Interim Final Rule and Surveyor Guidance for Long-Term Care Facility Testing Requirements

CMS has released guidance outlining details on how to comply with the new interim final rule requiring COVID-19 testing of staff and residents.

Testing Guidance

CMS is requiring facilities to conduct three types of testing: 

  1. Symptomatic Testing: Test any staff or residents who have signs or symptoms of COVID-19 (facility must continue screening all staff, residents and other visitors).
  2. Outbreak Testing: Test all staff and residents in response to an outbreak (defined as any single new infection in staff or any nursing home onset infection in a resident) and continue to test all staff and residents that tested negative every 3-7 days until 14 days has passed since the most recent positive result. An admit already confirmed does not constitute a facility outbreak.
  3. Routine Testing: Test all staff based on the extent of the virus in the community, using CMS’ published county positivity rate under “COVID-19 Testing”, in the prior week as the trigger for staff testing frequency as outlined in the table below:
  • Facilities are guided to monitor their county positivity rate every other week (e.g. first and third Monday of every month).
  • Staff and residents who have recovered from COVID-19 and are asymptomatic do not need to be retested for COVID within 3 months after symptom onset.
  • CMS provided guidance on staff who refuse to test:
    • Staff who refuse and have signs or symptoms must be prohibited from entering until the return to work criteria are met. CLICK HERE to review the CDC Criteria for Return to Work.
    • Asymptomatic staff who refuse testing should follow occupational health and local jurisdiction policies.
  • Facilities must maintain records of all testing for compliance and must be able to provide to surveyors.
  • Facilities that do not comply with the testing requirements will be cited for noncompliance with new F-tag, F-886.

CMS has also revised the focus surveys for nursing homes to ensure compliance with testing requirements, infection prevention standards, and compliance for infection preventionists.

Take CARE with Infection Control

With frequently updated guidance from federal and state agencies, we are continuously hearing the most current information on how to protect our residents from COVID-19 with best practice infection control. Keeping all members of the team informed of the most recent processes may appear to be a daunting task; however, with the uptick in COVID-19 cases in nursing homes and CMS administrator Seema Verma stating concern, it’s a great time to review how we can keep our residents, staff, and selves safe.

Reliant has created a 4-step approach to Take CARE with Infection Control:

When considering implementation, identify appropriate hand hygiene frequency, PPE based on type of precautions, and items and equipment that need routine cleaning and disinfection.  Be attentive to sequenced steps and processes for hand hygiene, donning and doffing PPE, and cleaning.  In order to ensure reliability, commit to self and peer accountability and implementing PPE peers using return demonstration. To monitor effectiveness of implementation, assess and adjust processes as necessary.

Download and review CMS’ latest Infection Control Survey Guidance (released 8/26/2020) as a guide.

By working together as an interdisciplinary team and holding each other accountable for best practice infection control practices, we can minimize the spread of COVID-19 within our facilities.  Practice extreme diligence and caution with infection control and prevention processes.

CLICK HERE for more information on Reliant’s Take CARE with Infection Control initiative.

Care Matters Spotlight – August 2020

Mrs. Mabary was admitted to Care Nursing and Rehab in Brownwood, TX, after a fall led to a hip fracture on her right side which also had a prior transtibial amputation.  Prior to her injury, Mrs. Mabary walked up and down the 20 stairs to her bedroom with her prosthesis.  However, due to weight bearing restrictions, the therapy team had to get creative with a technique for going up and down the stairs.  At first, Mrs. Mabary was unable to hop up and down even one step without her prosthesis.  After working hard in therapy, she is now more than halfway to her goal of 20 steps as she is able to hop up and down a step 13 times!

Her drive and determination didn’t stop there!   When Mrs. Mabary arrived at Care Nursing and Rehab, she had a great deal of pain and required moderate assistance for bed mobility and transfers.  Now she can perform bed mobility and transfers with someone just standing nearby for assistance, and with decreased pain.

Luckily for Mrs. Mabary, communication and training with her son (with whom she lives ) is easily achievable as her son is a certified nursing assistant at the facility. Mrs. Mabary has a follow up appointment next week, and the team is hoping for great news regarding her weight bearing restrictions. In the meantime, she will continue working hard to improve her strength and balance.

Thank you, Mrs. Mabary, for being a great example of perseverance while also encouraging the other residents to strive hard in therapy.  You are an inspiration to us all!

OCR Alert – Phishing Scam Targeting Compliance Officers

The Office of Civil Rights (OCR) issued an alert on August 6, 2020 reporting postcards are being sent impersonating the OCR to coerce compliance officers into visiting a website regarding HIPAA risk assessments.  This is a marketing ploy to trick the victim into engaging in services under the guise of a directive from OCR.  A risk assessment is a requirement of HIPAA as defined in §164.308(a)(1); however, it does not specifically state how often it is needed or how it is to be done.  Best practice is to conduct risk assessments annually or when significant changes or threats occur within or to the environment.

It is recommended by OCR that all covered entities alert their workforce about this misleading communication.  For more information and an example of the postcard, CLICK HERE.

MACs Resume Medical Review on a Post-Payment Basis

In the August 6, MLN, CMS announced Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs resumed with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.

CLICK HERE to review the MLN Connects newsletter.

Although medical review has not been initiated at this time for dates of service during the public health emergency, future RAC and MAC reviews are forthcoming. According to an article posted on RAC Monitor on 8/25/20, high priority audits may include claims with

  • Positive COVID-19 diagnoses to ensure testing results are accurately documented. 
  • Remote patient monitoring codes

Providers should be reviewing claims and supportive documentation now to identify potential areas of improvement.

Additionally, the introduction of remote audits is anticipated. The remote audits allow for the current work-from-home, travel-restricted business climate.

CLICK HERE to view the article in its entirety.

CMS FY 2021 SNF PPS Final Rule Released

Strengthening Medicare

CMS projects that aggregate Medicare program payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021 compared to FY 2020. This estimated increase is attributable to a 2.2 percent market basket increase factor, adjusted by a 0.0 percentage point productivity adjustment.

Updates to PDPM Clinical Diagnosis Mappings

In this final rule, in response to these stakeholder recommendations, CMS is finalizing changes to the ICD-10 code mappings, effective October 1, 2020.

SNF Value-Based Purchasing (VBP) Program

CMS made no changes to the measures, SNF VBP scoring policies, or payment policies in this final rule.  CMS announced performance periods and performance standards for the FY 2023 program year.

CLICK HERE to view the SNF PPS Final Rule.

CLICK HERE to view the SNF PPS Final Rule Fact Sheet.

CMS Physician Fee Schedule CY 2021 Proposed Rule Released

CY 2021 PFS Ratesetting and Conversion Factor

With the budget neutrality adjustment to account for changes in Resource Value Units (RVUs), CMS reports the proposed CY 2021 PFS conversion factor is $32.26, a decrease of $3.83 from the CY 2020 PFS conversion factor of $36.09.  CMS’ increases in RVU for Evaluation and Management (E/M) services codes in CY 2020 final rule are to take effect 1/1/2021. These increases are a positive for primary care physicians and some physical therapy and occupational therapy evaluation codes. However, the significant cuts to frequently used therapy intervention codes result in an overall 7-9% decrease in reimbursement for therapy services. CMS proposes these cuts to therapy as well as other critical care provisions in order to meet the budget neutrality requirements.

Advocacy efforts are underway to #fightthecut and protect our beneficiaries’ access to therapy, especially during this health care emergency.

Contact your congressman through your respective association below:





Additionally, comments can be sent directly to CMS here by October 5, 2020.

Medicare Telehealth

CMS is proposing to make permanent some telehealth provisions related to physician visits that have been extended as part of the public health emergency. Currently, a finite list of therapy services is reimbursable when provided via telehealth for as long as the public health emergency exists, and there is no proposal to make these therapy telehealth provisions permanent.

CLICK HERE to view the Physician Fee Schedule CY 2021 Proposed Rule.

CLICK HERE to view the Physician Fee Schedule Proposed Rule Fact Sheet.

MDS Updates

On Oct 1 MDS version 1.17.2 will be used. Updates include assessment changes that will support the calculation of PDPM payment codes for state Medicaid programs and on OBRA assessments when not combined with the 5-day SNF PPS assessment. This will specifically affect the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1.

The updated item sets will not have a revised RAI manual released.  Contact your state’s RAI coordinator for item set questions.

For more information, visit MDS 3.0 Technical Information page.

Emergency Declarations

Watch for more information from CMS regarding possible additional waivers for beneficiaries in Louisiana and Texas due to Hurricane Laura and in California due to the wildfires following declarations of public health emergency in those locations.

CLICK HERE for more information on the waivers when they become available.

CLICK HERE to read the press release regarding Hurricane Laura relief.