New guide to NHSN reporting. The National Healthcare Safety Network (NHSN), the entity to which SNFs must begin reporting COVID-19 cases and other data, released a guide to the reporting portal with screenshots showing each step. In the guide, NHSN emphasizes that providers should report only new cases since their last submission. The guide also addresses reporting frequency, with preference for daily but allowing up to weekly (same day each week). On their COVID-19 reporting website, NHSN announced repeats of last week's trainings to be held tomorrow and Tuesday. Please go to the site to participate. As for when the requirements will take effect, AHCA reports that they expect the Centers for Medicare and Medicaid Services (CMS) rule on point to be published in the Federal Register Friday, May 8, which will become the effective date. Providers can begin reporting sooner if they wish.

CDC changes criteria for discontinuing transmission-based precautions and return to work. CDC revised its guidance on when health care workers with confirmed or suspected COVID-19 can return to work. CDC extended the length of time for workers with symptoms to return to work from 7 to 10 days after symptoms appeared and for asymptomatic workers who test positive, 10 days after the positive test. CDC also eliminated the stated preference for a test-based strategy. The agency made similar changes to its guidance on discontinuing transmission-based precautions for patients with confirmed or suspected COVID-19, although note that Ohio guidelines call for 14 days after symptoms appeared for patients who have not been tested.

CMS in effect delays proposed MDS changes for two years. In the same interim final rule as the transparency requirements for SNFs, CMS followed up on its March 19 announcement that it is not finalizing last December's proposed changes to MDS assessments this October. The new rule indicates that CMS will not require SNFs to collect and submit data elements specified in the new MDS versions until the first October 1st that is two years after the end of the public health emergency (see pages 162-164). This is good news for Ohio and other states that have RUGs-based Medicaid payments because CMS had proposed to eliminate Section G of the MDS, which is used for RUGs case-mix scores.

PPE burn rate calculator mobile app. The National Institute for Occupational Safety and Health (NIOSH) introduced a mobile app version of their Excel-based personal protective equipment (PPE) burn rate calculator. Go to the NIOSH page on this subject to download the app from the Apple or Google store or to download the Excel version. The calculator determines how long PPE will last given current inventory. This is one element of the required reporting both for the Department of Health and now for NHSN.

IRS reduces value of PPP loan forgiveness. One of the attractive features of the Paycheck Protection Program is that loans taken out under the program can be converted into grants based on how the loan proceeds are used. Unfortunately, an Internal Revenue Service notice lowers the value of loan forgiveness by specifying that the expenses used to obtain forgiveness cannot be deducted for federal income tax purposes.

A little more detail on latest blanket waivers for SNFs. As reported previously in our COVID-19 Updates, CMS issued a number of new blanket 1135 waivers, which are indicated in red on their updated list of all blanket waivers. The new waivers allow SNFs, during the course of the public health emergency, not to comply with the following Requirements of Participation (ROPs):

• Quality assurance and performance improvement (QAPI) requirements other than relative to adverse events and infection control.
• Nurse aide in-service training.
• Providing detailed information for discharge planning.
• Timeframe for providing a copy of a patient's medical record - this is extended to 10 days.

The following waivers apply to ICFs/IID as well as SNFs:

• Inspection, testing, and maintenance requirements under the Life Safety Code and Health Care Facilities Code, except sprinkler system fire pump testing, portable fire extinguisher inspections, elevators with firefighters’ emergency operations testing, emergency generator 30-continuous-minute testing and associated transfer switch testing, and means of egress daily inspection in areas that have undergone construction, repair, alterations or additions to ensure its ability to be used instantly in case of emergency.
• Outside window/door requirements for space temporarily used for patient care.
  

Please review the waiver language in conjunction with the applicable requirements so you know exactly what is waived and what is not. Please also note that the CMS waivers are for certification only and do not waive similar state licensure requirements (e.g., in-service training).