COVID-19 Resources

This webpage contains the Alabama Nursing Home Association’s latest information related to COVID-19/Coronavirus. The date beside each item is when the information was published. Updated versions of guidance will be added as they are released, and older versions will be deleted.

Revised Isolation and Quarantine Guidance – July 30, 2020
The Centers for Medicare and Medicaid Services (CMS) has once again updated the Isolation and Quarantine Guidance as of July 28, 2020. Click here to download a PDF of the table.

NEW – Reporting Positive Results, COVID-19-Related Deaths, and Probable Cases – May 11, 2020
The Alabama Department of Public Health (ADPH) has updated the reporting of COVID-19. The PUI form has been deleted from the ADPH website. The new process is as follows:

An all-inclusive online COVID-19 REPORT Card is now available for reporting of:

  • Positive COVID-19 test results
  • COVID-19 related deaths
  • Probable COVID-19 cases
    • Must have compatible COVID-19 symptoms AND be epidemiologically-linked to a laboratory-confirmed case.
    • These cases either have not been tested or are awaiting test results.

This online automated COVID-19 Report Card is accessible from all electronic devices, including your Android and Apple devices as well as personal computers, laptops, etc. Once you have submitted a COVID-19 REPORT Card for your patient, there is no need to call the Alabama Department of Public Health (ADPH). However, our 24/7/365 emergency phone number (1-800-338-8374) is available if necessary.

Performing laboratories are required to report all negative and positive COVID-19 virus test results electronically (faxes do not count). If not already enrolled, laboratories will need to manually enter test results directly into the surveillance system; contact ALNEDSSsupport@adph.state.al.us to enroll staff today. More information can be found on the ADPH website at https://www.alabamapublichealth.gov/covid19/healthcare.html.

CMP grants for adaptive communicative technology – April 27, 2020
The Alabama Nursing Home Association (ANHA) was informed by the Alabama Department of Public Health that Civil Money Penalty (CMP) funds may be used to provide residents with adaptive communicative technologies. The ANHA encourages you to read these documents and apply for assistive technology via CMP grants. CMS requests that all application include the brand and model of the device and the process used for disinfection (must be on the EPA N list.) CMS also asks for an average daily census. Completed forms should be emailed to Dennis Blair at ADPH, dennis.blair@adph.state.al.us.

Background
The Centers for Medicare & Medicaid Services (CMS) issued Guidance in March for Infection Control and Prevention of COVID-19. This guidance directs nursing homes to significantly restrict visitors and nonessential personnel to protect nursing home residents. Recognizing that visitor restrictions may be difficult for residents and families, CMS developed the application template for requests to use Civil Money Penalty (CMP) Reinvestment funds to provide residents with adaptive communicative technologies. Applicants shall submit this CMP Reinvestment Application to the applicable state agency. The state agency shall make a determination on the potential of the project to benefit nursing home residents and improve their quality of care or quality of life. The applicant will be notified by the state agency about a funding decision, and applicants may contact the applicable state agency with questions about their CMP Reinvestment Application.

Reporting of COVID-19 – April 8, 2020
Please note that the reporting of COVID-19 residents or staff is NOT reportable through the online reporting system for Abuse, Neglect, Misappropriation or Mistreatment of residents.  Reporting must be done through the PUI form located on the ADPH website at https://www.alabamapublichealth.gov/infectiousdiseases/cov-healthcare.html.

Infection Control Focused Surveys – April 8, 2020
The Alabama Department of Public Health as well as surveyors from the Centers for Medicare and Medicaid Services (CMS), are conducting surveys focusing on infection control. Here are several documents that will assist in your preparation.  Facilities should be prepared for these surveys.

  1. COVID-19 Focused Survey Tool
  2. Summary Table of COVID-19 Focused Survey
  3. Entrance Conference Worksheet
  4. COVID-19 Focused Survey Protocol

Alternate Care Site Applications to ADPH – April 4, 2020
Click here for a short package developed by the Alabama Department of Public Health (ADPH) to assist health care providers in obtaining approval for alternate care sites during the COVID-19 health care emergency. This is an abbreviated process that the ADPH believes will enable providers to proceed expeditiously in an effort to respond to the emergency, while preserving the intent and requirements of the CMS blanket waivers. As detailed in the letter, an email box for submission is being set up by ADPH and all relevant information is in the process of being posted on the ADPH coronavirus website.

Updated: When COVID-19 Gets into Your LTC Facility (Assume It’s Already There) – April 4, 2020
The American Health Care Association (AHCA) has updated this resource as COVID-19 is rapidly spreading across the country and is increasingly impacting nursing homes. Due to the rapid progression of this virus, centers should assume it is already in their surrounding community and may be in their facility. This resource outlines four action steps.

ADPH Guidance on Transfer and Release from Hospitals – April 2, 2020
Alabama Nursing Home Association received “Guidance on Transfer to Hospitals and Release from Hospitals and Discontinuation of Transmission-Based Precautions for Long-Term Care Facilities for Confirmed or Suspected COVID-19 Patients” from the Alabama Department of Public Health. Click here to read the guidance.

Guidance on Reporting and Responding to COVID-19 Cases – March 30, 2020
This PDF contains important information on what you must do if a resident and/or employee in your nursing home receives a positive diagnosis for COVID-19. It also contains reminders on preventing COVID-19 and containing the spread. Several helpful links are included in the document.

Facility Self-Assessment – March 27, 2020
CMS is asking facilities to complete the CMS LTC Facility Self-Assessment Tool found at: https://qsep.cms.gov/data/252/A._NursingHome_InfectionControl_Worksheet11-8-19508.pdf.

It is possible that ADPH will call and request copies of this self-assessment tool. If they have further questions or are concerned, then they may ask for copies of policies and procedures, policies, etc. They may also ask for this information if they receive complaints. Facilities are encouraged to immediately complete and work on the self-assessment tool so they can be prepared if they receive a call from the Alabama Department of Public Health. ANHA has sent this tool before and most facilities should have already completed the document and have it on file.

ADPH Reminder on Reporting COVID-19 Cases – March 24, 2020
The Alabama Department of Public Health reminds everyone that facilities are responsible for reporting suspected COVID-19 to their local Health Department. If a facility is suspicious enough to test, it needs to report. The ADPH Bureau of Health Provider Standards would also appreciate a courtesy notification as well.

Crisis Standards of Care/Mutual Aid Compact – March 24, 2020
The Alabama Department of Public Health is sending the Crisis Standards of Care and Mutual Aid Compact to health care providers through the local Health Care Coalitions (HCCs). The Crisis Standards of Care provide guidance in the decision-making process and modifies the delivery of health care services in disasters and other health care emergencies. The Mutual Aid Compact serves as a non-binding guide in times of disaster for participating hospitals and other health care entities, to expedite the sharing of resources. 

Activate Your Facility’s AIMS Account – March 24, 2020
If you have not already done so, log-in and activate your facility’s Alabama Incident Management System (AIMS) account. AIMS is operated by the Alabama Department of Public Health and the University of South Alabama to coordinate health care services and needs during declared emergencies and disasters. Each nursing home has an AIMS account. If you don’t know your facility’s account information, contact the AIMS Coordinator at your local Healthcare Coalition (HCC). Click here for a list of the local AIMS Coordinators.

Here are links to CDC guidance specific to nursing homes are:

CDC Updates Transmission Based Precautions, Duration of Isolation and Return to Work Criteria – July 21, 2020
On July 17, the Centers for Disease Control and Prevention (CDC) posted substantial changes to the transmission-based precautions. As the CDC continues to learn more about the COVID-19 virus, it continues to revise prior guidance. The CDC updated the discontinuation of transmission-based precautions, duration of isolation and return to work criteria. Click here to a summary of the changes and links to the new CDC guidance.

CDC Updates COVID-19 Symptoms – April 29, 2020
The Centers for Disease Control and Prevention updated its list of COVID-19 symptoms. The symptoms now include cough and shortness of breath or difficulty breathing or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, vomiting, diarrhea, and new loss of taste or smell.

With the addition of these symptoms, AHCA/NCAL has updated relevant resources, including screening checklist for essential personnel and visitors, as well as sample daily log for personnel. If you created your own screening tools, you should update to include the additional symptoms.

Nebulizing Guidance – April 20, 2020
The American Health Care Association (AHCA) has developed new guidance that outlines when and what to do with COVID-19 residents with severe respiratory symptoms who need nebulizer treatments. CDC considers nebulizer treatments to be an aerosol generating procedure. This may increase risk of infection due to aerosols generated by the procedure or due to increased contact between health care providers and patients. Facilities should review the guidance and consider whether they can care for a resident who requires nebulizer treatment.

CMS Announces New Nursing Homes COVID-19 Transparency Effort – April 20, 2020
The Centers for Medicare & Medicaid Services (CMS) announced new regulatory requirements that will require nursing homes to inform residents, their families and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC). This information must be reported in accordance with existing privacy regulations and statutes. This measure augments longstanding requirements for reporting infectious disease to State and local health departments. Finally, CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.

CDC will be providing a reporting tool to nursing homes that will support Federal efforts to collect nationwide data to assist in COVID-19 surveillance and response. This joint effort is a result of the CMS-CDC Work Group on Nursing Home Safety. CMS plans to make the data publicly available. This effort builds on recent recommendations from the American Health Care Association and Leading Age, two large nursing home industry associations, that nursing homes quickly report COVID-19 cases. More details are available in the Press Release and Guidance Memo.

CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19 – April 20, 2020
The Centers for Medicare & Medicaid Services (CMS) issued new recommendations specifically targeted to communities that are in Phase 1 of the Guidelines for President Trump’s Opening Up America Again with low incidence or relatively low and stable incidence of COVID-19 cases. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures. The new CMS guidelines recommend a gradual transition and encourage health care providers to coordinate with local and state public health officials, and to review the availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness, and testing capacity when making the decision to re-start or increase in-person care.

The new recommendations can be found here: https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf. The Guidelines for Opening Up America Again can be found here: https://www.whitehouse.gov/openingamerica/#criteria

Suspension of Standard Surveys Continues – April 17, 2020
The Centers for Medicare and Medicaid Services (CMS) announced on its April 15 national call with nursing homes that the suspension of standard surveys will continue until further notice. This means the CMS guidance released March 23 has been extended until CMS states otherwise. CMS will continue to conduct surveys for immediate jeopardy situations and additional infection control focused surveys using this tool.

Use this tool to perform self-assessments of your infection control policies, plans and practices, including visitor entry and screening; infection surveillance; education, monitoring and screening of staff; handwashing, donning and doffing of PPE and other transmission-based precautions. You can find additional information to help you on ahcancalED. Surveyors entering the building should bring their own PPE; be sure to screen surveyors as you would any visitor to the building, which now includes temperature checks. Surveyors should spend as little time onsite as possible for these surveys and are instructed not to investigate routine issues.

CMS Releases Updated Questions and Answers on COVID-19 – April 12, 2020
The Centers for Medicare and Medicaid Services (CMS) has released updated FAQs to equip the American health care system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Check this resource often as CMS updates it on a regular basis – CMS inserts the date at the end of each FAQ when it is new or updated.

Recordings of CMS National Stakeholders call on COVID-19 – April 2, 2020
The Centers for Medicare and Medicaid Services has been hosting regular calls with a variety of clinicians, hospitals, other facilities and states in an effort to keep stakeholders updated on its COVID-19 efforts. CMS knows not everyone is available to attend the calls live, so it is sharing the call recordings and transcripts at the following link: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts. CMS will continue to host calls and share information through its list serves and media.

Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit – March 30, 2020
The Centers for Medicare and Medicaid Services issued an electronic toolkit regarding telehealth and telemedicine for Long-Term Care Nursing Home Facilities. CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a health care facility. This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS over the last week in response to the National Health Emergency. Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, software, initiating a telemedicine program, monitoring patients remotely and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic. The toolkit can be accessed here: https://www.cms.gov/files/document/covid-19-nursing-home-telehealth-toolkit.pdf.

Emergency Preparedness – 1135 Waiver Policy and Procedure – March 23, 2020
ANHA’s Life Safety Code and Physical Plant Committee developed tools for facilities in regard to emergency preparedness. The Committee developed a policy and procedure for an 1135 Waiver that meets the requirements as outlined in E0026.

As a reminder, life safety code surveyors must verify that the facility has included policies and procedures in its emergency plan describing the facility’s role in providing care and treatment at alternate care sites under an 1135 waiver. ANHA had this reviewed by ADPH Technical Services, and they have indicated they see no issues with this policy and procedure. This is one policy and procedure that is universal and can be used for all facilities regardless of size, type or location.

The policy and procedure in a Microsoft Word document (downloads automatically) so you can insert your specific facility information. The PDF contains several documents to accompany the policy and procedure.

Alabama Medicaid Modifies Recipient Signature Requirement during COVID-19 Emergency – March 20, 2020
The Alabama Medicaid Agency (Medicaid) is modifying the recipient signature requirement for services provided during the state of emergency effective March 16, 2020. During the time prescribed by the governor as a state of emergency due to the COVID-19 pandemic, recipient signatures are not required in cases where the provider has discontinued signature capture due to health concerns. Documentation of services provided to the recipient must be maintained by the provider. This action will be effective for one month, expiring on dates of service April 16, 2020. It will be reevaluated for a continuance as needed. If you have questions, please visit the Medicaid website at www.medicaid.alabama.gov, or call the Medicaid Fiscal Agent at 1-800-688-7989

Public Announcement from the Alabama Medicaid Agency – March 20, 2020
The Alabama Medicaid Agency, through the direction of Governor Kay Ivey, is taking precautions for the health and safety of stakeholders and Agency staff in response to the evolving outbreak caused by the Coronavirus Disease 2019 (COVID-19). These unprecedented times require limited interactions, and Medicaid began implementing temporary modified work schedules for our employees starting Wednesday, March 18, 2020 until April 6, 2020. Medicaid has developed staffing plans which allow the Agency to continue providing essential services to Medicaid recipients and providers.

We anticipate no disruption in our day-to-day functions, and all district offices will remain open with modified staffing requirements. The Lurleen B. Wallace central office building in Montgomery, Alabama, (which does not have an eligibility district office) will be open for visitors from 9:00 a.m. to 2:00 p.m.  Where possible, every attempt to eliminate face-to-face contact is encouraged while our staff acquires information throughout the modified schedules; therefore, providers and recipients are encouraged to call or email Medicaid staff if possible.

CMS is Delaying Implementation of the October 1, 2020 MDS Update – March 19, 2020
The Centers for Medicare and Medicaid Services (CMS) announced that they are delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.

This delayed release will eliminate the need for significant SNF MDS training during the upcoming months as well as avoid increased documentation nationwide.

CMS staff continues to be actively engaged in discussions with AHCA and various other stakeholders, regarding the various changes, the impacts of these changes, as well as, the timeline to educate and train facility staff and update software and IT systems.

Screening State Surveyors – March 13, 2020
The Alabama Department of Public Health’s Bureau of Health Provider Standards has advised survey team supervisors that survey teams will be subjected to a nursing home’s visitor screening procedures upon entering the building. If a survey team member does not meet your facility’s screening criteria, you should call ADPH and ask the surveyor to call ADPH too. ADPH will want to know why the surveyor doesn’t meet the screening criteria. ADPH will then decide how the survey team should proceed.

Update Care Plans – March 12, 2020
When you institute a “no visitors” policy or strictly limit visitation, you must care plan for the psychosocial needs of your residents during that time. Review and update care plans as needed based on how the policy may affect your residents. Also consider the spiritual needs of residents if church groups are unable to visit.

New Survey/Enforcement Plan Outlined in QSO-20-31-All – June 8, 2020
As reported last week, the Centers for Medicare and Medicaid Services (CMS) released this memo and laid out a new survey plan for state survey agencies, including requiring states to perform on-site surveys of nursing facilities with previous higher instances of COVID-19 outbreaks and requiring states to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases. A full breakdown of the new survey plan and future survey activity timelines is available here:

COVID-19 Survey Activities – In addition to ADPH completing the Focused Infection Control surveys of nursing homes by July 31, CMS is also requiring States to implement the following COVID-19 survey activities:

  • Perform on-site surveys (within 30 days of this memo) of nursing homes with previous COVID-19 outbreaks, defined as:
    1. Cumulative confirmed cases/bed capacity at 10% or greater; or
    2. Cumulative confirmed plus suspected cases/bed capacity at 20% or greater; or
    3. Ten or more deaths reported due to COVID-19.
  • Perform on-site surveys (within three to five days of identification) of any nursing home with 3 or more new COVID-19 suspected and confirmed cases in the since the last National Healthcare Safety Network (NHSN) COVID-19 report, or 1 confirmed resident case in a facility that was previously COVID-free. State Survey Agencies are encouraged to communicate with their State Healthcare Associated Infection coordinators prior to initiating these surveys.

In order to prepare for the Focused Infection Control surveys all facilities can expect, we encourage you to review the following documents:

  1. COVID-19 Focused Survey Tool
  2. Summary Table of COVID-19 Focused Survey
  3. Entrance Conference Worksheet
  4. COVID-19 Focused Survey Protocol

ADPH offers COVID-19 infection control consultation – April 20, 2020
The Alabama Department of Public Health is working with the Centers for Disease Control and Prevention to help strengthen infection prevention and control practices at long-term care settings in light of the current spread of COVID-19. ADPH is offering telephone infection control consultations to help protect your staff and residents from COVID-19. ADPH knows your time is valuable. The call should take about 30 minutes.Ideally, ADPH wants these three people on the phone:

  1. an infection preventionist or person in charge of infection prevention,
  2. someone from the facility’s administration (e.g., chief medical officer or administrator), and
  3. someone from environmental services if they are available.

Here are useful links:

  1. 5 Key Strategies for Preventing COVID-19 in Long-Term Care Settings
  2. Sample letter for communication with families of residents
  3. Video presentation on the importance of preventing spread of COVID-19 in long-term care facilities
  4. Tele-ICAR tool – this is what ADPH will discuss on the phone

ADPH knows many facilities are having a hard time securing adequate supplies of personal protective equipment (PPE). Some strategies for optimizing the use of PPE may be found here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html. To take part in this service, click here to download a PDF form. Please fill it out and send it to: Melanie Chervony, MPH, Epidemiologist, Infectious Diseases & Outbreaks Division, Alabama Department of Public Health, Office: (334) 206-3914, melanie.chervony@adph.state.al.us.

Resident Laundry Guidance with COVID-19 and When Families Want to Do Residents’ Laundry – March 21, 2020
With the restriction around non-essential visitors to skilled nursing centers and assisted living communities to minimize the risk of spread of COVID-19, there have been many questions on handling residents’ personal laundry, including for those who may have previously had their laundry done by a family member.

The American Health Care Association developed some additional guidance on this. You can also follow CDC guidelines for environmental infection control in healthcare facilities . CDC states that “Infection has not been linked to laundry procedures in residential-care facilities, even when consumer versions of detergents and laundry additives are used.”

NHSN Updates Instructions for Completing the Supplies and Personal Protective Equipment Pathway – August 4, 2020
The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) updated the instructions for completing the NHSN pathway for Supplies and Personal Protective Equipment.

Below is a summary of changes made to the instructions:

  • Section dedicated to selecting the correct facility type for NHSN enrollment
  • Section on conventional capacity for personal protective equipment (PPE) supply
  • Section on utilization of contingency capacity or crisis capacity strategies for PPE supply items
  • Do not include KN95 masks in the N95 mask supply item questions
  • Contingency and crisis level strategies are not considered as having “any” supply, and therefore, “NO” must be selected for each supply item in which contingency or crisis strategies are being used.

You can download the new instructions for the Supplies and Personal Protective Equipment pathway here.

NHSN Updates Instructions for Completing the Supplies and Personal Protective Equipment Pathway – July 21, 2020
The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) updated the instructions for completing the NHSN pathway for Supplies and Personal Protective Equipment.

Below is a summary of changes made to the instructions:

  • Section dedicated to selecting the correct facility type for NHSN enrollment.
  • Section on conventional capacity for personal protective equipment (PPE) supply.
  • Section on utilization of contingency capacity or crisis capacity strategies for PPE supply items.
  • Do not include KN95 masks in the N95 mask supply item questions.
  • Contingency and crisis level strategies are not considered as having “any” supply, and therefore, “NO” must be selected for each supply item in which contingency or crisis strategies are being used.

You can download the new instructions for the Supplies and Personal Protective Equipment pathway here.

Update on NHSN Reporting and Related Citations & Fines – June 15, 2020
We have received more communication from the Centers for Medicare and Medicaid Services (CMS) regarding NHSN reporting. CMS is researching the issues resulting in providers being marked as noncompliant.

CMS reports that there are a few common issues they have discovered so far, including:

  • facilities not entering the right CCN;
  • facilities not selecting the right facility type;
  • facilities entering data after the Sunday deadline, but for the reporting week; and
  • facilities entering data during the week but for previous week’s data.

CMS is seeking the center’s help to get these corrected and straightened out. The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) is looking into some actions that they can take to make it easier for these issues to be identified on the facility side of the platform.

Steps that your center can take now to ensure your data is being uploaded correctly include:

  • Check to make sure that your CCN number is correct.
  • Check to ensure that your facility type is correct.
  • Ensure that you are submitting data prior to 11:59 p.m. each Sunday.
  • Data submitted should be new data since previous submission. Do not enter cumulative data in NHSN.
  • Enter zero (0) if the answer is zero for questions requiring counts. Blank data elements equal missing data. All pathways must be completed.

See the instructions for facility type and CCN.

CMS has stated that they intend to be fair on reviewing IDRs for citations and CMPs issued as part of this regulation as long as providers can show that they did submit the data or have been trying to register or submit the data but had delays in resolving challenges because of CDC’s help line being overwhelmed with requests.

According to the CDC/NHSN, some centers are being identified as “duplicates” because they have registered more than once with the same CCN. Duplicate facilities can lead to problematic scenarios, including:

  • User reporting data for both NHSN facility accounts
  • User intermittently reporting into both NHSN facility accounts during the same time period
  • User reports into one account for a period of time, then switches to the other account for a period of time

Unfortunately, the CDC/NHSN system cannot delete either account due to not knowing which account is the accurate account. CDC/NHSN has provided the following guidance for centers to correct this issue:

Correct the Facility CCN
If you are unsure of your facility’s CCN, please refer to the look-up tool and follow the instructions below:

  1. Using the left navigation pane, select “Basic Search” under “Tool.”
  2. On the next page, enter your facility information and click the “Search” button.
  3. Select your facility on the basic search results report screen to view results and the CCN.
  4. Compare your CCN generated by the look-up tool to the CCN recorded in NHSN. If these differ, please enter the correct CCN for your facility in NHSN. To change the CCN listed in NHSN, please refer to this guidance document.

Remove Multiple Enrollments
A facility should not enroll in NHSN more than once and create more than one NHSN OrgID. Each NHSN Org ID should only have one CCN affiliated with that Org ID. Facilities enrolled more than once and share the same CCN will not have accurate data recorded and submitted to CMS.

Please follow these steps to withdraw any duplicate facilities:

Choose one NHSN facility OrgID to submit data and ensure the CCN is correct.

  1. Merged from any duplicate facilities into the one designated facility from step #1.
  2. Withdraw duplicate facilities from NHSN by doing the following:
    1. Log into the duplicate enrolled facility in NHSN.
    2. On the left navigation pane, select facility->facility info.
    3. Scroll down to the component itemization and deselect the component that is a duplicate.
    4. Accept the alert indicating that you’ve deselected the facility.
    5. Select update to reflect changes.
  3. Add users to the one NHSN facility chosen in step #1, if needed.

Add a NHSN User

  1. Log into SAMS and selecting NHSN reporting.
  2. Go to the left navigation pane and click on Users>ADD.
  3. Complete the required fields marked with an asterisk (*) and click SAVE at the bottom of the page.
  4. Assign user rights and click on SAVE at the bottom of page.
  5. Ensure that you have made all users an “Active User.”

If a newly added user does not have SAMS access, they should receive an email confirmation following this process. The email will also ask the new user to click on the corresponding link to agree to the NHSN Rules of Behavior. Once they agree to the Rules of Behavior, NHSN will automatically submit an invite to the user for SAMS authentication.

Correct Erroneous Data
Centers can correct errors in data by logging into the NHSN system and navigate to the calendar view.

  1. Click on the data that data needs correcting.
  2. Click on the pathway that needs correcting.
  3. Correct the erroneous data.
  4. Click SAVE

NHSN Help Desk contact info: nhsn@cdc.gov
SAMS Help Desk contact info: SAMSHelp@cdc.gov or (877) 681-2901
CMS Help Desk contact info: NH_COVID_Data@cms.hhs.gov

Correcting NHSN Data Errors – June 8, 2020
As you are aware, the Centers for Medicare and Medicaid Services (CMS) publicly released individual facility data related to COVID-19 on Nursing Home Compare. Some centers who reviewed their data, have found errors in the data as it appears on Nursing Home Compare. Centers are encouraged to check Nursing Home Compare for data accuracy. Nursing homes are required to report data to the National Healthcare Safety Network (NHSN). The data is then submitted from NHSN to CMS for upload into Nursing Home Compare.

Centers who review Nursing Home Compare and identify issues to their data may make corrections to data entered into the NHSN system by:

NHSN submits data to CMS every Monday morning. When CMS receives the data, the center’s revisions will be reflected with the next update of the CMS Nursing Home Compare webpage. The change will not be immediate due to the delayed upload to Nursing Home Compare.

NHSN Efforts and Supportive Documentation – June 8, 2020
The grace period for National Healthcare Safety Network (NHSN) reporting has officially ended and CMS will automatically issue civil monetary penalties (CMPs) if facilities fail to report by the June 7, 2020 deadline. Nursing homes are required to report COVID-19 related information to NHSN at least weekly. Centers who fail to report to NHSN will be issued per day CMPs by CMS and amounts will increase if nursing homes fail to report in subsequent weeks. Read More

CMS Announcement on NHSN Data and Guidance on COVID-19-Related Survey Activity – June 2, 2020
The Centers for Medicare and Medicaid Services (CMS) has released a memorandum (QSO-20-31-ALL) addressing NHSN data, COVID-19 survey activities, enhanced enforcement, and engagement of Quality Improvement Organizations (QIOs). This guidance is effective immediately and will cease to be in effect when the Secretary determines there is no longer a Public Health Emergency due to COVID-19. At that time, CMS will send public notice that this guidance has ceased to be effective via its website.

NHSN Data Initial Release: CMS released a state-by-state report on COVID-19 cases for residents and staff along with numbers of infection control focused surveys completed. CMS will post the underlying CDC-collected data on a link on Nursing Home Compare later this week. The data will be broken down by state, number of residents and number of staff. The data will be searchable by facility name and will be downloadable so researchers and other stakeholders can perform their own in-depth analysis. CMS will update the data weekly. Ensure systems and processes are in place to report at least weekly to NHSN per CMS requirements. If you have difficulty reporting or accessing NHSN, keep documentation of all efforts made to be in compliance.

Focused Infection Control Nursing Home Surveys and CARES Act Supplemental Funding
Based on the COVID-19 nursing home data being reported to the CDC, CMS believes further direction is needed to prioritize completion of focused infection control surveys in nursing homes.

  • States that have not completed focused infection control surveys in 100% of their state’s nursing homes by July 31, 2020, will be required to submit a corrective action plan to their CMS location outlining the strategy for completion of these surveys within 30 days.
  • If, after the 30-day period, states have still not conducted surveys in 100% of their nursing homes, their CARES Act FY2021 allocation may be reduced by up to 10%.
  • Subsequent 30-day extensions could result in an additional reduction up to 5%. These funds would then be redistributed to those states that completed 100% of their focused infection control surveys by July 31.
  • Access to FY 2020 CARES Act allocations will be impacted by state performance on completing the nursing home infection control focused surveys.

COVID-19 Survey Activities
CMS is also requiring states to implement the following COVID-19 survey activities. States that fail to perform these survey activities timely and completely could forfeit up to 5% of their CARES Act Allocation, annually.

  1. Perform on-site surveys (within 30 days of this memo) of nursing homes with previous COVID-19 outbreaks, defined as:
    • Cumulative confirmed cases/bed capacity at 10% or greater; or
    • Cumulative confirmed plus suspected cases/bed capacity at 20% or greater; or
    • Ten or more deaths reported
  2. Perform on-site surveys (within three to five days of identification) of any nursing home with 3 or more new COVID-19 suspected and confirmed cases in the since the last NHSN COVID-19 report, or 1 confirmed resident case in a facility that was previously COVID-free.
    • State survey agencies are encouraged to communicate with their state health care associated infection coordinators prior to initiating these surveys.
  3. Starting in 2021, perform annual focused infection control surveys of 20 percent of nursing homes based on state discretion or additional data that identifies facility and community risks.

Enhanced Enforcement for Infection Control Deficiencies
CMS is expanding enforcement for infection control deficiencies. Specifically, CMS announced it will impose remedies for infection control deficiencies based on the scope and severity of the current deficiency as well as findings of prior infection control deficiencies. For all infection control deficiencies at a scope and severity of D or above, CMS will impose a directed plan of correction that will include the use of root cause analysis.

The use of remedies will increase as the scope and severity of the survey findings increase and based on the scope and severity of prior infection control deficiencies and will include discretionary denials of payment for new admissions (DPNA) and per instance civil money penalties (CMPs). Nursing homes cited for noncompliance with infection control regulations at the immediate jeopardy level will face mandatory statutory remedies as well as a discretionary DPNA with 15 days to demonstrate compliance and the highest CMP amount as indicated in the CMP analytic tool.

For further details, review the memo. Use the self-assessment tool (.zip) provided by CMS to evaluate your infection prevention & control program in advance of focused infection control surveys.

Support from Quality Improvement Organizations (QIOs)
CMS states that nursing homes can take advantage of weekly National Infection Control Training that focuses on infection control, prevention and management to help prevent the transmission of COVID-19. The memo adds that QIOs are being deployed to provide technical assistance to nursing homes, which includes a targeted focus on nursing homes with a history of infection control challenges. Additionally, States may request QIO technical assistance for a specific nursing home(s) that have experienced an outbreak.

NHSN Update and FAQs – May 27, 2020
Nursing facilities were required to submit their first set of data to NHSN by 11:59 pm on May 17, 2020 to be compliant with the new requirements. Facilities may choose to report more frequently, but at minimum must report at least once every seven days. The initial two-week grace period ends at 11:59 pm on May 24, 2020. Facilities that fail to begin reporting after the third week, ending at 11:59 pm on May 31, will receive a warning letter reminding them to begin reporting the required information to CDC/NHSN. Facilities who have not started reporting in the NHSN system by 11:59 pm on June 7th, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for one day for the failure to report that week. Each subsequent week that the facility fails to report will result in an additional one-day PD CMP imposed at an amount increased by $500.

NHSN updated the instructions for the pathway forms on May 12. When completing the data collection and upload, be sure that you are using the most current instructions. You can find the new instructions on the NHSN website. During one of the NHSN data reporting webinars, the NHSN team identified that each item question must have an answer entered or it will be counted as missing data and it will be counted as not being reported. When you enter count data, even if the answer is nothing or zero, you must enter 0 in the data field. If you leave it empty, it will be flagged as “no answer.”

According to the CDC, “to maintain consistency in reporting, if a facility is using crisis level strategies” the facility is experiencing a shortage. “In other words, PPE strategies that do not commensurate with U.S. standards of care are considered as a shortage. For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), we encourage facilities to refer to Optimize PPE Supply website.

A center can easily identify if they are missing data in the NSHN module by reviewing the calendar view page. Any pathway that is incomplete will be highlighted as a tan color. Pathways highlighted as green indicated all questions were answered. Missing pathway means the pathway has not been started. As of right now, NHSN does not send notices for incomplete data. Centers are encouraged to review the calendar view to ensure all four pathways are highlighted in green to ensure compliance with reporting to NHSN.

Centers are continuing to report a delay in being able to register and upload data to NHSN. There are also centers who are reporting significant delays in having their questions answered via NHSN help desk. Centers who are experiencing delays are encouraged to keep documentation of all attempts of contacting NHSN and any communications you have with them.

Some centers are reporting that they are not receiving the Agreement to Participate and Consent email. If this is happening to your center and you do not receive the Agreement to Participate and Consent in your inbox for whatever reason, you should follow these instructions:

  • Log-in to SAMS.
  • Select Long-term Care Facility Component and your facility/group name.
  • Click “Submit” to review the “Agreement to Participate and Consent”.
  • Click ‘Accept’ next to the appropriate contact name.
  • Click “Submit”. A pop-up notification will appear confirming this action.
  • Click “ok” to acknowledge the notification.
  • If you log in to SAMS and see the “Annual Survey” alert on your facility homepage, you should follow these steps to remove the alert:
  • On the facility homepage, click “Survey Required 2020” alert on the facility homepage to be directed to the online survey
  • Complete the “Facility Characteristics” section and scroll to the bottom to click “save” to submit your survey.
  • CDC Posts NHSN Training Recording and Offers Webinar for Groups

The COVID-19 Module Overview for Long-term Care Facilities recorded video presentation and slides are now available on the COVID-19 LTCF Module webpage, as well as COVID-19 Module Enrollment Guidance for LTCF under Training.

Reporting Accurately to NHSN COVID-19 – May 15, 2020
The American Health Care Association previously provided guidelines on accurately reporting staffing and PPE shortages to NHSN COVID-19 LTC module. As stated in the update, it is important the data reported to NHSN gives an accurate picture as this data will be used by state, federal governments and other stakeholders. The AHCA  received questions about the staffing guidance and have revised as shown below based on review of the latest CDC instruction for NHSN reporting.

NHSN asks, “Does your organization have a shortage of staff and/or personnel?” Any of the following situations support a YES response:

  • Staffing less than your facility needs or internal policies for staffing ratios (despite efforts made by the facility to secure staff)
  • Employing crisis strategies for staffing shortage
  • Using any temporary positions per waiver allowances (such as temporary nurse aide or temporary feeding assistant) or agency staff, yet staffing ratios for facility needs and internal policies are still not met

As a reminder, keep documentation of efforts to secure more PPE as well as staffing. Report to your local and state health departments if employing contingency and crisis strategies to conserve PPE and staffing.

NHSH resources for nursing homes – May 14, 2020
From the Alabama Department of Public Health: As we get closer to the official NHSN COVD-19 report date (May 17), we (ADPH) wanted to share the following resources with you regarding facility enrollment, data collection and data entry into the NHSN system. If you have any questions, please contact Melanie Chervony, HAI Coordinator at Melanie.Chervony@adph.state.al.us.

In addition, please send the contact information for your primary NHSN user to HAI@adph.state.al.us.

  • Please include the following elements:
  • NHSN Org ID:
  • Facility Name:
  • NHSN Facility Contact:
  • Title:
  • Phone Number:
  • Email address:

NHSN COVID-19 LTC Module Resources


NHSN COVID-19 Reporting: Accurately Reporting Staffing & PPE Shortages 
– May 12, 2020
NHSN COVID-19 mandated reporting for nursing homes has begun. The American Health Care Association recommends accurately reporting the staffing and PPE situation at nursing homes based on normal standards and guidance for PPE and staffing, not conservation guidance. Federal and state governments will use this data to hold nursing homes accountable for care and services provided and to identify who needs additional resources. It is important that the data reported to NHSN gives an accurate picture of staffing and PPE as well as the other areas collected in NHSN. Given the instructions on NHSN, reporting that you have what you need, tells CMS that you have enough PPE and staff to follow conventional and normal practices, which will likely be used by surveyors when comparing what they find during their surveys. Please use the below guidelines.

Staffing: NHSN asks “Does your organization have a shortage of staff and/or personnel?” Answer YES if any of the following are occurring during the time period of reporting:

  • Staffing less than your facility needs or internal policies for staffing ratios prior to COVID or based on increased needs since COVID
  • Employing contingency or crisis strategies for staffing shortage
  • Using more agency staff than you used before the pandemic
  • Using volunteers for staffing needs more than what you may have used prior to the pandemic
  • Using any temporary positions per waiver allowances (such as temporary nurse aide or temporary feeding assistant)

PPE: NHSN asks “Do you have enough for one week?” each for N95 masks, surgical masks, eye protection, gowns, gloves, alcohol-based hand sanitizer. Answer NO if any of the following are occurring during the time period of reporting:

  • Employing any conservation strategies for PPE use; if you are not able to use PPE per conventional transmission-based precautions in place before the pandemic you should answer NO
  • Using alternative PPE such as cloth masks or other types of face coverings, clothing or other types of coverings instead of surgical gowns, or glasses for eye protection
  • Reusing any single use supply item such as gown or masks
  • If additional residents in the next week will need to be placed on precautions, it will compromise your PPE supply
  • If additional staff in the next week will need to use PPE when returning to work, it will compromise your PPE supply
  • If visitors or contractors in the next week need to visit, it will compromise your PPE supply

As a reminder, nursing homes should keep documentation of their efforts to secure more PPE as well as staffing. You should report to your local and state health departments that you are employing contingency and crisis strategies to conserve PPE and staffing.

NHSN Enrollment Delays & Tips – May 11, 2020
It is taking longer than anticipated for nursing homes to enroll in CDC’s National Healthcare Safety Network (NHSN) due to high demand from the new CMS reporting requirements. The NHSN have recruited additional staff to reduce the processing time of enrollment requests. Access detailed registration instructions for new facilities. Facilities are encouraged to review the Enrollment Guidance document for a more in-depth explanation of the enrollment process. Nursing homes should keep documentation of efforts made to enroll in NHSN.

IMPORTANT NOTE: For the best experience and quicker access to the system, please be sure you are replying to a registration/enrollment email. Emailing the NHSN user support help desk will result in longer wait times for a reply.

Additionally, NHSN is providing two live Zoom sessions to address enrollment specific questions. After registering, you will receive a confirmation email containing information about joining the meeting.

LTCFs COVID-19 Live Q&A Session for Module and Enrollment Specific Questions 
Tuesday, May 12, 2020, 12:00 p.m. CT
Register

Thursday, May 14, 2020, 1:00 p.m. CT
Register

Still Waiting for NHSN to Complete Your Registration? Start Data Collection Now – May 6, 2020
Is your nursing center still waiting access to the National Healthcare Safety Network (NHSN) COVID-19 reporting module? There is a lag time between initiating registration to NHSN and completion of the registration process due to the number of long-term care facilities that are trying to gain access. NHSN is reporting a 24-48 hour, and in some instances longer, lag time between initial registration to actual completion of registration and the ability to use the COVID-19 reporting module.

While waiting for the registration process to complete, you should download now the four data collection pathway forms and accompanying instructions to start collecting the data that you will be uploading to NHSN once registration process is complete. It is extremely important to download, and refer to, the instructions page for each of the four data collection pathways. Refer to the definitions of each term prior to completing the data collection form.

The four data collection pathway forms are:

New Reporting Requirements for Nursing Homes Effective May 1 – May 4, 2020
The Centers for Medicare and Medicaid (CMS) release of an interim final rule with comment period which revises § 483.80, establishing explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this interim final rule, which is the date of the publication at the Office of the Federal Register. CMS stated that the new requirements for nursing homes in this rule was effective as of May 1.  CMS’s intention is that the first of the weekly reporting’s to CDC in the NHSN COVID-19 module are submitted by May 8. We are advocating that there be a grace period for enforcement of this rule given the lack of clarity on the notifications to residents, their representatives and families, as well as the technical complexities and quantity of information that must be submitted to CDC for NHSN COVID-19 reporting.

The American Health Care Association (AHCA) is developing resources to help members with these new requirements, including a template communication for notifications to residents, their representatives and families. AHCA is also working with CDC NHSN team to get resources to members on using NHSN. See article below for further developments on that front.

More Materials Available from CDC NHSN on New COVID-19 Module for Nursing Homes – May 4, 2020
CDC NHSN has released more materials for nursing homes to prepare for this new reporting requirement, including a guide to using the COVID-19 module. Visit the CDC website to sign up for updates. There are two upcoming webinar trainings for the new LTCF COVID-19 Module. The training webinars will be recorded and posted to the LTCF COVID-19 Module webpage with a PDF of the slide presentation.

COVID-19 Module for Long-term Care Facilities Enrollment Guidance 
Monday, May 4, 2020
1:00 – 2:30 PM

COVID-19 Module Overview for Long-term Care Facilities 
Tuesday May 5, 2020
2:00 – 3:30 PM

Learn how to join these webinars on the CDC NHSN website. If you have any questions, please email CDC at NHSN@cdc.gov and include LTCF COVID-19 in the subject line.

CMS Issues Interim Final Rule with New Requirements for COVID-19 Reporting for Nursing Homes – May 1, 2020
The Centers for Medicare and Medicaid Services late Thursday night issued an interim final rule with comment period which revises § 483.80 establishing explicit reporting requirements for long-term care facilities (LTCF) to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this interim final rule which is the date of the publication at the Office of the Federal Register. The American Health Care Association (AHCA) will notify members when it is published.

Under this new requirement nursing facilities must:
Electronically Report to CDC’s National Healthcare Safety Network (NHSN)

  • Electronically report information about COVID-19 in a standardized format specified by the Secretary, which will rely on CDC NHSN portal that went live on Wednesday, April 29 with the new LTCF COVID-19 module. This report to CDC must include but is not limited to:
    • Suspected and confirmed COVID-19 infections among residents and staff, including residents previously treated for COVID-19;
    • Total deaths and COVID-19 deaths among residents and staff;
    • Personal protective equipment and hand hygiene supplies in the facility;
    • Ventilator capacity and supplies in the facility;
    • Resident beds and census;
    • Access to COVID-19 testing while the resident is in the facility;
    • Staffing shortages; and
    • Other information specified by the Secretary.
  • Provide the information specified in the list above at a frequency specified by the Secretary, but no less than weekly to NHSN.
  • This information will be posted publicly by CMS to support protecting the health and safety of residents, personnel, and the general public.

In addition, providers must continue to comply with state and local reporting requirements for COVID-19.

Inform Residents, their Representatives, and Families 

  • Inform residents, their representatives, and families of those residing in facilities by 5 p.m. the next calendar day following the occurrence of:
    • Either a single confirmed infection of COVID-19, or
    • Three or more residents or staff with new onset of respiratory symptoms occurring within 72 hours of each other.
  • This information must:
    • Not include personally identifiable information;
    • Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered; and
    • Include any cumulative updates for residents, their representatives, and families at least weekly or by 5 p.m. the next calendar day following the subsequent occurrence of either:
      • Each time a confirmed infection of COVID-19 is identified, or
      • Whenever three or more residents or staff with new onset of respiratory symptoms occur within 72 hours of each other.
    • The preamble to the rule states that facilities are not expected to make individual calls. Providers may use general communication platforms easily available to residents, representatives and families such as listservs, website postings, and recorded telephone messages.

The AHCA will continue to advocate for CMS to issue clarifying language that makes this feasible and as least burdensome as possible.

Long-Term Care Facility COVID-19 Module
The Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) continues to support the nation’s COVID-19 response with the new Long-Term Care Facility COVID-19 Module in NHSN’s Long-Term Care Facility (LTCF) Component. LTCFs eligible to report into the new COVID-19 Module include skilled nursing facilities/nursing homes, long-term care for the developmentally disabled, and assisted living facilities. Furthermore, NHSN group users (for example, health departments, corporate entities) can bulk upload COVID-19 data to NHSN on behalf of member facilities in their NHSN groups.

The new Long-Term Care Facility COVID-19 Module enables LTCFs to report COVID-19 data elements:

  1. Counts of residents and facility personnel with suspected and laboratory positive COVID-19.
  2. Counts of suspected and laboratory positive COVID-19 related deaths among residents and facility personnel.
  3. Staffing shortages.
  4. Status of personal protective equipment (PPE) supplies such as ventilator supplies, N95 masks, and gloves.
  5. Ventilator capacity and supplies for facilities with ventilator dependent units.

LTCF data submission options include manual entry, CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities. NHSN, in turn, will use the existing Group function to make COVID-19 data accessible to state and local health departments for LTCFs in their jurisdictions. Based on recent guidance from the Centers for Medicare and Medicaid Services (CMS), NHSN will also provide COVID-19 data reported by nursing homes to CMS. Please see recent guidance from CMS here.

Facility-level data collected through NSHN as part of the COVID-19 Module are being made available to a broader set of Federal, state, and local agency data users than data typically collected by NHSN. Specifically, COVID-19 data at the state, county, territory, and facility level submitted to NHSN will continue to be used for public health emergency response activities conducted by CDC’s Emergency Operations Center, the White House Coronavirus Task Force, and by the Office of the Assistant Secretary of Preparedness and Response as part of the National Response Coordination Center at the Federal Emergency Management Agency (FEMA), which maintains data in the U.S. Department of Health and Human Services’ (HHS’) COVID-19 tracking system.

NHSN’s new LTCF COVID-19 Module underscores the imperative for LTCFs to continue to report COVID-19 data to state and local health departments in accordance with requirements and reporting mechanisms currently in use. Data submission to the NHSN COVID-19 Module does not replace state and local public health reporting requirements. If NHSN’s COVID-19 data overlaps with a state or local health departments’ requirements, the data aggregated by NHSN can add value to current reporting by providing national level data. In some public health jurisdictions, the data that LTCFs report to the new Module may supplement the data that the LTCFs already report to public health.

Please visit https://www.cdc.gov/nhsn/ltc/covid19/index.html for more information and for upcoming trainings.

CDC Webinars on COVID-19 Reporting
The presentation slides for the Thursday, April 30 CDC webinar will be available on the CDC COVID-19 LTCF website: https://www.cdc.gov/nhsn/ltc/covid19/index.html in a few days. The video recording will be available later. The CDC will repeat the April 30 and May 1 presentations Monday, May 4 at 1:00 p.m. and & Tuesday, May 5 at 2:00 p.m. The ANHA will provide details when it receives them.

Supporting Your Loved One in a Long Term Care Facility – June 2, 2020
The CDC released a fact sheet on Supporting Loved Ones in a Long-Term Care Facility providers can share with residents’ families. The fact sheet includes ideas on how to keep in touch and ways providers are supporting communication between residents and their families. Read More

CMS Issues Nursing Home Reopening Recommendations for State and Local Officials – May 19, 2020
The Centers for Medicare and Medicaid Services (CMS) provided recommendations on a nursing home phased reopening for states. The recommendations cover the following items:

  • Recommendations for testing residents and staff
  • Dedicated space for cohorting residents with COVID-19
  • Criteria for relaxing certain restrictions and mitigating the risk of resurgence
  • Visitation and service considerations
  • Restoration of survey activities

The guidance encourages state leaders to collaborate with the state survey agency and local health departments to decide how these criteria should be implemented. Given the critical importance in limiting COVID-19 exposure in nursing homes, CMS recommends that decisions on relaxing restrictions be made with careful review of the following facility-level, community, and state factors:

  • Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (e.g., face coverings)
  • Status of COVID-19 cases in the local community
  • Status of COVID-19 cases in nursing homes
  • Adequate staffing
  • Access to adequate personal protective equipment (PPE)
  • Local hospital capacity

Read the press releaseguidance and FAQs from CMS.

Recommendations for When a Resident Wants to Leave the Building – April 15, 2020
The American Health Care Association (AHCA) has developed recommendations to help you address when a resident wants to leave the building to go into the surround community and then return. This could introduce COVID-19 into the building and endanger others. AHCA’s recommendations include communicating with the resident and family, requiring isolation and contacting the ombudsman and the local health department.

Alabama Department of Public Health – March 19 and as amended March 20, 2020
ADPH prohibits all visitors and non-essential health care personnel, except for certain compassionate care situations. Read the order here.

Alabama Nursing Home Association statement on visitation – March 14, 2020
The ANHA issued a statewide media statement on restricts on nursing home visitation. You can read it here.

CMS Guidance for Visitation – March 13, 2020
The Centers for Medicare and Medicaid Services issued revised visitation guidance for nursing homes. The memo, QSU-20-14-NH (March 13, 2020), updates memos that were issued March 4 and March 9. You can read the memo here.

Economic Impact Payments (Stimulus Checks) FAQs – June 26, 2020
The Alabama Nursing Home Association worked with the Alabama Medicaid Agency, the State Ombudsman and the Medicaid Fraud Control Unit of the Alabama Attorney General’s Office to answer frequently asked questions regarding the Economic Impact Payments (EIPs) or stimulus funds residents have received. In addition, the ANHA developed a form that facilities can use to document the use of EIP funds. Click here to read the FAQs. Click here to download the form.

Economic Impact Payment Guidance – Stimulus Money – June 10, 2020
Skilled nursing facility (SNF) and assisted living (AL) residents were eligible for Economic Impact Payments (EIPs). EIPs are one-time payments of $1,200. The Internal Revenue Service (IRS) began issuing electronic EIPs on or about April 15 to people who received a tax refund electronically, and to the same account as the tax refund. If people did not get an electronic refund or no refund, the IRS sent the payment by mail. Important questions have been raised about SNF and AL resident checks and management of these dollars. Below are FAQs and guidance:

Does the EIP payment impact Medicaid eligibility immediately?
No. Under Medicaid rules, a stimulus payment is not counted as income. Therefore, receiving a stimulus payment does not change a resident’s monthly payment (often called a “patient pay amount” or “share of cost”). The resident pays the same monthly amount to the nursing facility and keeps the stimulus payment for their own use. In addition, the stimulus payment does not count as a Medicaid resource for 12 months. In other words, for the first year, the payment cannot cause you to have “too much” savings. After 12 months, EIP could push a resident over asset limits and result in the need to spend down to Medicaid asset limits. Medicaid asset limits are state specific.

Can Social Security benefit representative payees manage the EIP dollars?
No. Under the Social Security Act, a representative payee is only responsible for managing Social Security or SSI benefits. An EIP is not such a benefit. A representative payee should discuss the EIP with the beneficiary. If the beneficiary wants to use the EIP independently, the representative payee should provide the EIP to the beneficiary. If the beneficiary asks the representative payee for assistance in using the EIP in a specific manner or saving it, the representative payee can provide that assistance outside the role of a representative payee.

What if a beneficiary alleges a representative payee misused the economic impact payment (EIP)?
Because an EIP is not a Social Security or SSI benefit, SSA does not have authority to investigate or determine whether the EIP has been misused. However, if SSA receives an allegation that the EIP was not used on behalf of the beneficiary, SSA may decide to investigate for possible misuse of the beneficiary’s Social Security or SSI benefit payments. SSA may also determine the representative payee is no longer suitable and appoint a new representative payee.

Are SNFs and ALs allowed to use EIPs dollars to pay resident bills?
The EIP dollars belong to the recipient and are at his/her discretion for use. Providers may not access these funds without the permission of a resident who is legally competent or, in the case of someone with a cognitive impairment, the permission of a court appointed guardian or other individual with power of attorney.

Are there other considerations for EIP and SNF and AL residents?
Yes. If the resident or legal representative uses the funds to cover any sort of resident expenses, evidence must document there was no coercion on the part of a family member, provider or other.

What should a resident do if she/he feels their EIP dollars have been misused?
A resident, family member or legal guardian can contact the Elder Care Locator network at 1-800-677-1116 for more information about local legal aid offices and your state’s Protection and Advocacy System and State and Local Long-Term Care Ombudsman Offices.

Advisory from the Alabama Attorney General’s Office on Nursing Home Resident Stimulus Funds – May 26, 2020
On May 15, 2020, the Federal Trade Commission issued guidance to consumers concerning CARES Act economic stimulus payments to Medicaid recipients who reside in nursing homes. Pursuant to the provisions of the CARES Act, those payments are tax credits and, as such, do not count as resources for federal benefits programs including Medicaid. Accordingly, facilities in which these residents reside are not entitled to summarily keep the stimulus payment. The Federal Trade Commission brought the issue to the attention of the US Department of Justice and the National Association of Medicaid Fraud Control Units. The Alabama Attorney General’s Medicaid Fraud Control Unit has received calls from sponsors of nursing home residents whose stimulus payments have been retained by the facility. Attorney General Marshall asks that Alabama nursing homes remain vigilant in abiding by the law governing the handling of these stimulus payments.

Economic Impact Payments for Social Security and SSI Beneficiaries with Representative Payees – May 19, 2020
The Social Security Administration recently issued an update that beneficiaries who have their regular monthly payments managed for them by another person, called a representative payee, will begin receiving their economic impact payments (EIPs) from the IRS in late May.

It is important to note that under Medicaid rules, a stimulus payment is not counted as income. Therefore, receiving a stimulus payment does not change a resident’s monthly payment (often called a ‘patient pay amount’ or ‘share of cost’). The resident pays the same monthly amount to the nursing facility and keeps the stimulus payment for their own use. In addition, the stimulus payment does not count as a Medicaid resource for 12 months. In other words, for the first year, the payment cannot cause you to have ‘too much’ savings.

More details on these payments can be found in this SSA press release. You may also find information about the eligibility requirements and other information about the Economic Impact Payments here. In addition, please continue to visit the IRS at www.irs.gov/coronavirus for the latest information. Social Security will continue to update the agency’s COVID-19 web page with additional information.

COVID-19 Personal Incentive Checks (Stimulus) – April 22, 2020
A number of questions have come up related to COVID-19 Personal Incentive. Listed below are a couple of summary statements as well as some lengthier explanations:

  1. Medicaid eligibility is protected;
  2. Medicare coverage is protected, and coinsurance begins as it did before COVID-19;
  3. $1,200 will be deposited as their current benefit checks are deposited and managed; and
  4. Pre-COVID-19 SNF and NF patient and resident income and asset management protections remain in place for the $1,200.
Detailed Discussion & Resources
  • Medicaid Treatment of Relief Payments in CARES Act. CMS has clarified that the relief payments people receive from the CARES Act may not be counted as income when making Medicaid and CHIP eligibility determinations. In addition, these payments may not be counted as resources for 12 months. See Question 54 in the Medicaid FAQ here.
Question 54 Text:  Is the relief payment to individuals and families provided by section 2201 of the CARES Act countable for Medicaid and CHIP eligibility? No. Section 2201 of the CARES Act allows a refundable tax credit for 2020 to eligible individuals. It also directs the Internal Revenue Service to provide payments in 2020 as an advance refund of the credit to eligible individuals, called “Recovery Rebates.” The payments are not taxable income and are therefore not countable in MAGI-based eligibility determinations. Separately, 26 U.S.C. § 6409 prohibits the counting of federal tax rebates or advance payments with respect to refundable tax credits as income, and, for 12 months following receipt, resources, in the eligibility determination of any federal needs-based program (such as Medicaid). Thus, the Recovery Rebates may not be counted as income, and, for 12 months, as resources, in non-MAGI financial eligibility determinations.
  • Personal Incentive Check Distribution to SSA Beneficiaries (virtually ALL SNF patients are Medicare beneficiaries and therefore are receiving SSDI or OASDI and most long-stay residents are receiving SSI and are therefore Medicaid eligible):  For Social Security retirement, survivors, or disability beneficiaries (this includes OASDI (old age retirement), SSDI (disabled workers), SSI (elders and persons with disabilities with very low incomes) who do not have qualifying children under age 17, do not need to take any action with SSA or the IRS.  Treasury will automatically deposit the $1,200 economic impact payment directly from the IRS as long as into the bank account on record as a long as an SSA-1099 for 2019 was filed.  If not, the beneficiary simply goes to a form at the IRS webpage to provide the information. Click here for SSA guidance.
  • Implications for SNF Patients and NF Residents: 
    • This means that the $1,200 do not impact Medicaid eligibility and will help Medicare PAC Patients – no one switches over to private pay nor is required to private pay for whatever period would have taken to burn through the $1,200 and spend down to Medicaid eligibility.  For Medicare beneficiaries, because their coinsurance and deductibles are not changed, their coinsurance simply would begin for SNF Medicare PAC on day 21 as it did prior to COVID.  If anything, this will help folks cover their coinsurance payments.  So SNFs and NFs DO NOT receive any extra private pay associated with the checks.
  • Because these checks are being deposited largely using the same process as OASDI, SSDI and SSI checks, the checks will go to the beneficiaries’ bank accounts or Legal Representative managed bank accounts. SNFs and NFs will have NO NEW access to these funds. The existing SNF and NF protections for be COVID remain in place.  
  • CMS Beneficiary Statement: “You have the right to manage your own money or choose someone you trust to do this for you. If you ask the SNF to manage your personal funds, you must sign a written statement that allows the SNF to do this for you. However, the SNF must allow you access to your bank accounts, cash, and other financial records. The SNF must place your money (over $50) in an account that provides interest, and they must give you quarterly statements. The SNF must protect your funds from any loss by buying a bond or providing other similar protections.” Click here to view the full CMS beneficiary protections webpage.

UPDATED CDC Testing Guidelines for Nursing Homes – June 26, 2020
This guidance has been updated to reflect the following:

Reorganized recommendations to address:

  • Viral testing of healthcare personnel
  • Viral testing of residents
  • Viral testing in response to an outbreak

Added the following recommendations:

  • Testing the same individual more than once in a 24-hour period is not recommended.
  • Clinicians are encouraged to consider testing symptomatic residents for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2.

To learn more, please visit: Testing Guidelines for Nursing Homes.

AIMS Nursing Home Supply Request Reporting Form – June 26, 2020
There is a new process for nursing homes to request PPE and supplies. The following information is provided regarding the new process:

Process for Nursing Homes to request PPE/supplies:

  • Beginning Monday, June 29, Nursing Home AIMS users will have access to a new report form to request PPE and other supplies as needed, via the “Nursing Home Supply Request” reporting form.
  • The AIMS Supply Request form should be completed when a facility has a need that cannot be filled through their normal supply chains.
  • Requests will be filled by ADPH as the supplies are available. There is no guarantee the resources requested will be available or filled.
  • Nursing homes who do not have an AIMS account may contact their District AIMS Coordinator (click here for a map and contact info) to request an account; if the NH is not a member of the District HCC, they may request membership information.

How to Access the AIMS Nursing Home Supply Request reporting form:

  • Login into AIMS (aimslive.org)
  • Click on the Status tab
  • Click on the Reporting Forms, the page defaults to the Supply Request form

How to Complete the AIMS Nursing Home Supply Request reporting form:

  • Complete form as supplies are needed
  • Complete each field on the survey
  • Select the SAVE button
  • Requests will be filled by ADPH as supplies are available
  • A record of all Form Submissionsis viewable to the facility at the bottom of the report form
  • Nursing Homes who complete the Supply Request, do not need to create a message and notificationin AIMS, simply submit the form
  • In the event of an urgent, critical need, a Nursing Home should contact their Healthcare Coalition for assistance.
  • When possible, ADPH will notify the HCC Coordinators/EP Directors when supplies are being shipped to their District Nursing Homes.

If you have any questions or need assistance with AIMS, please contact your HCC AIMS Coordinator and/or the University of South Alabama’s Center for Domestic Health Preparedness.

FDA Removes Many Respirators Manufactured in China from Approved List for Decontamination – June 10, 2020
In a recent press release, the FDA announced that it has modified its guidance related to the decontamination of many respirators manufactured in China.

“In response to public health and safety concerns about the appropriateness of decontaminating certain respirators, the agency is reissuing certain emergency use authorizations (EUAs) to specify which respirators are appropriate for decontamination. Based on the FDA’s increased understanding of the performance and design of these respirators, the FDA has decided that certain respirators should not be decontaminated for reuse by health care personnel.”

“For example, the FDA has learned from the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) testing that authorized respirators manufactured in China may vary in their design and performance. As such, the FDA has determined that the available information does not support the decontamination of these respirators and has accordingly revised the relevant EUAs. In addition, the FDA is also revising relevant EUAs to no longer authorize decontamination or reuse of respirators that have exhalation valve”

The list of respirator models that no longer have Emergency Use Authorization for decontamination can be found here.

Updated CDC Testing Guidance for Nursing Homes – May 27, 2020
The guidance has been updated to include the following:

Performing Facility-wide COVID-19 (SARS-CoV-2) Testing in Nursing Homes – May 27, 2020
This document describes considerations for performing facility-wide testing among nursing home residents and HCP. Facility-wide testing involves testing all residents and HCP for detection of SARS-CoV-2, the virus that causes COVID-19, and can be used to inform infection prevention and control (IPC) practices in nursing homes. This document is intended for health departments and nursing homes conducting viral testing for current infection, such as reverse-transcriptase polymerase chain reaction (RT-PCR). To learn more, please visit: Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes.

Alabama nursing homes submit PPE needs in AIMS – May 12, 2020
In order to ensure your PPE needs are known to the Alabama Department of Public Health (ADPH), you must enter your PPE needs into the Alabama Incident Management System (AIMS) system regardless of what you enter into the NHSN System! The health care facilities who enter their PPE needs into the AIMS system receive priority as PPE is distributed throughout the state. If you have an immediate need, contact your local EMA to inquire if it has any supplies. Currently, the ADPH has distributed all the PPE from its warehouse. More shipments have arrived, but must be tested in ensure these vital items are not faulty.

If you have not already done so, log-in and activate your facility’s AIMS account. AIMS is operated by the ADPH and the University of South Alabama to coordinate health care services and needs during declared emergencies and disasters. Each nursing home has an AIMS account. If you don’t know your facility’s account information, contact the AIMS Coordinator at your local Healthcare Coalition (HCC). Click here for a list of the local AIMS Coordinators.

PPE Supplier List – May 11, 2020
Knowing whether a Personal Protective Equipment (PPE) supplier is reliable is challenging these days with all the pop-up PPE suppliers and PPE scams. To assist members, AHCA/NCAL has developed a list of PPE suppliers that have recently served long term care providers . The list is not an endorsement or seal of approval of any particular PPE supplier, but can be used as a resource when PPE is not available through their ordinary supply chains. Members should keep in mind that PPE demand currently far exceeds PPE supply. Suppliers are facing unprecedented challenges obtaining PPE, so the suppliers on this list may not have PPE at the time they are contacted. These PPE suppliers are doing their best to fill orders as PPE shipments arrive or their PPE is manufactured. If a supplier is out of stock, ask when to check back. This list will be updated as more PPE suppliers are identified that have successfully delivered PPE supplies to American Health Care Association members during the pandemic.

Webinar on PPE Use – May 11, 2020
The National Emerging Special Pathogens Training and Education Center (NETEC) is hosting a town hall forum to answer frequently asked questions surrounding the use of Personal Protective Equipment in the care of COVID-19 patients. See how to register online below.

NETEC Webinar: PPE! You’ve Got Questions. We’ve Got Answers.
Wednesday, May 13, 2020, 11:00 a.m. CT
Register

PPE Scams Are Abundant, Particularly for N-95 – May 6, 2020
Shortages of PPE such as N95 respirators persist. However, there is no shortage of non-medical suppliers and distributors that claim to have N95 and KN95 masks and other PPE for sale. Many of the sales calls come from third party representatives claiming to have ready access to PPE. Be cautious and ask yourself, “Why does this non-medical distributor have access to PPE when the major medical distributors and suppliers that I have used in the past do not?”

Be on the lookout for these BIG red flags when contacted by these salespersons:

  • Emails that come from personal email accounts such as Gmail or Yahoo accounts.
  • No last name from the sender or company contact information in the email, including a website that you independently can verify through a web search engine.
  • Pressure tactics such as “you must place your order and pay today/now if you want to get your order in the next shipment.”
  • A requirement that you must pay up front to place your order usually through wire transfers, direct transfers from your bank accounts, PayPal or Venmo.

When working with a new supplier, ask for references of other long-term care providers who have ordered from the company and had the PPE delivered. Then, independently check those references. Read more complete guidance on avoiding scams.

Coronavirus Pandemic Response: PPE Packages for Nursing Homes – May 4, 2020
Under the direction of the White House Coronavirus Task Force, FEMA will coordinate two shipments totaling a 14-day supply of personal protective equipment (PPE) to more than 15,000 nursing homes across the Nation. The mission will supplement existing efforts to ensure nursing homes across the country have PPE during the coronavirus (COVID-19) pandemic. FEMA will ship PPE to Medicaid- and Medicare-certified nursing homes based on input from the American Health Care Association to serve as a bridge between other PPE shipments.

  1. Each nursing home will receive two shipments with a combined total of 14 days’ worth of PPE.
  2. Shipments of the first seven-day supply are expected to begin the first week of May.
  3. Shipments of an additional seven-day supply will begin in early June.
  4. The first shipments will focus on facilities within prioritized hotspots and expand to facilities across all 50 states, the District of Columbia, Puerto Rico, and Guam.
  5. The total estimated amount of PPE includes more than 7.1 million surgical masks, nearly 32.3 million gloves, more than 922,000 goggles and other eye protection, and nearly 9.7 million gowns.
  6. Each facility will receive an allotment of all four items based on the staff size of the facility, which ranges from fewer than 10 employees to nearly 500.
  7. The level 1 medical gowns included in the shipments are intended for use in basic care settings for minimal risk situations. The gowns are durable and can be washed 30 to 50 times.
  8. Due to the large number of nursing homes, facilities are not likely to receive notification prior to their shipment arriving. However, as possible, FEMA will provide notification to a state prior to shipments arriving at their Medicaid/Medicare-certified facilities.
  9. The distributor that was awarded the contract to deliver these supplies is not involved with FEMA Project Airbridge initiative. Rather, this effort taps into the smaller operations that have supplies of various items in high demand, such as the level 1 medical gowns.
  10. Due to the critical need for PPE at nursing homes where some of our Nation’s most vulnerable residents live, these supplies are meant to supplement existing PPE efforts by the federal government. FEMA and HHS continue working with states, territories, and tribes on PPE needs through a variety of ways.

PPE Burn Rate Calculator – Mobile App – May 4, 2020
The Personal Protective Equipment (PPE) Burn Rate Calculator is now available as a mobile app. Facilities can use the NIOSH PPE Tracker app to calculate their average PPE consumption rate or “burn rate.” The app estimates how many days a PPE supply will last given current inventory levels and PPE burn rate. For the excel version, please visit the CDC website.

CDC Launches LTC Frontline Staff Training Webinar – April 29, 2020
The Centers for Disease Control and Prevention (CDC) has developed resources for frontline staff in long term care facilities. These short webinars are all published on the Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs) webpage at the bottom under a “Webinar Series” section. These new webinars are intended to be a training tool/resource for frontline long-term care staff members. CDC has also listed three “Additional Resources” to this page, which have been updated previously.

Here are the direct links to each webinar:

And the new additional resources are

CDC Increases Priority for COVID-19 Testing in Long-Term Care Residents – April 29, 2020
This week, the Centers for Disease Control (CDC) made changes to its priority classifications for COVID-19 testing. The CDC has now modified its priority classifications into two categories: high priority and priority, and both health care facility workers with symptoms and residents in long term care facilities with symptoms are classified as high priority.

In addition, the CDC states that health care workers with contact with a person with known or suspected COVID-19 should be considered for testing. Residents and health care workers in long-term care facilities without symptoms may also be prioritized by state or local health departments or clinicians, for reasons including public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals.

Previously, the CDC identified three priority levels for testing. Patients in long term care facilities with symptoms were identified as priority two for testing while healthcare workers with symptoms were identified as priority one and healthcare workers without symptoms as priority three.

This update represents a positive step in continuing the push for better access to testing for both long term care residents and staff. Providers should use this guidance when seeking testing from hospitals, physicians, labs and local officials and advocating for faster turnaround times.

For more information, please see AHCA’s recent guidance on testing. Facilities can refer to AHCA/NCAL’s list of vendors who provide testing in nursing home setting and are FDA-approved.

Where to Turn for Help – April 17, 2020
The American Health Care Association (AHCA) has developed brief guidance for facilities facing PPE and staffing shortages, as well as other challenges in receiving assistance. It is critically important that you raise the alarm and you document your efforts to obtain support.

Disposable Face Shields Available from MIT – April 15, 2020
The Massachusetts Institute of Technology (MIT) has designed and licensed a manufacturer to produce disposable face shields in high volume. These face shields do not replace the need for face masks such as N95s but do offer splash protection and can extend the useful life of N95 respirators and surgical masks. Long-term care facilities facing shortages of face masks and other PPE should continue efforts to obtain N95s and other PPE, even if they order the MIT face shields. The face shields cost $348.75 for a box of 125 ($2.79 each). Learn more and access their order form at https://project-manus.mit.edu/fs-health.

New OSHA Resources: Low/Unavailable PPE and Reporting Staff Cases – April 14, 2020
Four new resources have been released on guidance from the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) on critically low or unavailable Personal Protective Equipment (PPE). These new resources are applicable to all long-term care providers.

  • A form letter (downloads as MS Word document) providers can fill in when responding to OSHA inquiries due to complaints regarding limited or unavailable PPE.
  • A document on OSHA guidance when PPE is critically low or unavailable including steps providers can follow.
  • An explanation of OSHA and CDC guidance on N95 respirators that are critically low or unavailable. This resource provides five options with guidance on what to do for a limited supply of N95 or other respirators to no N95 or other respirators available.
  • A document with updated guidance from OSHA on employer recording and reporting requirements for COVID-19.

ADPH Resources for Optimizing PPE – April 10, 2020
The Alabama Department of Public Health has added some resources to our web page on optimizing PPE. I have included links below that will take you directly to the PDF’s, and ask that you please share this information with your health care providers. These materials area also available on our “COVID-19 Resources for Healthcare Providers” page (https://www.alabamapublichealth.gov/infectiousdiseases/cov-healthcare.html). They can be accessed under the “ADPH Resources” section, along with other materials that are available.

Update on Personal Protective Equipment – April 10, 2020
Obtaining personal protective equipment (PPE) continues to be a challenge for long term care providers in many parts of the country.  FEMA is now playing a primary national role in determining how PPE is distributed across the country. State and local governments are also playing a role in the supply and distribution of PPE.

There are no quick fixes to the national PPE shortage. One coalition, Project N95, has formed to help link PPE suppliers with health care providers, including long term care, in need. More information on PPE availability, conservation, and what to do when you are running low are available here.

The American Health Care Association will keep members apprised of any developments with the PPE supply as those details become available.

COVID-19 Testing Vendors for LTC – April 10, 2020
On April 7, the American Health Care Association provided a summary of the challenges LTC providers are facing in gaining access to COVID-19 testing. AHCA has been seeking companies who can provide testing for LTC providers with reasonable turnaround times and have put together a list of credible vendors here. This list will be continuously updated as more vendors are found. If you know of any vendors that should be added to this list, please contact us at COVID19@ahca.org.

Be Prepared – OSHA Requirements for PPE – April 8, 2020
The American Health Care Association (AHCA) has learned that some members and other health care entities are receiving letters from OSHA regarding lack of PPE. AHCA has consulted with it outside consultants who recommend preparing a plan with the following information:

  1. If you are running low on PPE, follow the CDC guidance and guidance from your local health department.
  2. Have a plan in place that deals with potential exposure to COVID-19 for employees, for example, what happens if a staff member has respiratory or other symptoms indicative of COVID-19 or tests positive with COVID-19.
  3. Communicate this plan to all staff often and have it available for staff to review.

Access to COVID-19 Testing in LTC – April 8, 2020
COVID-19 testing continues to be a significant point of concern for LTC providers. LTC residents with symptoms fall into Priority 2 for testing, according to CDC guidance. While not required, some state and local health departments and/or individual clinicians are using this guidance to prioritize testing. There is also a significant backlog of tests and growing shortage of testing supplies in labs across the country, which is also causing delays.

Members who are approached by companies selling antibody tests (blood tests with rapid result) should be aware that this is different than a PCR test and cannot diagnose a patient with COVID-19. Members should also verify that any company selling a test has an EUA from the FDA. More information is provided here. The Alabama Nursing Home Association and the American Health Care Association continue to seek options for vendors that can provide testing for LTC and will continue to update you when new information is available.

To Access PPE, You Must Activate Your Facility’s AIMS Account – April 2, 2020
In order to ensure your PPE needs are known to the Alabama Department of Public Health (ADPH), you must enter your PPE needs into the Alabama Incident Management System (AIMS) system. The health care facilities who enter their PPE needs into the AIMS system receive priority as PPE is distributed throughout the state. If you have an immediate need, contact your local EMA to inquire if it has any supplies. Currently, the ADPH has distributed all the PPE from its warehouse. More shipments have arrived but must be tested in ensure these vital items are not faulty.

If you have not already done so, log-in and activate your facility’s AIMS account. AIMS is operated by the ADPH and the University of South Alabama to coordinate health care services and needs during declared emergencies and disasters. Each nursing home has an AIMS account. If you don’t know your facility’s account information, contact the AIMS Coordinator at your local Healthcare Coalition (HCC). Click here for a list of the local AIMS Coordinators.

Guidance on PPE and Exposure – March 24, 2020
The Alabama Nursing Home Association was contacted by the Alabama Department of Public Health (ADPH) to remind facilities about personal protective equipment (PPE) and exposure. The exposure level is key. It is recommended that health care workers don appropriate PPE for respiratory illnesses before entering the room. This practice appears to be a key factor in whether they are sent home for 14 days or not. Click here for further information and an exposure/risk chart from ADPH.

Beware COVID-19 Scams Selling PPE or Other Supplies – March 21, 2020
Providers are receiving vendor emails or other contact offering PPE supplies, and some may not be legitimate vendors or businesses. Please beware that some offers are scams and are not credible businesses. To help you spot the difference between legitimate businesses and scams, the Federal Trade Commission (FTC) has provided some general guidance on COVID-19-related scams. AHCA/NCAL has also compiled a list of helpful questions to ask yourself and the business in question.

New CDC Guidance on the use of PPE to conserve supplies – March 18, 2020
The Centers for Disease Control and Prevention issued new guidance on the use of mask, gowns and face shields including suggestions on what to do in shortages and when your supplies are exhausted.
Click for the guidance on each:

CMS Guidance on Industrial Respirators by Health Care Personnel – March 10, 2020
The Centers for Medicare & Medicaid Services (CMS) issued a memo that clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidance expanding the types of face masks health care workers may use in situations involving COVID-19 and other respiratory infections. You can read the memo here.

Claims Processing Guidance for 3-Day Stay and Spell-of-Illness Waivers – June 29, 2020
The Centers for Medicare and Medicaid Services (CMS) has updated SNF billing guidance related to Medicare beneficiaries receiving care when a SNF utilizes the COVID-19 public health emergency (PHE) 3-day stay and spell-of-illness waivers. The new guidance was posted in a revised MLN Matters article SE20011 under the heading “Skilled Nursing Facility (SNF) Benefit Period Waiver – Provider Information” (pages 9-13).

This section includes a summary of the waivers, examples of how beneficiaries could qualify for the qualifying hospital stay (QHS) 3-day stay waiver as well as the spell-of-illness benefit period waiver. Most importantly, CMS included detailed guidance for documentation, completing MDS assessments, and entering claims data needed in order to permit processing of claims using the waivers. CMS notes that the MACs will be required to manually process waiver claims but must “make every effort to ensure timely payment” within the 14-day payment floor. Finally, CMS provided guidance related to handling claims previously submitted that need to be addressed to bypass existing edits.

We highly recommend that providers review the guidance and share with clinical and billing staff. CMS is expected to post frequently asked questions (FAQs) associated with is updated billing guidance soon. We will notify members when the FAQs are posted.

CMS Announces Plans to End the Blanket Waiver Requiring Nursing Homes to Submit Staffing Data – June 26, 2020
The Centers for Medicare & Medicaid Services (CMS) has announced plans to end the emergency blanket waiver requiring all nursing homes to resume submitting staffing data through the Payroll-Based Journal (PBJ) system by August 14, 2020. The PBJ system allows CMS to collect nursing home staffing information. The blanket waiver was intended to temporarily allow the agency to concentrate efforts on combating COVID-19 and reduce administrative burden on nursing homes so they could focus on patient health and safety during this public health emergency. The memorandum released June 25 also provides updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System. Click here to view the memorandum to states and nursing home stakeholders.

CMS Releases Additional Blanket Waivers – May 15, 2020
The Centers for Medicare and Medicaid Services (CMS) has recently issued additional waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 public health emergency (PHE). This is in addition to the waivers that were released on April 30. The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration.

Paid Feeding Assistants
CMS is modifying the minimum timeframe requirements for feeding assistant training to allow the training to be a minimum of 1 hour in length. CMS is not waiving any other requirements related to paid feeding assistants or the required training content which contains infection control training and other elements. Additionally, CMS is also not waiving or modifying the requirements which requires that a feeding assistant must work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN).

With this waiver, the American Health Care Association’s (AHCA) Temporary Feeding Assistant training is allowable. However, additional state requirements may need to be waived to permit individuals completing this program to assist with care in your location. ANHA reached out to ADPH regarding this program being approved in Alabama. It has been approved for Alabama as long as it meets the parameters outlined above. ADPH reminds the ANHA that facilities must also ensure that feeding assistants receive the necessary training as outlined in F947 “In-service training must include dementia management training and resident abuse prevention training.”

CMS Issues Additional Blanket Regulatory Waivers – May 1, 2020
The Centers for Medicare and Medicaid Services (CMS) issued several new blanket waivers for long-term care providers. The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. The American Health Care Association offers a summary below.

New Blanket Waivers
Quality Assurance and Performance Improvement (QAPI)
CMS is modifying certain QAPI program requirements—specifically, §483.75(b)–(d) and (e)(3)—to the extent necessary to narrow the scope of the QAPI program to focus on adverse events and infection control.

The following sections are waived:

  • 483.75(b) Program design and scope, which includes “address all systems of care and management practices”;
  • 483.75(c) Program feedback, data systems and monitoring;
  • 483.75(d) Program systematic analysis and systemic action; and
  • 483.75(e)(3) Performance improvement projects.

In-Service Training
CMS is modifying the requirement that the nursing assistant must receive at least 12 hours of in-service training annually by postponing the deadline for completing this requirement until the end of the first full quarter after t