenance Citations;
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Comprehensive Outreach Rehabilitation Facility (CORF) - Local, State, Tribal Collaboration Process Citations;
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Home Health Agency (HHA) - Incomplete Individualized Plan of Care Citations;
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Rural Health Clinic (RHC) - Preventative Maintenance Program Citations;
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Portable X-ray - Personnel Monitoring Citations;
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End Stage Renal Disease (ESRD) - Cleaning and Disinfecting Citations;
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Hospital - Patient Safety
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NEW RESOURCE AVAILABLE: Third Edition QRP
COVID-19 Public Reporting Tip Sheets
The purpose of the Third Edition Quality Reporting Program (QRP) COVID-19 Public Reporting (PR) Tip Sheets are to help providers understand CMS’ public reporting approach to the HH, IRF, LTCH, and SNF QRPs to account for CMS quality data submissions that were either optional or excepted from public reporting due to the COVID-19 public health emergency. The impacts on CMS’ Care Compare website refreshes are also outlined. These tip sheets serve as companion documents to the first and second edition QRP COVID-19 PR Tip Sheets published in 2020 and 2022.
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CMP Grant Opportunities Available
CMP Reinvestment Fund
OIG seeks innovative projects that support, protect, and benefit certified nursing facility residents. These initiatives must be outside the scope of normal facility operations and cannot be used to fund goods or services that the applicant already offers or is required to provide by state or federal law or regulation.
- There is no minimum or maximum amount that can be applied for
- There is currently no application deadline and applications can be submitted at any time.
COVID-19 Emergency CMP Grants
The COVID-19 Emergency CMP Grants are temporary programs in place during the federal Public Health Emergency. Kentucky will continue to accept applications until CMS closes the programs. CNFs can apply for all three programs for up to a total of $9,000 for the purchase of:
- Communication devices and accessories to allow residents to communicate remotely
- In-person visitation aids such as tents/outdoor shelters, outdoor furniture, clear dividers, and more
- Portable fans and/or room air cleaners with HEPA filters (H-13, -14)
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Division of Health Care Contact Information
Central Office
Belinda Beard, Director
Marissia Izlar, Assistant Director
275 E. Main St., 5E-A Frankfort, KY 40621
Phone: 502-564-7963
Fax: 502-564-6546
Western Enforcement Branch
Darlene Fryar, Human Services Program Branch Manager
901 B South Main Street, Hopkinsville, KY 42240
Phone: 270-889-6052
Fax: 270-889-6089
Northern Enforcement Branch
Patricia Hinson, Regional Program Manager
L & N Building 10-W, 908 W. Broadway, Louisville, KY 40203
Phone: 502-595-4958
Fax: 502-595-4540
Southern Enforcement Branch
Tammy Ricks, Regional Program Manager
116 Commerce Ave., London, KY 40744
Phone: 606-330-2030
Fax: 606-330-2054
Eastern Enforcement Branch
Will Hendrickson, Human Services Program Branch Manager
455 Park Place, Suite 120A, Lexington, KY 40511
Phone: 859-246-2301
Fax: 859-246-2307
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Create Circles is seeking residents to participate in the
Engage With Your Community Project
Create Circles Corporation is currently recruiting CMS certified nursing facilities (CNF) to participate in a unique resident engagement program funded by Kentucky’s Civil Money Penalty (CMP) Fund. The 3-year Engage With Your Community project matches trained volunteers with CNF residents based on hobbies, likes, interests and other factors. These volunteers meet with their matched resident twice a week, over at least 12 weeks, to complete a long-term shared project, or multiple mini projects, that are then shared with the resident and their family.
The goal of the Engage With Your Community project is to increase the quality of life for CNF residents by reducing loneliness and isolation through cognitive engagement, companionship, and crafting a sense of purpose.
The program is free to CMS Certified Nursing Facilities!
For more information on how to participate in the project please contact Anish Reddy, Director of Operations, at info@createcircles.org, or 502-276-5264.
Additional information on the program, including requirements, can be found here.
CNFs that are interested in participating, but do not have the necessary virtual meeting technology (i.e. tablets, iPads) may be able to utilize the CMP COVID-19 Communication Technology Emergency grant to purchase the necessary equipment. Please contact Lena Mullins-Datko, Grants Administrator, at lena.mullinsdatko@ky.gov for more information.
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Kentucky's Top 10 Citations
for Nursing Homes
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Informal Appeal of Survey Findings
Interested in Serving on an IDR Panel?
Kentucky requires one member of the IDR panel to be "a person currently engaged in the provision of Long Term Care services who has no affiliation with the provider disputing a deficiency." Typically, a Long Term Care Administrator is on each IDR panel. There is no payment or travel reimbursement for an Administrator serving on a panel. Administrators will be rotated. If a Long Term Care Administrator is interested in serving on a panel, a confidentiality statement must be signed prior to the participation in the first IDR panel.
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Jennifer Smith, RN
RAI/Oasis/IDR-IIDR Coordinator
Office of Inspector General
Division of Health Care
275 E. Main St., 5E-A
Frankfort, KY 40621
Fax: (502) 564-6546
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MDS/RAI CONTACT INFORMATION
For questions regarding MDS Assessment, Coding, Transmission or
Please do not send any identifiable patient information through e-mail. This includes patient names, SSNs, dates of birth, or any other data items considered identifiers or Protected Health Information (PHI) under HIPAA. Please redact any PHI prior to sending.
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All certified nursing facilities must sign up for ePOC. Please be diligent about keeping your account and password up to date. All correspondence is handled in the ePOC system, including the plan of correction. Furthermore, if there is a change in administrator, it is incumbent upon the facility to update the system.
If your facility is not yet signed up, see the Account Setup instructions.
Not sure if your facility has any ePOC accounts or have other questions? E-mail ePOC.Support@ky.gov or Melissa Richard, Training & QA Branch Manager, or call 502-564-7963 x.3310.
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Have you notified your residents?
Click the link below to download and/or print the contact list for various agencies.
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Which Branch is Serving You?
To provide the highest level of service, the Division of Health Care operates through four regional offices. Knowing the appropriate Branch to contact with questions and concerns will ensure you receive maximum service in minimum time. Review links below for detailed information.
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CMS Survey and Certification memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.
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Transfer/Discharge Hearing Appeals
Please submit your requests for transfer/discharge hearing appeals to Secretary Eric C. Friedlander, Cabinet for Health and Family Services, by emailing:
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LTC Facility Self-Reported
Incidents & Complaints
New email addresses have been established for communications regarding LTC Facility Self-Reported Incidents and for use by residents and the general public to report possible violations of regulatory requirements. Click Here for the email addresses and additional contact information.
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Quality, Safety & Education Portal
CMS's QSEP provides the full curriculum of surveyor training and guidance on health care facility regulations. All training is available on-demand on a top-notch self-service portal. 24/7 access means you have the freedom to learn what you want, where you want, when you want.
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Employment Opportunities
To search and apply for positions within the Office of Inspector General, please visit the Kentucky Personnel Cabinet's web page by clicking below.
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DHC Leadership Team:
Inspector General
Deputy Inspector General
Director
Assistant Director
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Want to Sign Up for This Newsletter?
If you have received a copy of this newsletter from a friend or co-worker, you can click here and enter your information to join our mailing list, or contact MelissaD.Richard@ky.gov.
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Commonwealth of Kentucky | Office of Inspector General | 275 East Main St., Frankfort, KY 40621 |
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The Office of Inspector General is the regulatory and licensing agency for all health care, day care and long-term care facilities and child adoption/child-placing agencies in the commonwealth.
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