MDS Alert

Know which red tape has been cut, and which guidance has evolved.

The Centers for Medicare & Medicaid Services (CMS) is trying to make things easier for facilities amidst the pandemic by providing more guidance for testing for the SARS-CoV-2, the virus that causes COVID-19, as well as simplifying some of the backend administrative logistics of vaccinating residents.

If you’re curious how your facility’s approach to vaccinating staff compares with others, read on for more information.

Understand This Bundling Discretion Measure

In a recent announcement, CMS stated it will allow some entities to be directly reimbursed for vaccinating skilled nursing residents, saying: “… in order to facilitate the efficient administration of COVID-19 vaccines to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance (collectively, ‘SNF Consolidated Billing Provisions’). Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.”

See the full notice online at www.cms.gov/medicare/covid-19/snf-enforcement-discretion-relating-certain-pharmacy-billing.

Consider Ramifications of Paying Staff to Get Vaccinated

Nursing facilities struggling with gaining staff buy-in for COVID-19 vaccinations may want to borrow a page from a Houston, Texas, hospital’s playbook.

Houston Methodist is offering a $500 “hope bonus” to employees who agree to receive the vaccination, reports ABC News. Similarly, Northampton County in Pennsylvania is offering employees at Gracedale, the county nursing home, $750 each to get a COVID-19 vaccine, ABC News says.

Other businesses are hopping on the money-for-vaccination bandwagon, too, with reports in national media outlets of Dollar General and Trader Joe’s grocery store paying employees to get vaccinated.

The tactic comes with pros, cons, and ethical gray areas. For example, it may lead staff to think the vaccine is more dangerous than it is, medical ethicists warn.

Conversely, there have been some reports of nursing homes firing staff who refuse to get vaccinated. The Janesville, Wisconsin, GazetteXtra reports that the local, county nursing home will lay off staff members who do not get vaccinated, but also notes that some area private nursing homes are not requiring vaccination.

For more information on whether to make vaccination a mandate, see “Understand How COVID-19 Vaccines Might Impact NFs” in AAPC’s MDS Alert, Volume 19, No. 1.

Know These Changes to Antigen Testing Recs

The Centers for Disease Control and Prevention (CDC) has updated some of its guidance for antigen testing in long-term care facilities. Antigen testing allows a rapid turnaround for results, making it an important and helpful tool in identifying positive cases and preventing outbreaks.

One major takeaway: “Asymptomatic people who test antigen positive should have a confirmatory test performed. Symptomatic people who test antigen negative should have a confirmatory test performed,” the CDC says.

Resource: See this flowchart for a visually simplified way to figure out when to use antigen testing for symptomatic and asymptomatic residents: www.cdc.gov/coronavirus/2019-ncov/downloads/hcp/nursing-home-testing-algorithm-508.pdf.

Keep an Eye on Care Compare

Don’t forget that Care Compare, the newest iteration of Nursing Home Compare, has again began incorporating inspections that had been paused since the beginning of the public health emergency (PHE) in March 2020.

Background: On March 23, 2020, CMS “suspended certain inspections, including standard, fire, and safety inspections, while also implementing a new focused infection control inspection process to concentrate on preventing the spread of COVID-19. CMS began posting the reports and findings from the focused infection control inspections through a link on the Nursing Home Compare website. Since certain inspections were suspended, CMS held the Health Inspection Rating domain of the Five Star Quality Rating System constant,” says David Wright, director of quality, safety & oversight at CMS.