Below you will find a list* of items related to Currently Happening Updates and Events in Senior Living.

*This is a listing of materials that may be helpful to your facility and  is not an all-inclusive list and is intended to assist you in your efforts within your facility.

++These are NOT educational events or webinars, written information only++

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes-including, for the first time, national minimum nurse staffing standards-to ensure access to safe, high-quality care for the over 1.2 million residents living in nursing homes each day. This proposed rule builds on the President's historic Action Plan for Nursing Home Reform launched in the 2022 State of the Union.

Overview

The proposed rule consists of three core staffing proposals:

1. minimum nurse staffing standards of 0.55 (33 minutes) hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 (2 hours 27 minutes) HPRD for Nurse Aides (NAs);

2. a requirement to have an RN onsite 24 hours a day, seven days a week; and

3. enhanced facility assessment requirements.

The proposed rule also includes a staggered implementation approach and possible hardship exemptions for select facilities.

Links:

Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (CMS 3442-P) | CMS

  HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes | CMS

Below you will find a list* of items related to the COVID-19 Corona Virus. This is a listing of materials that may be helpful to your facility.

*This is not an all-inclusive list and is intended to assist you in your efforts within your facility.

++These are NOT educational events or webinars, written information only++

• Social Security Act Section 1135 emergency waivers for health care providers will terminate with the end of the COVID-19 Public Health Emergency (PHE) on May 11, 2023.
• Certain regulations or other policies included in Interim Final Rules with Comments (IFCs) will be modified with the ending the PHE. Certain policies, such as the Acute Hospital at Home initiative and telehealth flexibilities have been extended by Congress through December 31, 2024.
• Long Term Care and Acute and Continuing Care providers are expected to be in compliance with the requirements according to the timeframes listed below

CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements.

This memorandum replaces memoranda QSO 22-07-ALL Revised, and QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised to consolidate the information into a single memorandum. The guidance in this memorandum applies to all states.

The staff vaccination requirement for all CMS-certified providers and suppliers has been enforced in all states since February 20, 2022. To date, most providers and suppliers surveyed by states have been found to be in substantial compliance with this requirement.

Memorandum Summary
• CMS is committed to continuing to take critical steps to ensure America's healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
• Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE.
• Visitation is allowed for all residents at all times.
• Updated guidance for face coverings and masks during visits.
• Removed vaccination status from the guidance.

Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

• Routine testing of asymptomatic staff is no longer recommended but may be performed at the discretion of the facility. 
• Updated recommendations for testing individuals who have recovered from COVID-19.

Survey oversight of the staff vaccination requirement for Medicare and Medicaid-certified providers and suppliers will continue to be performed during initial andrecertification surveys, but will now only be performed in response to complaintsalleging non-compliance with this requirement, not all surveys. Under prior guidance,all surveys included oversight of the staff vaccination requirement.

Memorandum Summary
• CMS continues to review the need for existing emergency blanket waivers issued in response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
• Over the course of the COVID-19 PHE, skilled nursing facilities/nursing facilities (SNFs/NFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities have developed policies or other practices that we believe mitigates the need for certain waivers.
• Applicable waivers will remain in effect for hospitals and critical access hospitals (CAH).
• CMS will end the specified waivers in two groups:
o 60 days from issuance of this memorandum
o 30 days from issuance of this memorandum

This attachment is a supplement to and should be used in conjunction with the following
memoranda: QSO-22-07-ALL-Revised, QSO-22-09-ALL-Revised, and QSO 22-11-ALL-Revised memorandum: Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination.

Revised Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

Revised Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

Revised Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory
Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

• Replaced the term "vaccinated" with "Up-to-date with all recommended COVID-19 vaccine doses" and deleted the term "unvaccinated."
• Updated the recommendations for testing individuals within 90 days after recovering from COVID-19.

Nursing Home Visitation -COVID-19 (REVISED)

•Replaced the term "vaccinated" with "up-to-date with all recommended COVID-19 vaccine doses" and deleted "unvaccinated."
•Updated visitor screening and quarantine criteria.

This attachment is a supplement to and should be used in conjunction with QSO 22-07-ALL memorandum: Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination.

On November 05, 2021, CMS published an interim final rule with comment period (IFC).This rule establishes requirements regarding COVID-19 vaccine immunization of staffamong Medicare- and Medicaid-certified providers and suppliers.
•CMS is providing guidance and survey procedures for assessing and maintainingcompliance with these regulatory requirements.
•The guidance in this memorandum does not apply to the following states at this time:Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky,Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota,Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia and Wyoming.Surveyors in these states should not undertake any efforts to implement or enforce the IFC.

COVID-19 Staff Vaccination Matrix and Instructions for use.

Entrance Conference Worksheet - Note: Surveyors in a state that is subject to QSO-22-07-ALL should start using this document on 01/27/2022. Surveyors in a state that is subject to QSO-22-09-ALL should continue using the Sept 2021 version until 02/13/2022 and start using this document on 02/14/2022. Surveyors in a state that is subject to QSO-22-11-ALL should continue using the Sept 2021 version until 02/21/2022 and start using this document on 02/22/2022.

Federal Regulatory Groups for Long Term Care Update

This attachment is a supplement to and should be used in conjunction with QSO-22-11-ALL memorandum: Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19  Health Care Staff Vaccination.

On November 05, 2021, CMS published an interim final rule with comment period (IFC). This rule establishes requirements regarding COVID-19 vaccine immunization of staff among Medicare- and Medicaid-certified providers and suppliers.
• CMS is providing guidance and survey procedures for assessing and maintaining compliance with these regulatory requirements.
• The guidance in this memorandum specifically applies to the following state: Texas.
• States that are not identified above are expected to continue under the timeframes and parameters identified in either the December 28, 2021 or January 14, 2022 memoranda (QSO-22-07-ALL and QSO 22-09-ALL).

This attachment is a supplement to and should be used in conjunction with QSO 22-09-ALL memorandum:
Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus
COVID-19 Health Care Staff Vaccination.

Memorandum Summary
• CMS is committed to ensuring America's healthcare facilities respond effectively in an evidence-based way to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
• On November 05, 2021, CMS published an interim final rule with comment period (IFC). This rule establishes requirements regarding COVID-19 vaccine immunization of staff among Medicare- and Medicaid-certified providers and suppliers.
• CMS is providing guidance and survey procedures for assessing and maintaining compliance with these regulatory requirements.
• The guidance in this memorandum specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.
• The guidance in this memorandum does not apply to the following state at this time: Texas. Surveyors in Texas should not undertake any efforts to implement or enforce the IFC.
• States that are not identified above are expected to continue under the timeframes and parameters identified in the December 28, 2021 memorandum (QSO-22-07-ALL).

Memorandum Summary
• CMS will begin posting the following information for each nursing home on the
Medicare.gov Care Compare website:
o Weekend Staffing: The level of total nurse and registered nurse (RN) staffing on weekends
provided by each nursing home over a quarter.
o Staff Turnover: The percent of nursing staff and number of administrators that stopped working
at the nursing home over a 12-month period.
This information will be added to the Care Compare website in January 2022 and used in the Nursing
Home Five Star Quality Rating System in July 2022.
• Posting Detailed Staffing Data: CMS will begin posting the submitted employee-level
staffing data for all nursing homes.
• Reminder for Nursing Homes to Link Employee Identifiers when they are changed due to
the changes in the facility's staffing data systems.

•Visitation Guidance: CMS is issuing new guidance for visitation in nursing homesduring the COVID-19 PHE, including the impact of COVID-19 vaccination.
•Visitation is now allowed for all residents at all times.

•CMS remains committed to taking critical steps to protect vulnerable Americans to ensure the nation's health care facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

• CMS is announcing steps to assist State Survey Agencies (SAs) in addressing the backlog of complaint and recertification surveys. These steps include: o Revising the criteria for conducting COVID-19 Focused Infection Control (FIC) Surveys; o Guidance for resuming recertification surveys; and o Temporary guidance and minor flexibilities related to complaint investigations.

• CMS is increasing oversight in nursing homes to allow a more focused review of quality-of-life and quality-of-care concerns.

• CMS is committed to taking critical steps to ensure America's healthcare facilities continue to respond effectively to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

• On August 25, 2020, CMS published an interim final rule with comment period (IFC). This rule establishes Long-Term Care (LTC) Facility Testing Requirements for Staff and Residents. Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the HHS Secretary. This memorandum provides guidance for facilities to meet the new requirements.

• Revised COVID-19 staff testing is based on the facility's county level of community transmission instead of county test positivity rate. The frequency of testing has also been updated.

• Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach.

On May 11, 2021, CMS published an interim final rule with comment period (IFC). This rule establishes Long-Term Care (LTC) Facility Vaccine Immunization Requirements for Residents and Staff. This includes new requirements for educating residents or resident representatives and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine, and offering the vaccine. Furthermore, LTC facilities must report COVID-19 vaccine and therapeutics treatment information to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN).

Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE, including the impact of COVID-19 vaccination.

Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID19 Focused Survey Tool

CMS continues to review the need for existing waivers issued in response to the Public Health Emergency (PHE). Over the course of the PHE, nursing homes have developed policies or other practices that we believe mitigates the need for certain waivers.

 NOTE: CMS revised guidance on March 10, 2021 for nursing home visitation during the COVID-19 Public Health Emergency, which supersedes the visitation guidance in this memo. See CMS memorandum QSO-20-39-NH Revised, Nursing Home Visitation-COVID-19.

• CMS is committed to continuing to take critical steps to ensure America's healthcarefacilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) PublicHealth Emergency (PHE).
• Visitation Guidance: CMS is issuing new guidance for visitation in nursing homesduring the COVID-19 PHE, including the impact of COVID-19 vaccination.

The Alabama Department of Public Health (ADPH) just received the HAN regarding the updated guidance for isolation and quarantine

WASHINGTON, DC - The U.S. Department of Labor announced today that its Occupational Safety and Health Administration has issued stronger worker safety guidance to help employers and workers implement a coronavirus protection program and better identify risks which could lead to exposure and contraction. Last week, President Biden directed OSHA to release clear guidance for employers to help keep workers safe from COVID-19 exposure.

Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes

The Infection Prevention,  Control & Immunization Focus Survey Tool Updated Form. This is used to investigate compliance at F880, F881, F882, F883, F885, and F886. For the purpose of this task, "staff" includes all facility staff (direct and indirect care functions), contracted staff, consultants, volunteers, others who provide care and services to residents on behalf of the facility, and students in the facility's nurse aide training programs or from affiliated academic institutions. The infection prevention and control program (IPCP) must be facility-wide and include all departments and contracted services.



The Centers for Disease Control and Prevention (CDC) recently added two options for states to consider concerning the quarantine time frames of close contacts to COVID-19 cases, even though the recommended quarantine period of 14 days remains. Only the State Health Officer can establish quarantine and isolation requirements

 • CMS is committed to continuing to take critical steps to ensure America's healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

• Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE. The guidance below provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.

• Use of Civil Money Penalty (CMP) Funds: CMS will now approve the use of CMP funds to purchase tents for outdoor visitation and/or clear dividers (e.g., Plexiglas or similar products) to create physical barriers to reduce the risk of transmission during in-person visits.



CMS has revised the Survey tool for surveyors. Added to the process is the assessment of compliance with requirements for facilities to designate one or more individuals(s) as the Infectionist Preventionist f-882; also added is the staff and resident testing requirements- F886.

Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID- 19 Focused Survey Tool



Interim Final Rule (IFC), CMS-3401-IFC, Updating Requirements for Reporting of SARS-CoV-2 Test Results by Clinical Laboratory Improvement Amendments of 1988 (CLIA) Laboratories, and Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency



• CMS is committed to taking critical steps to ensure America's health carefacilities continue to be prepared in response to the threat of the 2019Coronavirus Disease (COVID-19).

• CMS is revising guidance on the expansion of survey activities to authorizeonsite revisits and other survey types.

• CMS is providing guidance to State Survey Agencies (SAs) on resolvingenforcement cases: CMS is providing guidance on resolving enforcement casesthat were previously directed to be held, and providing guidance on Civil MoneyPenalty (CMP) collection.

• Expanded Desk Review Authority: CMS is temporarily expanding the deskreview policy to include review of continuing noncompliance following removalof Immediate Jeopardy (IJ), which would otherwise have required an onsite revisitfrom March 23, 2020, through May 31, 2020.

• CMS is also issuing updated guidance for the re-prioritization of routine SAClinical Laboratory Improvement Amendments (CLIA) survey activities, subjectto the SA's discretion, in addition to lifting the restriction on processing CLIAenforcement actions, and issuing the Statement of Deficiencies and Plan ofCorrection (Form CMS-2567).



The Centers for Medicare and Medicaid Services (CMS) has once again updated the Isolation and Quarantine Guidance as of July 28, 2020.

CDC publishes recent changes as of July 17, 2020 for Healthfcare Personnel with SARS-CoV-2 Infection.

Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

Posting of Nursing Home Inspections

Release of COVID-19 Nursing Home Data

COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes 



Document, document, document-a phrase that is familiar in the senior living industry and many other healthcare arenas. During the COVID-19 pandemic, documentation is critical in order to provide a historical timeline of the facility's response to the COVID-19 pandemic. Many facilities may be at risk for lawsuits and CMS Infection Control Focused Surveys in the future, and the documentation process for providing a historical timeline of each facility's individual response is key.



CMS is committed to taking critical steps to ensure America's nursing homes are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).  Recommendations for State and Local Officials: CMS is providing recommendations to help determine the level of mitigation needed to prevent the transmission of COVID-19 in nursing homes. The recommendations cover the following items:

Criteria for relaxing certain restrictions and mitigating the risk of resurgence: Factors to inform decisions for relaxing nursing home restrictions through a phased approach.  

Visitation and Service Considerations: Considerations allowing visitation and services in each phase.

Restoration of Survey Activities: Recommendations for restarting certain surveys in each phase.



On April 19, 2020, CMS released memo QSO -20-26, "Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID-19 Persons under Investigation) Among Residents and Staff in Nursing Homes," summarizing new facility reporting requirements that would soon be released through rulemaking.

On May 8, 2020, CMS will publish an interim final rule with comment period, titled "Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program". The unpublished rule is available for public inspection at the Federal Register website (Agency Docket: CMS-5531-IFC and Regulation ID Number (RIN): 0938-AU32).

 

Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions



•CMS is committed to taking critical steps to ensure America's health carefacilities are prepared to respond to the 2019 Novel Coronavirus (COVID-19)Public Health Emergency (PHE).

•Communicable Disease Reporting Requirements: To ensure appropriate tracking, response, and mitigation of COVID-19 in nursing homes, CMS is reinforcing an existing requirement that nursing homes must report communicable diseases, healthcare-associated infections, and potential outbreaks to State and Local health departments. In rulemaking that will follow, CMS is requiring facilities to report this data to the Centers for Disease Control and Prevention (CDC) in a standardized formatand frequency defined by CMS and CDC. Failure to report cases of residents or staff who have confirmed COVID -19 and Persons under Investigation (PUI) could result in an enforcement action. This memorandum summarizes new requirements which will be put in place very soon.

•Transparency: CMS will also be previewing a new requirement for facilities to notify residents' and their representatives to keep them up to date on the conditions inside the facility, such as when new cases of COVID-19 occur.



This survey tool must be used to investigate compliance at F880 and determine whether the facility is implementing proper infection prevention and control practices to prevent the development and transmission of COVID-19 and other communicable diseases and infections.  Entry and screening procedures as well as resident care guidance has varied over the progression of COVID-19 transmission in facilities. Facilities are expected to be in compliance with CMS guidance that is in effect at the time of the survey.  Refer to QSO memos released at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.



The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration's aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration



CMS is prioritiizing and suspending certain federal and SSA surveys, and delaying revisit surveys, pursuant to federal requirements for the next three weeks, beginning March 20,2020, for all certified provider and supplier types.

During the three-week timeframe, SSAs and CMS surveyors will prioritize and conduct surveys(including revisit surveys) related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level, for all allegations, in addition to a review with a Focused Infection Control survey. Federal surveyors will perform targeted Infection Control surveys of facilities in those areas most in need of additional oversight, as identified through collaboration with the CDC and ASPR.

Guidance for Infection Control and Prevention of COVID-19 - CMS is providing additional guidance to nursing homes to help them improve their infection control and prevention practices to prevent the transmission of COVID-19, including revised guidance for visitation.

CMS is committed to taking critical steps to ensure America's health care facilities are prepared to respond to the threat of the COVID-19 and other respiratory illness. With this announcement, health care workers in providers and suppliers certified by CMS will have a more expansive range of options to protect themselves and those receiving their care.

"CMS is responsible for ensuring the health and safety of nursing home residents by enforcing the standards required to help each resident attain or maintain their highest level of well-being. In light of the recent spread of COVID-19, we are providing additional guidance to nursing homes to help control and prevent the spread of the virus."

"CMS is committed to taking critical steps to ensure America's health care facilities and clinical laboratories are prepared to respond to the threat of COVID-19 and other respiratory illness. Specifically, CMS ids suspending non-emergency inspections across the country, allowing inspectors to turn their focus on the most serious health and safety threats like infectious diseases and abuse."

CMS is responsible for ensuring the health and safety of nursing homes by enforcing the standards required to help each resident attain or maintain their highest level of well-being. In light of the recent spread of COVID-19, we're providing additional guidance to nursing homes to help control and prevent the spread of the virus."

"This 2019 Nursing Home Infection Control Worksheet is a collaborative effort by CMS and CDC and meant to be used by facilities as a self-assessment tool. It comprises both regulatory requirements and best practices in infection prevention and control. A facility that uses this tool will identify gaps in practice and have a "roadmap" that can lead to an improved infection prevention and control program."

The facility task must be used to investigate compliance of F880, F881, and F883.The Infection Prevention and Control Program (IPCP) must be facility-wide and include all departments and contracted services.