CMS Issues Guidance to States on Reopening Nursing Homes: Universal Testing Needed to Lift Visitation Ban
Verma: COVID-19 Data Will Appear on Nursing Home Compare, First Public Report by End of MayBy Alex Spanko | May 14, 2020
CMS Issues Nursing Homes Best Practices Toolkit to Combat COVID-19
New Guidance Available on Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes
CMS issued a memo and frequently asked questions addressing the new requirement that nursing homes and long term care facilities report COVID-19 facility data to the Centers for Disease Control and Prevention (CDC) and to residents, their representatives, and their families. This action, included in the recent Interim Final Rule with Comment Period, will support surveillance of COVID-19 cases and increase transparency.
Under Interim Final Rule, Mandatory COVID-19 Reporting for Nursing Homes to Begin This Week
The Centers for Medicare & Medicaid Services (CMS) on Friday released an interim final rule that, among other provisions, will require nursing homes to begin reporting detailed COVID-19 information to the federal government this week.
“We believe that these reporting requirements are necessary for CMS to monitor whether individual nursing homes are appropriately tracking, responding, and mitigating the spread and impact of COVID-19 on our most vulnerable citizens, personnel who care for them, and the general public,” CMS wrote in the rule. “The information provided may be used to inform residents, families, and communities of the status of COVID-19 infections in their area.”
Providers will be required to submit the data through the CDC’s National Healthcare Safety Network (NHSN) platform;
Operators can register their facilities, and also submit large batches of information for multiple properties at once, through a dedicated long-term care portal.
White House creates national nursing home safety panel, will deliver 2 weeks’ worth of PPE to every facility in response to COVID-19 crisis
Also Thursday afternoon, the administration released an interim final regulation outlining long-awaited details of a plan to have nursing homes report COVID-19-related infections directly to the Centers for Disease Control and Prevention. Enforcement details were not announced, but providers are required to report about infections and deaths at least weekly to federal authorities, and by 5 p.m. the next day to residents and family members.
CDC starts much-anticipated training for mandatory COVID-19 reporting by nursing homes
Details about the new process nursing homes will have to use to report COVID-19 infections and deaths directly to the Centers for Disease Control and Prevention began flowing Wednesday.
The first training sessions on how to report will begin today, with a national conference call introducing the new module starting at 1:30 p.m. ET.
Nursing homes are on the front lines of COVID-19 and are faced with unprecedented challenges in providing care to residents through the pandemic. As a result, many nursing homes face financial strain and require enhanced resources to care for their residents. Federal action, such as the HHS Provider Relief Fund and the CMS Medicare Part A Advance Payments, have provided some financial support to nursing homes, and states are stepping up as well to supplement these emergency funds.
As of April 27, LeadingAge has identified several states that have taken some action, most through the Medicaid program, to direct increased funding to nursing homes. Most states have used the Medicaid state plan amendment process to secure rate increases for these providers. In many cases, rate increases are based on how much Medicaid paid nursing homes before the pandemic. Rhode Island, Connecticut and Oregon, for example, have each increased their Medicaid nursing home rates by 10% through the COVID-19 pandemic. Other states provide add-on payments at a flat rate, such as Alabama ($20 per day) and Washington ($29 per day). In addition to Medicaid rate increases, states have appropriated or otherwise directed funds to support nursing facilities and other health care providers, such as Massachusetts and Minnesota.
It is notable that Medicaid historically has not paid nursing homes (or other aging services providers) for the full cost of care to the people they serve. This shortfall in Medicaid rates likely exacerbated the financial strain on Medicaid providers like nursing homes as the pandemic began and underscores the need for enhanced federal and state support to this group. LeadingAge and its state partners have advocated at multiple levels of government for such funds and encourage further action to ensure that people receiving aging services get the support they need.
A list of states LeadingAge identified as providing enhanced funds to nursing homes as of April 27 is below, along with a description of their respective policy actions.
Alabama: On April 13, the state received approval for a $20 per diem add on payment per Medicaid resident. In addition, nursing homes with residents or staff diagnosed with COVID-19 are able to receive a one-time payment to help cover cleaning costs, based in part on the nursing home’s square footage and its volume of Medicaid services. Both payments, the per diem add on and the cleaning fee reimbursement, are retroactive to March 1 and will expire when the national public health emergency ends.
Connecticut: On April 3, the state announced an immediate 10% rate increase for nursing homes from April 1 to June 30. According to the state’s announcement, this increase will “be applied toward employee wages, including staff retention bonuses, overtime, and shift incentive payments; and new costs related to screening of visitors, personal protective equipment, and cleaning and housekeeping supplies.” The state estimates the increase will cost about $35.7 million. With 213 nursing homes in the state, this averages to just over $165,000 per facility. Nursing homes are also able to self-nominate to be a COVID-19-specific facility and receive a Medicaid reimbursement of $600 per day. The state describes this rate as being “more than double the average daily Medicaid payment rate.”
Massachusetts: On April 7, the state announced more than $80 million for nursing facilities. $50 million will be distributed across all nursing homes in the state, and an additional ~$30 million will go to “designated COVID-19 sites of care”. The state notice does not explain the exact methodology for how these funds will be disbursed at the facility-level.
Minnesota: The state appropriated $200 million to support health care providers through the COVID-19 pandemic, including nursing homes. Other eligible provider types include hospices, assisted living, home health agencies, health systems and others. The first $50 million went out as short-term emergency funds. Nursing homes did not receive these dollars and the state indicated that they were able to get expenses covered by the state agency. The remaining $150 million has not been distributed, but nursing homes can qualify.
North Carolina: Effective April 1, the state increased Medicaid rates for nursing homes by 5%. According to rate data published by the state, the median daily increase is $9.62.
Oregon: On April 1, the state announced a 10% rate increase for all Medicaid long-term services and supports, including nursing homes. The increase runs from April 1 through June 30. Adult day, assisted living, home-based services and PACE organizations also received the 10% rate increase.
South Carolina: On April 21, the state received approval for a daily add-on equivalent to 4% of a nursing home’s rate as of October 1, 2019. The state will calculate each facility’s add-on using the October 1 rate minus the following components: “Inflation Factor Trend, Cost of Capital, Profit Incentive, Cost Incentive, Effect of Cap on Cost/Profit Incentives, and NEMT Add-On”. The remainder will be multiplied by 4%, and the product of that will be the facility’s add-on for each day from March 1 through the end of the national emergency. In addition, the state indicated it if “Medicaid’s share of the coronavirus protection cost is less than Medicaid’s COVID-19 add-on payment amount, the [state Medicaid agency] will recover the excess.”
Rhode Island: On April 15, the state received approval for a 10% rate increase for nursing facility “direct and indirect care services”. Rate increases are retroactive to April 1 and will expire on June 30, or earlier if the national public health emergency ends before June 30.
Washington: On April 16, the state received approval for a daily add-on reimbursement of $29 for nursing homes. The add-on is retroactive to February 1. This add on will “end on the last day of the calendar quarter in which the COVID-19 declared emergency period ends.” For example, if the national emergency ends in June, the add-on would end on June 30. If it ends in July, the add-on would run through September 30.
TRACKING COVID-19 NURSING HOME CASES- BY STATE
Managed Care Contract & Consulting Services
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)
Note: On June 1, 2020, we revised the article to add a section on Clarification for Using the “CR” Modifier and “DR” Condition Code. All other information remains the same.
The Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the U.S. Department of Health & Human Services (HHS) continue to implement changes. We will continue to monitor all regulatory communications and keep you promptly updated.
The U.S. Department of Health & Human Services (HHS) has just announced that HHS is distributing billions in relief funds from the Coronavirus Aid, Relief & Economic Security (CARES) Act targeted to skilled nursing facilities (SNFs) to help those on the front lines of the COVID-19 pandemic. The HHS announcement acknowledges the unique challenges that nursing facilities have in caring for high-risk seniors and vulnerable patients. HHS notes that this supplemental funding is intended to help facilities with the significant expenses or lost revenue attributable to COVID-19, including critical needs such as labor, scaling up testing capacity, acquiring personal protective equipment (PPE) and other expenses directly linked to COVID-19.
HHS is making relief fund distributions to SNFs on both a fixed and variable basis. To begin, each SNF will receive a fixed distribution of $50,000, plus a distribution of $2,500 per bed. All certified SNFs with six or more certified beds are eligible for this targeted distribution. HHS' state-by-state breakdown on how the funding will be distributed says, "All relief payments are being made to billing tax identification numbers (TINs). There may be instances where a billing TIN includes multiple SNFs."
HHS also notes that recipients of these funds must attest that the nursing home will only use Provider Relief Fund payments for permissible purposes, as set forth in the Terms and Conditions, and agree to comply with future government audit and reporting requirements.
An updated FAQ is available here. More information is available at hhs.gov/providerrelief.
COVID-19: Payment for Diagnostic Laboratory Tests
Earlier this year, CMS took action to ensure America’s patients, health care facilities, and clinical laboratories were prepared to respond to the 2019-Novel Coronavirus (COVID-19). To help increase testing and track new cases, CMS developed two HCPCS codes that laboratories can use to bill for certain COVID-19 diagnostic tests. Health care providers and laboratories may bill Medicare and other health insurers for SARS-CoV2 tests performed on or after February 4 using:
HCPCS code U0001 for tests developed by the Centers for Disease Control and Prevention (CDC)
HCPCS code U0002 for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)
Laboratories and other health providers can also bill Medicare for tests using CPT codes created by the American Medical Association, provided testing uses the method specified by each CPT code:
CPT code 87635 for infectious agent detection by nucleic acid tests for dates of service on or after March 13
CPT codes 86769 and 86328 for serology tests for dates of service on or after April 10
Finally, for dates of service on or after April 14, 2020, Medicare pays $100 for laboratory tests for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 making use of high throughput technologies. Laboratories can bill Medicare for these tests using:
U0003: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
U0004: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
Neither U0003 nor U0004 should be used to bill for tests that detect COVID-19 antibodies.For COVID-19 tests that do not use high throughput technology, Medicare Administrative Contractors developed payment amounts for claims in their jurisdictions that will be used until we establish national payment rates though the annual laboratory meeting process. There is no cost-sharing for Medicare patients
The guidance released today can be found here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfs-states-and-regopolicy-and/nursing-home-reopening-recommendations-state-and-local-officials
The frequently asked questions can be found here: https://www.cms.gov/files/document/covid-nursing-home-reopening-recommendation-faqs.pdf
Nursing homes will face fines of “at least” $1,000 per week for not reporting COVID-19 infections within 12 hours of learning about them, federal regulators said Monday.
CMS is providing supplemental information for transferring or discharging residents between skilled nursing facilities (SNFs) and/or nursing facilities based on COVID-19 status (i.e., positive, negative, unknown/under observation).
Access “LTC Facility Transfer Scenarios” for a depiction and explanation of these scenarios here:
On April 10th, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1737-P] for Fiscal Year (FY) 2021 that updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs).