LeadingAge National News

Reminder - Public Health Emergency ended - May 11, 2023.   In addition to the LeadingAge Resource page on this topic, here are some helpful resources:

• Additional summary details are found in this LeadingAge article, and also here (Medicaid enrollment ramifications), and here (other considerations).  
  
  
• LA QuickCasts for Nursing Homes on End of PHE. Part 1 is an 11-minute QuickCast that provides an overview of what nursing homes need to know about the end of the PHE while Part 2 is a 16-minute QuickCast outlining what nursing homes need to do about the end of the PHE. 
  
  
• CMS QSOs:
• General Summary QSO - QSO-23-13-ALL, (May 1, 2023).  Staff vaccination mandate that requires staff in most CMS-certified settings to be “fully vaccinated” (complete a primary series) against COVID-19 will end - BUT HAS NOT YET.
• CMS Updates Visitation Memo to Align with Ending of the PHE.  On May 8 CMS revised QSO-20-39-NH directing nursing homes to follow nationally accepted standards such as the CDC recommendations for resident and staff testing, indoor visitation and the adherence to infection prevention and control.  The FAQ document attached to the Memo has also been updated.
• Testing. Effective May 11 QSO-20-38-NH is no longer in effect.  See LeadingAge article here.
  
  
• CMS fact sheets on Waivers, Flexibilities, and the Transition Forward from the COVID-19 PHE.  See the factsheet here, this roadmap, the CMS 1634 agreements, and the related FAQ here. Also here: Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)  (PDF); Home Health Agencies  (PDF); and here - Hospice (PDF).
  
  
• HHS Distribution of COVID Test Kits to Nursing Homes and Assisted Living Providers WILL continue after the PHE ends. Please email Binax.Team@HHS.gov.  
  
  
• CDC Releases Updated Recommendations for Healthcare Providers. This LeadingAge article provides details. The Community Transmission rates metric for SARS-CoV-2 data will sunset and has been removed from the guidance.  Updates in the Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic include: 
• Admission testing in nursing homes will be at the discretion of the facility, as it already is for other healthcare settings.   
  • Facilities are encouraged to look beyond SARS-CoV-2 and make broader masking decisions based on facility-and-patient-level characteristics and local metrics that could reflect increasing respiratory virus transmission in the community.   

• FDA Guidance on PHE Ending. Read more here. 

National Provider Resources. LeadingAge has created new landing pages under Find Information on their main webpage for a variety of topics and provider types and would encourage members to review and provide feedback.   

Upcoming 3:30 Update Calls - Mondays and Wednesdays. Next calls - Wednesday, May 24 (homecare workforce issues), and Wednesday, May 31 (exceptional acts of caregiving in LTC).  If you haven’t registered for LeadingAge Update Calls, you can do so here.  You can also find previous call recordings here.  Note that to access recordings of the calls you need a LeadingAge password. Any staff member of any LeadingAge member organization can set up a password to access previous calls and other “members only” content.

First Managed Care Solutions Member Network meeting:  We will be holding the first meeting of the Managed Care Solutions Member Network next week on Wed., May 24 - 2:00 PM ET. Members can still sign up for this or future network meetings by contacting Nicole via email at nfallon@leadingage.org.  

LPC Member Meeting. Join us on Thursday, May 25 at 2:00 PM ET for a pivotal examination of current contract language changes and actuarial implications for LPCs. If you haven’t yet received the invitation, email Dee and you will be added to the list. All members are welcome!

Assisted Living Member Network Meeting: Please join Assisted Living members at our May monthly meeting, on May 30 from 2-3pm EST. To join, please contact Janine Finck-Boyle at JFinck-Boyle@leadingage.org

NHSN Updates and Training. NHSN will be updating the Long-Term Care Facility COVID-19 module and COVID-19 Vaccination module. Registration is required for the training sessions on June 1, June 7, June 8, and June 13. Go here to learn more and to register for these webinars.

Big News - CMS To End Staff Vaccination Mandate and Other Requirements. CMS released memo QSO-23-13-ALL on May 1 providing guidance for the end of the PHE. Notably, CMS announced that the current staff vaccination mandate that requires staff in most CMS-certified settings to be “fully vaccinated” (complete a primary series) against COVID-19 will end. 

New Rules for HCBS (AL) providers - Biden Administration has announced new quality measures for HCBS providers; some are mandatory.  CMS further explains in this fact sheet.  The proposed rules announced Thursday are scheduled to be published May 3, but are available for review as PDFs now: Medicaid Program: Ensuring Access to Medicaid Services; Medicaid Program: Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality.  See this related coverage in McKnight’s Home Care here: CMS proposes that 80% of Medicaid payments for home care go to direct care workers.

Public Health Emergency will end - May 11, 2023.  When the PHE ends on May 11, there will be a significant impact on older adults, according to preliminary analysis from Forbes.  A previous article on Medicaid Unwinding can be found here.  Read more details in this LeadingAge article, and also here and in this table - here.  Also, CMS has updated provider specific waiver information and that can be found in this roadmap and also here:

• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)  (PDF)
• Home Health Agencies   (PDF)
• Hospice (PDF)
• HHS Establishes Transition Period for Post-PHE Telehealth Compliance. HIPAA and Telehealth; HHS Releases Guidance on Audio-Only Telehealth Services
• CMS fact sheet on Waivers, Flexibilities, and the Transition Forward from the COVID-19 PHE.  See the factsheet here.
• FDA Guidance on PHE Ending. Read more here.
• KFF Releases State-by-State Analysis of Medicaid Unwinding Activities. See the report.    
• New QuickCasts for Nursing Homes on End of PHE. Part 1 is an 11-minute QuickCast that provides an overview of what nursing homes need to know about the end of the PHE while Part 2 is a 16-minute QuickCast outlining what nursing homes need to do about the end of the PHE.

National Provider Resources. LeadingAge has created new landing pages under Find Information on their main webpage for a variety of topics and provider types and would encourage members to review and provide feedback.  

Upcoming 3:30 Update Calls - Mondays and Wednesdays. Next calls - Wednesday, May 3 (innovations in senior living), and Monday May 8 (behavioral health matters).  If you haven’t registered for LeadingAge Update Calls, you can do so here.  You can also find previous call recordings here.  Note that to access recordings of the calls you need a LeadingAge password. Any staff member of any LeadingAge member organization can set up a password to access previous calls and other “members only” content.

Nursing Home Presentation at Leadership Summit by CMS. Here is an in-depth article on Evan Shulman’s remarks.      

CMS releases Optional State Assessment Item Set and Manual for nursing homes. The Optional State Assessment (OSA) Item Set, OSA Manual, and OSA Change History table are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The OSA is not a Federally required assessment; rather, it may be required in some States for payment purposes. We believe Indiana is one of these. 

State Department Issues a Cap on EB-3 International Visa Petition Filings. The U.S. Department of State’s Bureau of Consular Affairs May bulletin, released on April 14, imposes a cap on new employment-based (EB) visa petition filings.

FY 2024 SNF PPS Proposed Rule Analysis. Please find a members-only analysis of the FY 2024 SNF PPS proposed rule here. Your LeadingAge login is required to access. We will also host a special Nursing Home Network call on Friday, April 28 at 1 PM ET to discuss the rule in depth and solicit feedback from members as we construct comments on the rule. To provide feedback, or if you want to join the call and you’re not yet a member of the Nursing Home Network, email Jodi (jeyigor@leadingage.org).

FDA Announces Changes to COVID Vaccine Guidelines and Eligibility. The Emergency Use Authorization has been extended for both the Modern and Pfizer updated bivalent formulations of the COVID vaccine for a period of five years. So, only the updated bivalent formulations may be used for vaccinations, and only one (1) administration of this updated vaccine is needed to be “up to date.” Generally, individuals who are already “up to date” do NOT need to have the updated vaccine to continue to be “up to date.” Those who have NOT completed their original vaccine series OR have never been vaccinated will have to have one (1) administration of the updated vaccine to be “up to date.

White House Executive Order and Fact Sheet on Caregivers.  President Biden signed an Executive Order summarizing his Administration’s caregiver actions and proposals; Katie Smith Sloan was among the invited guests. A Fact Sheet – “Biden Harris Administration Announces Most Sweeping Set of Executive Actions to Improve Care in History” released earlier outlined key measures included in the Executive Order. This LeadingAge article summarizes the Fact Sheet and its implications for LeadingAge members.

Public Health Emergency will end - May 11, 2023.  When the PHE ends on May 11, there will be a significant impact on older adults, according to preliminary analysis from Forbes.  A previous article on Medicaid Unwinding can be found here.  Read more details in this LeadingAge article, and also here and in this table - here.  Also, CMS has updated provider specific waiver information and that can be found in this roadmap and also here:

• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)  (PDF)
• Home Health Agencies   (PDF)
• Hospice (PDF)
• HHS Establishes Transition Period for Post-PHE Telehealth Compliance. HIPAA and Telehealth; HHS Releases Guidance on Audio-Only Telehealth Services
• CMS fact sheet on Waivers, Flexibilities, and the Transition Forward from the COVID-19 PHE.  See the factsheet here.
• FDA Guidance on PHE Ending. Read more here.
• KFF Releases State-by-State Analysis of Medicaid Unwinding Activities. See the report.    
• New QuickCasts for Nursing Homes on End of PHE. Part 1 is an 11-minute QuickCast that provides an overview of what nursing homes need to know about the end of the PHE while Part 2 is a 16-minute QuickCast outlining what nursing homes need to do about the end of the PHE.

National Provider Resources. LeadingAge has created new landing pages under Find Information on their main webpage for a variety of topics and provider types and would encourage members to review and provide feedback.  

Upcoming 3:30 Update Calls - Mondays and Wednesdays. Next calls - Wednesday, April 26, and Monday May 1.  If you haven’t registered for LeadingAge Update Calls, you can do so here.  You can also find previous call recordings here.  Note that to access recordings of the calls you need a LeadingAge password. Any staff member of any LeadingAge member organization can set up a password to access previous calls and other “members only” content.

National Stakeholder Call with the CMS Administrator. On April 25, 1- 2pm ET, CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide an update on CMS’ recent accomplishments and how CMS’ cross-cutting initiatives are advancing CMS' Strategic Plan. RSVP for the call here.

CMS Office Hours on PHE Ending. CMS will host informational office hours on April 25 from 3:30-4:30 PM ET to discuss the end of the PHE. Register here. In preparation for this webinar, CMS recommends reviewing the following resources:

• What Do I Need to Know? CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency
• Current Emergencies
• Coronavirus Waivers and Flexibilities

CMS and HHS Host Educational Webinar on Medicaid Unwinding. CMS and HHS will host a webinar on “Medicaid and CHIP Continuous Enrollment Unwinding: What to Know and How to Prepare” on April 26 at 12:00 Noon ET. You can register here for the webinar and you will receive the Zoom link for it. Presenters will cover a recent issue brief from the Assistant Secretary for Planning and Evaluation and employers roles in outreach related to the end of Medicaid continuous coverage. LeadingAge is maintaining information related to unwinding for members here; you can access a high level QuickCast on the topic here. Reach out to Georgia (GGoodman@leadingage.org) if you have questions or challenges.

LPC April Member Network. Please mark your calendars for the next LPC Member Network call on Thursday, April 27, 2pm ET (waiting room opens at 1:45pm ET.) Our panel of experts, including both members and their architect/ design firms, will discuss ‘the business case for going green.’ We’ll also hear some ‘teasers’ about incentives available for sustainability projects under the Inflation Reduction Act. All members are welcome; please email Dee Pekruhn to register.

CMS releases Optional State Assessment Item Set and Manual for nursing homes. The Optional State Assessment (OSA) Item Set, OSA Manual, and OSA Change History table are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The OSA is not a Federally required assessment; rather, it may be required in some States for payment purposes. We believe Indiana is one of these. 

State Department Issues a Cap on EB-3 International Visa Petition Filings. The U.S. Department of State’s Bureau of Consular Affairs May bulletin, released on April 14, imposes a cap on new employment-based (EB) visa petition filings.

FY 2024 SNF PPS Proposed Rule Analysis. Please find a members-only analysis of the FY 2024 SNF PPS proposed rule here. Your LeadingAge login is required to access. We will also host a special Nursing Home Network call on Friday, April 28 at 1 PM ET to discuss the rule in depth and solicit feedback from members as we construct comments on the rule. To provide feedback, or if you want to join the call and you’re not yet a member of the Nursing Home Network, email Jodi (jeyigor@leadingage.org).

PRF Late Reporting Request for RP4 – Due by April 28. More information on making a late reporting request due to extenuating circumstances can be found here. Here is a LeadingAge article with additional details about how to submit a request.

FDA Vaccine Updates and What It Means for Vaccination Requirements.  A summary of all changes is available here.

FDA Announces Changes to COVID Vaccine Guidelines and Eligibility. The Emergency Use Authorization has been extended for both the Modern and Pfizer updated bivalent formulations of the COVID vaccine for a period of five years. So, only the updated bivalent formulations may be used for vaccinations, and only one (1) administration of this updated vaccine is needed to be “up to date.” Generally, individuals who are already “up to date” do NOT need to have the updated vaccine to continue to be “up to date.” Those who have NOT completed their original vaccine series OR have never been vaccinated will have to have one (1) administration of the updated vaccine to be “up to date.”

White House Executive Order and Fact Sheet on Caregivers.  President Biden signed an Executive Order summarizing his Administration’s caregiver actions and proposals; Katie Smith Sloan was among the invited guests. A Fact Sheet – “Biden Harris Administration Announces Most Sweeping Set of Executive Actions to Improve Care in History” released earlier outlined key measures included in the Executive Order. This LeadingAge article summarizes the Fact Sheet and its implications for LeadingAge members.

Did COVID Change LTC Insurance?  Many LeadingAge members are interested in trends in LTC insurance sales, purchase, coverage, etc. The Long-Term Care Discussion Group will meet on Thursday, April 27, from 2:00 – 3:00 PM ET to hear from Sandy Jones, Partner, Faegre Drinker, about “How COVID has Changed Long-Term Care Insurance.” To join the call, simply connect to: Join Zoom Meeting; https://ahip-org.zoom.us/j/83679926540?pwd=K3d3NnhHTGE4aGYvTzNRS0c4WEhoZz09; Meeting ID: 836 7992 6540; Passcode: 071916.   

LeadingAge Seeking Experiences/Stories on HCBS Settings Rule Implementation.  More stories would be great. Georgia (ggoodman@leadingage.org) would appreciate your insights or a quick discussion.

Medicaid Advisory Group to Discuss HCBS, Duals, and Other Issues of Interest to LeadingAge Members.  The Medicaid and CHIP Payment and Access Commission will host its April meeting on Thursday, April 13 and Friday, April 14. Interested individuals can register here for a zoom link to attend the meeting. Here is the day and a half long agenda. 

CCRC Occupancy Report Card: News from NIC. The National Investment Center has published provocative findings for not-for-profit CCRCs, following a review of occupancy performance from Q4 of 2022.