Summary of Weekly Call with CMS

Members | March 19, 2020 | by Ruth Katz

Yesterday, LeadingAge staff met with CMS Quality, Safety & Oversight Group staff, along with AHCA, AAPACN, NADONA, and AMDA, for our weekly COVID-19 call.  The following is a Q&A that summarizes what we heard. This is NOT a CMS document.

 

Here is the summary of what LeadingAge staff heard on the call, which is an open line of of communication the associations have in order to provide real time questions to CMS and hear the answers. This is not official communication from CMS.

Q.  What happened with the 4:30 call to clarify 1135 and telehealth questions?

A.  The technology didn’t work – not even for the CMS speakers -- and no one got in. Nevertheless, CMS plans to continue scheduling these calls to clarify guidance and memos.

Q.  What is the top line message CMS wants the associations to push out to providers?

A.  The most important thing is to make it clear that CMS guidance and interpretation of regulation cannot speak to every situation.  Take the information and make decisions based on your best judgment.

Q.  We’ve heard that all survey activity may be suspended.  If so, when will you put that out in writing?

A.  We have no update on annual licensure surveys being suspended at this time. Infection control surveys are still going on. We’ve instructed surveyors that when they survey, they should focus on infection control and they should maximize time spent off site; minimize onsite.  CMS is working on FAQs to speak to these topics.

Q.  Can anything be done about PPE?

A.  Follow the new CDC guidance about optimization.

Q.  How do providers determine which visiting health care professionals to allow in?  

A.  Visiting health care professionals are permitted to enter.  However, facilities need to assess very carefully what the needs are before they let anyone in.  The facility should determine that the visit is necessary.  Anyone coming in must be screened.

Q.  What about routine maintenance workers?  They aren’t on the exception list.

A.  For building maintenance workers, facilities should determine the need.  If the heating system is broken and the facility is in a cold climate where heat is necessary, let them come fix it.  If it’s warmer and the temperature inside is ok, don’t fix the heating system right now.

Ask yourself, what are essential things that need to happen and go from there, as long as you can maintain resident health and safety.  “This virus kills our people.”

Q.  Are hospice workers allowed in?

A.  Yes, they are.  But hospices should re-evaluate how they approach what they are doing and how they are conducting visits.  Hospices are encouraged to bundle visits whenever possible (e.g., instead of two on Wednesday and three on Thursday, do five on Wednesday).

Q.  What about inspections related to life safety or fire protection?  Like the fire alarms and the sprinkler system.

A.  That’s another story, and we will have to get back to you on that. However, your standard life safety code inspections will continue at this time, as they are a statutory requirement.

Q.  We’re having this problem with the US Postal Service.  They won’t be screened and they won’t drop the mail off, they have to deliver it.  They say screening violates the bargaining rights of the union.

A.  Thank you for sharing this, we were not aware that it’s a big problem but now we are hearing from you that it is.  We will get back to you on that.

Q.  In the revised visitor guidance released on March 13, you removed the step of screening for contact and exposure. Should facilities still be screening for this?

A.  We are working with CDC and following the changes they made. CDC has removed contact and exposure from their recommended screening procedures.

Q.  If a facility has zero COVID-19 positive residents and a resident is trying to return from the hospital and tests positive, can the facility refuse to readmit the person?

A.  We can’t speak for CDC.  Soon it will be widespread in all communities.  Visitors and health care providers will be going in and out of many facilities.  We know that in some cases, people don’t test positive until a month after exposure.  It could be unrealistic to allow facilities to refuse to admit in this case.

Q.  As hospitals become increasingly at and over capacity, will CMS be changing guidance?  How will CMS guidance change as the situation goes on?

A.  [This question got lost in the conversation.  We will ask it again.]

Q. What about ombudsmen?

A.  You have to make decisions based on the needs of the resident. Facilities must maintain the health and safety of residents; this is a case by case determination.

Q.  When supplies really do run out, do providers have to admit people for whom they’d need PPE?

A.  [This question got lost in the conversation.  We will ask it again.]

Q.  Does the waiver of the 3 day stay apply to communities that do not have any COVID-19 cases and to non-COVID infected individuals?

A.  It is a blanket waiver. It applies across the board, no matter where people are admitted from – hospitals, community, physician’s offices, anywhere.  The 3 day stay requirement is waived nationally.

Q.  If a current resident finishes a Medicare Part A stay, can they go back on Medicare without a 3-day stay or 60-day period of wellness?

A.  Yes.

Q. The waiver for completion and transmission of MDS can affect states that use case-mix reimbursement methodologies.  What then?

A. [This question got lost in the conversation.  We will ask it again.]

Q.  Will CMS adjust MDS coding for isolation of one person in a semi-private room?  We need a new code.

A.  [This question wasn’t answered directly.  We will ask it of the payment staff.]