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Activity Directors Network Forum - CMS Emergency Declaration Blanket Waivers for Health Care Providers

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COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
 
A.D.N. will continue to provide updates from CMS to keep you informed. The following portions has been extracted from CMS bulletin to highlight areas of immediate concern to you – please see the following link for the full article.
 
The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration. For general information about waivers, see Attachment A to this document. These waivers DO NOT require a request to be sent to the 1135waiver@cms.hhs.gov mailbox or that notification be made to any of CMS’s regional offices.
 

Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs)
  • 3-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).
  • Reporting Minimum Data Set. CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.
  • Staffing Data Submission. CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system.
  • Waive Pre-Admission Screening and Annual Resident Review (PASARR). CMS is waiving 42 CFR 483.20(k) allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available
  • Physical Environment. CMS is waiving requirements related at 42 CFR 483.90, specifically the following:
- Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under § 483.90 to allow for a non-SNF building to be temporarily certified and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults. CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care. CMS will waive certain conditions of participation and certification requirements for opening a NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
 
- CMS is also waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met. This can be done so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department.
 
  • Resident Groups. CMS is waiving the requirements at 42 CFR 483.10(f)(5), which ensure residents can participate in-person in resident groups. This waiver would only permit the facility to restrict in-person meetings during the national emergency given the recommendations of social distancing and limiting gatherings of more than ten people. Refraining from in-person gatherings will help prevent the spread of COVID-19.
  • Resident roommates and grouping. CMS is waiving the requirements in 42 CFR 483.10(e) (5), (6), and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19, and separating them from residents who are asymptomatic or tested negative for COVID-19. This action waives a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room, and to provide for a resident’s refusal a transfer to another room in the facility. This aligns with CDC guidance to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission of COVID-19 to other residents
 
Home Health Agencies (HHAs)
  • Requests for Anticipated Payment (RAPs). CMS is allowing Medicare Administrative Contractors (MACs) to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs) during emergencies.
  • Reporting. CMS is providing relief to HHAs on the timeframes related to OASIS Transmission through the following actions below:
- Extending the 5-day completion requirement for the comprehensive assessment to 30 days.
- Waiving the 30-day OASIS submission requirement. Delayed submission is permitted during the PHE. 13
  • Initial Assessments. CMS is waiving the requirements at 42 CFR §484.55(a) to allow HHAs to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review. This will allow patients to be cared for in the best environment for them while supporting infection control and reducing impact on acute care and longterm care facilities. This will allow for maximizing coverage by already scarce physician and advanced practice clinicians and allow those clinicians to focus on caring for patients with the greatest acuity.
  • Waive onsite visits for HHA Aide Supervision. CMS is waiving the requirements at 42 CFR §484.80(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. This waiver is also temporarily suspending the 2-week aide supervision by a registered nurse for home health agencies requirement at §484.80(h)(1), but virtual supervision is encouraged during the period of the waiver.
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Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org
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  • both post support for the NAAPCC Credentialing Center
     
    Comments From Students
     
     Thank you for correcting the information that was released. I recently took the test for certification with NAAPCC and it was a very comprehensive and thorough test. It was not a simple easy test to get you certified. You had to know the information in order to complete and pass. I would recommend this avenue to anyone especially if finances are a struggle for MEPAP I & II. I did purchase the book for long-term care seventh edition and without that I would have struggled.
    Connie Gangwish, AP-BC Colorado
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    To: Activity Directors Network
    Celeste is awesome!! Anytime i have a question she gets right back with me and she is very informative. At first I didn't know if i was going to like the new course just for the fact my MEPAP course was the own pace and I work Full time plus have 3 kids. But i am loving it! It is very structured and with due dates I feel like i am holding myself more accountable for completed assignments sooner than later. It has actually been a beneficial change for me.. Thanks so much!!!
    L Williams reprinted with permission

    To: Activity Directors Network
    Good Evening I wanted to let you know that I had completed mepap 1 and had only a couple weeks left of mepap 2 so I had looked at path 2 and have taken the activities test and passed so just sending in the application. I wanted to thank you for giving all your time to us even while Kathy was ill. It didn't go unnoticed, you was a great support and helpful at ideas or even different ways of changing thoughts to positive while feeling defeated. Thank You Stacey Passa AP-BC
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