Elevating the Post-Acute and
Long Term Care Profession

April 8, 2021

Not COVID-19-Related, But Important: Proposed SNF Medicare Rule Out. This afternoon, the Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare reimbursement rule for SNFs. When finalized, the rule will set rates beginning October 1, 2021. CMS provided a detailed fact sheet on the Notice of Proposed Rulemaking. The rule as proposed would apply a 1.3% net market basket adjustment to Patient-Driven Payment Model (PDPM) rates, after downward adjustments for both productivity and forecast error. CMS scores the net increase in payments to SNFs nationwide at $444 million, but notes that a proposed 0.8% across-the-board Value-Based Purchasing (VBP) reduction would remove $184.25 million. CMS proposes not to calculate facility-specific VBP adjustments because of the COVID-19 pandemic, but to apply the standard adjustment to everyone. More ominously, CMS asks for comments on data showing that PDPM is not budget-neutral, but resulted in a 5% positive revenue variance. CMS acknowledges the data may be skewed by COVID-19 and seeks input on how to adjust for the lack of budget neutrality and whether to delay such an adjustment. Among a number of other proposed changes is a plan to add healthcare-associated infections requiring hospitalization and staff COVID-19 vaccination rates to the Quality Reporting Program for Federal Fiscal Year 2023.

CDC on PPE for Outbreaks. Last week, the Centers for Disease Control and Prevention (CDC) issued new guidance for SNFs that consolidates and reorganizes previous guidelines and makes a few changes. One of the most significant changes - or apparent changes - relates to full personal protective equipment (PPE) when there is an outbreak at the facility. The guidance appears to suggest that full PPE must be worn throughout the building until 14 days pass since the last positive test result, instead of only in the area affected by the outbreak as under the former guidelines. It is not entirely clear, however, that CDC intended to change the guidance this radically. CDC does not call out a change either in the introduction to the new guidelines or in the section on outbreaks. Another possible interpretation is that CDC intended to recommend full PPE only until the first round of testing reveals the extent of the outbreak, which is the approach they and CMS took for visitation. We will continue to try to discern CDC's intent so we may inform members. In the meantime, please let us know immediately if you encounter surveyors interpretating the guidance stringently.

A Message from Mark Parkinson. Please see this message from AHCA/NCAL President/CEO Mark Parkinson sharing his perspective on the state of the SNF industry relative to COVID-19. He discusses cases, census, funding, vaccinations, and much more. The message was written before CMS released the payment rule after 4:00 p.m. today. Mr. Parkinson concludes with a paragraph that also reflects how we at OHCA feel:

The hardest parts of the pandemic are behind us. But this year will still be very tough. Economic recovery will be difficult, and we will continue to have obstacles thrown at us by our critics. But we will get through it. This sector is resilient and essential. And that’s just one of many reasons we are so fortunate to represent you in D.C. every single day. Hang in there, stay vigilant, and I hope to see you soon.

More Frequently-Asked Questions. These questions were in chat at the end of the SNF member call on Tuesday.

  • If you have a resident that requires a bipap and a cpap do they have to isolate indefinitely? Not unless they would require isolation anyway (e.g., COVID-19-positive, unvaccinated new admission).
  • If we have a positive resident that had no exposure to any other residents on their unit, can we move that resident to an isolation area and continue to allow residents on that unit to have visitors? No, not until outbreak testing every 3-7 days reveals no new positive results.
  • So in an outbreak, an employee would wear a mask, eye protection, and a gown in any patient care area? Switching only when going into isolation rooms? See the discussion above, "CDC on PPE for Outbreaks."
  • In regards to a quarantine after vacation, is it only in reference to travel to certain areas? And did you only say that was for people that are not vaccinated? CDC recommends 7-day self-quarantine following all travel for unvaccinated individuals, but not for vaccinated individuals. This is true regardless of the travel destination.

Long-Term COVID-19 Cases Back Down, Countering General Trend. The latest results on the state's COVID-19 dashboard for long-term care facilities show a total of 868 current cases, 89 fewer than last week. This differs from the state's overall numbers of 2,742 new cases today and a two-week cases-per-100,000 ratio of 183.7, up from 167.1 last week. The state attributes these increases to variants that apparently are not having a similar impact on facilities. The long-term care dashboard announced that the cumulative case totals (49,567 residents and 35,532 staff) were increased by previously unreported cumulative cases from the past.

PRF Use – A Refresher and Preparing for Reporting (from AHCA/NCAL). All recipients of Provider Relief Fund (PRF) payments must comply with the reporting requirements described in the Terms and Conditions and specified in directions issued by the U.S. Department of Health and Human Services (HHS) Secretary. Recipients of PRF payments exceeding $10,000 in aggregate must register in the Provider Relief Fund Reporting Portal. At present, there is no deadline for completing registration in the portal. Recipients will later receive a notification about when they should complete the second step of submitting reporting requirements information on the use of funds. The Health Resources and Services Administration (HRSA) will send a broadcast email to the email address you provide during the registration process.  The registration process will take at least 20 minutes to complete and must be completed in one session. You cannot save a partially complete registration. Make sure you have all of the information required to register before you begin. 

It is important to note that, as of now, PRF must be expended no later than June 30, 2021. HHS will provide directions in the future about how to return unused funds. HHS reserves the right to audit PRF recipients now or in the future, and is authorized to collect any PRF amounts that were overpaid or not used in a manner consistent with program requirements or applicable law. All payment recipients must attest to the Terms and Conditions, which require the submission of documentation to substantiate that these funds were used for health care-related expenses or lost revenue attributable to coronavirus.

More details on the reporting requirements can be found on the HHS webpage here. AHCA/NCAL also has available a pre-recorded webex on the January 15, 2021 PRF Reporting Registration instructions as well as the updated reporting guidance for members. The video recording includes detail on registration, important registration FAQs, recommended terms and conditions compliance controls and a PRF reporting update overview. Finally, AHCA/NCAL has a dedicated PRF webpage with resources and information you might find of assistance – including an AHCA/NCAL document that offers detail on u se of funds for health care related expenses and transfer of funds to higher need buildings. Please send any PRF related questions to COVID19@ahca.org.