MDS Alert

CMS is carrying on with some regular updates and introducing others specifically to deal with COVID-19.

The Centers for Medicare & Medicaid Services (CMS) has announced that it will now be enforcing already established requirements surrounding the reporting of infection diseases in nursing facilities, according to a recent memorandum, QSO-20-26-NH, sent to state survey agency directors. Until now, nursing facilities could voluntarily report but were not required to do so.

“Current requirements at 42 CFR 483.30 and CDC guidance specify that nursing homes notify State or Local health department about residents or staff with suspected or confirmed COVID-19, residents with severe respiratory infection resulting in hospitalization or death, or ≥ 3 residents or staff with new-onset respiratory symptoms within 72 hours of each other. At present, these data are not collected by CMS, CDC, or the Federal Emergency Management Agency (FEMA),” says David R. Wright, director of the quality, safety, and oversight group at CMS in Baltimore.

A separate regulation will require nursing homes to alert residents and resident representatives to cases of COVID-19 within the facility.

“At a minimum, once these requirements are in place, nursing homes must inform residents and their representatives within 12 hours of the occurrence of a single confirmed infection of COVID-19, or three or more residents or staff with new-onset of respiratory symptoms that occur within 72 hours,” Wright says.

Facilities must provide these updates weekly or whenever a (or another) case of COVID-19 is identified and confirmed or when three or more residents or staff are exhibiting a new onset of respiratory symptoms within 72 hours.

“Scientific data derived from solid surveillance is a key element of recommendations to protect Americans, particularly our most vulnerable, from the devastating impact of COVID-19,” says Robert Redfield, MD, director of the Centers for Disease Control and Prevention (CDC) in a recent CMS release. “This coordinated effort with CMS will allow CDC to provide even more detailed information to state and local health departments about how COVID-19 is affecting nursing home residents in order to develop additional recommendations to keep them safe.”

Note that some states are enforcing different reporting requirements. New York, for example, has been requiring nursing homes to report COVID-19 deaths, along with the amount of personal protective equipment (PPE) facilities have on hand.

Make These Changes Now

Take these steps from law firm Hall Render to streamline your communication with resident representatives, as well as local, state, and federal health authorities, if you haven’t already:

• Establish or update policies and procedures for reporting infectious disease to health authorities, residents, and resident representatives.
• Design templates that staff can use to communicate updates to residents and their representatives without compromising resident privacy.
• Make sure facility policies and procedures are updated so public health authorities can “perform on-site infectious disease surveillance, testing of health care personnel and residents, or other related activities.” Don’t forget to keep staff in the loop on all updates.

Peruse Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released and published the proposed rule for 2021: “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Value-Based Purchasing Program for Federal Fiscal Year 2021” in April.

One big takeaway is an increase in payments to skilled nursing facilities (SNFs).

“CMS projects aggregate payments to SNFs will increase by $784 million, or 2.3 percent, for FY 2021 compared to FY 2020. This estimated increase is attributable to a 2.7 percent market basket increase factor with a 0.4 percentage point reduction for multifactor productivity adjustment,” CMS says in a news release concerning the proposed rule.

See These ICD-10-Related Changes

The proposed rule shows CMS’ efforts to fix some inadequacies. Some ICD-10 and clinical category mapping updates should better reflect the level of care some diagnoses require, especially for some cancers.

Specifically, CMS proposes updating the surgical clinical categories so that clinical mapping of some ICD-10 codes associated with some diagnoses more accurately reflect what the ICD-10 code or corresponding diagnosis entail, in terms of care, including some major procedures.