• Outbreak of Contagious Disease or Condition Among Assisted Living Residents

    Monday February 27, 2012

    Once an outbreak has been identified, it is important the facility take the appropriate steps to contain it. State, local and county health departments offer guidance and regulations regarding responding to and reporting outbreaks.  This information is often received in advance of an outbreak and included in the infection prevention and control program. Plans for containing outbreaks usually include efforts to prevent further transmission of the infection while considering the need of all residents and staff.

    We suggest that you review the Regulations in Assisted Living and Specialty Care Assisted Livings to ensure Regulatory Compliance. This information can be found in: Alabama Assisted Living Rules and Regulations 420-5-4-.05 Records and Reports andAlabama Specialty Care Assisted Living Rules and Regulations 420-5-20-.05 Records and Reports.

    It is important that all infection prevention and control practice reflect current Centers for Disease Control guidelines.

    Each facility should refer to their specificState:

    • Rules and Regulations; and
    • State and local health departments for reporting guidelines and recommendations.
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  • Infection Control and the Norovirus

    Monday February 27, 2012

    Due to the recent reported cases of the Norovirus in nursing homes and assisted living facilities it is important that we remember what the facility's role and responsibility is regarding infection control.

    Under the guidance for Surveyors in the State Operations Manual, F-441Infection Control, states; Recognizing and Containing Outbreaks An outbreak is typically one or more of the following:

    • One case of an infection that is highly communicable;
    • Trends that are 10% higher than the historical rate of infection for the facility that may reflect an outbreak or seasonal variation and therefore warrant further investigation; or
    • Occurrence of three or more cases of the same infection over a specified length of time on the same unit or other defined areas. 

    Once an outbreak has been identified, it is important the facility take the appropriate steps to contain it.  State health departments offer guidance and regulations regarding responding to and reporting outbreaks.  This information is often received in advance of an outbreak and included in the infection prevention and control program. Plans for containing outbreaks usually include efforts to prevent further transmission of the infection while considering the need of all residents and staff.

    It is important that all infection prevention and control practice reflect current Centers for Disease Controlguidelines.

    Component of an infection Prevention and Control Program

    • Policies and procedures
    • Infection Preventionist
    • Surveillance( process and outcome)
    •  Documentation
    • Monitoring
    • Data Analysis
    • Communicable Disease Reporting
    • Education
    • Antibiotic Review

    Facilities should review the complete guidance under CFR ยง483.65 Infection Control F441 for more details.

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  • HHS Announces Intent to Delay ICD-10 Compliance Date

    Tuesday February 21, 2012

    As part of President Obama's commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). 

    The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 - a delay of two years from the compliance date initially specified in the 2008 proposed rule.  HHS will announce a new compliance date moving forward.

    "ICD-10 codes are important to many positive improvements in our health care system," said HHS Secretary Kathleen Sebelius.  "We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system."

    ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10.  Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

    All HHS press releases, fact sheets and other press materials are available at: http://www.hhs.gov/news.

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  • Norovirus Update

    Tuesday February 21, 2012

    Healthcare facilities, including nursing homes and hospitals, are the most commonly reported settings for norovirus outbreaks in the United States. The virus can be introduced into healthcare facilities by infected patients/residents--who may or may not be showing symptoms--or by staff, visitors, or contaminated food products. Outbreaks in these settings can be quite long-sometimes lasting months-and illness can be more severe, occasionally even fatal, in hospitalized or nursing home patients than for otherwise healthy persons.

    Noroviruses are responsible for about half of all reported outbreaks of gastroenteritis (vomiting, diarrhea, and stomach cramping caused by inflammation of the stomach and intestines). While the vast majority of norovirus illnesses are not part of a recognized cluster, outbreaks provide important information on how the virus is spread and, therefore, how best to prevent infection.  Norovirus outbreaks occur throughout the year, but over 80% of them occur during November-April. In addition, norovirus outbreaks tend to increase periodically when new strains of the virus appear. The virus can be spread through food, water, by touching things that have the virus on them, as well as directly from person to person. There is no long-lasting immunity to norovirus; thus, outbreaks can affect people of all ages and in a variety of settings

    Due to the recently reported outbreaks of the norovirus in Long Term Care and Assisted Living facilities we have attached several CDC norovirus related documents.

    For more information we encourage you to visit the CDC web site at: http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm

    Norovirus-Guideline for Healthcare Settings-2011

    Norovirus Worksheet

    Norovirus Poster

    Norovirus Comm Framework

    Norovirus Case Fact Sheet

    NoroVirus-Management of Outbreaks in Healthcare Settings

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  • Centers for Medicare and Medicaid Services is Considering Extending its Timeline for ICD-10 Code Conversion Compliance

    Wednesday February 15, 2012

    Healthcare providers could get some regulatory deadline relief soon. The acting head of the Centers for Medicare and Medicaid Services said today the agency is considering extending its timeline for ICD-10 code conversion compliance.

    Under current ICD-10 rules, healthcare providers, payers, and others have until Oct. 1, 2013 to switch over their claims, billing, and other systems from current ICD-9 to ICD-10 codes for medical diagnosis and inpatient procedures. The transition from ICD-9 to ICD-10 involves expanding medical diagnosis codes from the current 14,000 to more than 67,000, and procedure codes from 13,000 to 85,000.

    Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, told a conference of the American Medical Association (AMA) that her agency could delay adoption of the ICD-10 system. Current law calls for physicians to adopt the new codes next year.

    "I'm committing today to work with you to re-examine the pace at which we implement ICD-10," she said to loud applause. "I want to work together to ensure that we implement ICD-10 in a way that [meets its] goals while recognizing your concerns."

    Critics - including the AMA - say switching to ICD-10 coding will require doctors' offices to deal with some 68,000 codes, more than five times the current 13,000. The change, according to the AMA, would cost medical practices anywhere between $83,290 and more than $2.7 million, depending on size.

    Speaking to reporters after her prepared remarks, Tavenner said her office would formally announce its intention to craft new regulations "within the next few days."

    LTC Provider University will provide updates when they become available.

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  • CMS Allows Physician Assistants to Perform SNF Level of Care Certification and Recertifications

    Monday February 13, 2012

    On January 13, 2012 CMS published a pair of transmittals that revise Chapter 8, section 40.1 of the Medicare Benefit Policy Manual to add physician assistants to the list of practitioners that can perform the required initial certification and periodic recertifications of the need for skilled nursing facility (SNF) level of care. 

    On January 13, 2012 CMS   issued Transmittal 153, entitled -"Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications".  The transmittal provides guidance on the ability of physician assistants to perform level of care certifications and recertifications in skilled nursing facilities. The guidance implements Section 3108 of the Affordable Care Act.  According the guidance, a physician assistant may now perform the certification or recertification if the physician assistant collaborates with the physician but does not have a direct or indirect employment relationship with the facility.  

                                                                                           

    Please review the following two attachments for details.

    Physician Assistants January 13, 2012

    Physician Assistants Flyer

     

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  • CMS Updates Information Related To Reporting Reasonable Suspicion of a Crime

    Monday February 13, 2012

    The Centers for Medicare and Medicaid Services (CMS) has recently issued an updated S&C memo on reporting the reasonable suspicion of a crime.

    This memorandum informs SAs of the new section 1150B of the Act, which was established by section 6703(b)(3) of the Affordable Care Act and is entitled "Reporting to Law Enforcement of Crimes Occurring in Federally Funded Long-Term Care Facilities." In order to promote timely application of the protections offered by section 1150B of the Act for LTC facility residents, CMS is explaining now the current obligations of LTC facilities to comply with the law as it is plainly written, without any delay that might be occasioned by waiting for any administrative rule-making process that might further clarify application of the law.

    The updates appear in the Definitions and Questions and Answers sections.

    In the definitions, the terms "agent" and "contractor" are further defined in Appendix One. These definitions will assist providers in determining who is included in "covered individuals."  

    In the Q&A section of the memo, additional clarity is provided regarding the role of the facility in reporting the suspicion of a crime. It should be noted that this memo specifically states that a facility may report of a reasonable suspicion of a crime directly to the state survey agency and law enforcement on behalf of covered individuals. Additionally, the Q&A section provides clarity about the impact of this requirement on ICFs/MR.  

    Please see the attached S&C letter for more detailed information.

    Reporting Suspicion of Crime 20Jan2012 update

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