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We invite you to share your knowledge and expertise at our Spring PADONA Conference! Join us April 2 – 5, 2024 at the beautiful Hotel Hershey, where Pennsylvania leaders in post-acute senior services will gather for 4 days of learning, networking, relaxation, and fun! This is a great opportunity to showcase your expertise with 300 nursing home leaders across the Commonwealth.
The PADONA Call for Speakers 2024 Conference FINAL must be submitted by October 31, 2023.
Questions can be directed to Candace McMullen at email@example.com
On September 1, 2023, CMS issued a press release regarding the highly anticipated federal staffing mandates for nursing homes. The staffing mandates were initially discussed by President Joseph Biden in a state of the union address. Nursing home providers have been awaiting the announcement for some time. The proposed rule consists of three core staffing proposals that are staggered across a period of time. There is a 60-day comment period from the issue of the Federal Register outlining the staffing mandate proposal and several other items that impact nursing home providers. The Federal Register with the federal staffing mandate proposal is attached, along with the CMS press release from September 1 for your review.
The Centers for Medicare and Medicaid Services (CMS) has revised the MDS assessment used for the coding of resident data representative of care and services. This data is also used for the quality measures reports which impact the Five Star Quality Rating and for reimbursement for both skilled services through the Patient Driven Payment Model (PDPM) and Medicaid as part of the quarterly Case Mix Index (CMI) score. The MDS assessment data elements are also utilized to correlate to the person centered care plan. The revised MDS and all related item sets are now available on the CMS website and on the PANAC website at Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual | CMS and News | PANAC (paanac.net).
Additionally, CMS will no longer support the RUG classifications effective September 30, 2023. Pennsylvania will continue to utilize the RUG classifications for the Medicaid CMI quarterly reports for reimbursement. Thus Pennsylvania will begin using the Optional State Assessment (OSA) to collect data required to achieve the RUG classifications. The OSA will collect data in addition to the required OBRA MDS assessments. The OSA data set can also be found and reviewed on the CMS website.
The Pennsylvania state regulations have been revised for the first time in many years. These revisions include a stepped adjustment to required staffing mandates. The revised staffing mandates include both a PPD adjustment as well as inclusion of ratio requirements for RN, LPN and CNA staffing. Both must be achieved for compliance. Several updates were also made to update definitions to current terms and to align with federal and/or OAPSA definitions.
The revised state regulations, an education power point reviewing the regulations, regulation guidelines and FAQs regarding the revised regulations can be found on the PA state Department of Health website at Regulations (pa.gov).
Join us for our first ever Quality Symposium focused solely on practice standards for high risk / high volume care areas necessary to provide quality care and produce quality outcomes.
Virtual Platform – July 12 – 13
Session Topics Include:
*Pressure Ulcer/Injury Prevention and Management
* Trauma Informed Care
* Medication Management
* Pulmonary Assessment
* SBAR Use
* Incontinence Management
* Accident Prevention
CMS issued memos on May 8, 2023 regarding guidance for visitation in nursing homes and COVID-19 testing in nursing homes. The memos are Ref: QSO-20-39-NH (nursing home visitation) and Ref: QSO-20-38-NH (nursing home COVID-19 testing). Previous memos regarding these nursing home topics issued in 2020 during the pandemic have been either revised or expired as of the end of the Public Health Emergency declaration on May 11, 2023.
Please go to the CMS site to retrieve the memos for additional information.
Federal Trade Commission Proposed Rule on Non-Compete Clauses
Background On January 5, 2023, the Federal Trade Commission released a Notice of Proposed Rulemaking (NPRM) to prohibit employers from imposing noncompete clauses on workers. True to their name, non-competes block people from working for a competing employer, or starting a competing business, after their employment ends. Evidence shows that noncompete clauses bind about one in five American workers, approximately 30 million people. By preventing workers across the labor force from pursuing better opportunities that offer higher pay or better working conditions, and by preventing employers from hiring qualified workers bound by these contracts, non-competes hurt workers and harm competition.
Proposed Rule on Noncompete Clauses
Based on concerns about these harms to workers and to competition, the FTC has proposed a rule concerning non-competes.
- The rule would provide that noncompete clauses are an unfair method of competition. As a result, the rule would ban employers from entering noncompete clauses with their workers, including independent contractors.
- The rule would require employers to rescind existing noncompete clauses with workers and actively inform their employees that the contracts are no longer in effect.
- In the proposed rule, for which the agency invites comment, the FTC estimates that the rule would: o Increase workers’ earnings by nearly $300 billion per year o Save consumers up to $148 billion annually on health care costs o Double the number of companies founded by a former worker in the same industry
- The proposed rule seeks public comment on a number of topics, in particular: o Whether franchisees should be covered by the rule o Whether senior executives should be exempted from the rule, or subject to a rebuttable presumption rather than a ban o Whether low- and high-wage workers should be treated differently under the rule
Join our elite group of sponsors of our 35th Annual PADONA Conference and be part of our 35th year celebration!
We are grateful to the following business partners for their generous support of our conference!
Phoebe Pharmacy – Conference Bag Sponsor
Jewish Healthcare Foundation – Partial Virtual Conference Sponsor
Affinity Health Services – Party Band Sponsor
Pelican Insurance –Wednesday and Thursday Afternoon Coffeee Sponsor
CHR Consulting Services – Party Door Prize Sponsor
Premier Therapy – Registration Sponsor
PointClickCare – Partial Clinical Track Sponsor
Eshyft – Lanyard Sponsor
Diamond Pharmacy – Hand Sanitizer Sponsor
General Healthcare Resources – Educational Session Gift Card Giveaways
Brockie Pharmatech – Celebration Party Food Station
Remaining Conference Sponsorships 02.24.2023
All Sponsorships Include:
- ROUTINE EMAILS TO ATTENDEES
- ROUTINE SOCIAL MEDIA POSTINGS
- DISPLAY OF SPONSORSHIP DURING THE CONFERENCE
- HIGHLIGHT ON THE CONFERENCE PAGE OF THE PADONA WEBSITE
- SPONSORSHIP INCLUDED IN THE WELCOME/MORNING ANNOUNCEMENTS FROM THE EXECUTIVE DIRECTOR
- SPECIAL INVITATION TO PADONA EVENTS
SPONSORSHIPS AT THE $1500 LEVEL AND ABOVE RECEIVE 2 COMPLIMENTARY ATTENDEE REGISTRATIONS.
PADONA is a non-profit organization committed to serving nurse professionals working in long-term care. We commit to you by providing resources that promote higher education and additional learning opportunities to assist you as you care for Pennsylvania’s seniors. Each year, we offer three different types of nursing education scholarships for members in pursuit of additional education.
Primary PADONA members can apply for OR recommend an applicant for an educational scholarship for any one of the following opportunities:
- Scholarship Award towards a nursing degree;
- Scholarship Award toward annual convention attendance; and/or
- Scholarship Award toward our annual Leadership Development Course.
- be a Primary Member of the Pennsylvania Association Directors of Nursing Administration (PADONA) for two consecutive years.
- be recommended by a Primary Member of the Pennsylvania Association Directors of Nursing Administration (PADONA) who has been a member for two consecutive years.
- be a staff member or a family member of a Primary Member.
- have a Pennsylvania permanent address and be enrolled on a part time or full time basis in one of following programs:
– An NLN accredited LPN program.
– An NLN accredited diploma or associate RN program.
– An NLN accredited BSN program.
– An NLN accredited program leading to a master’s degree in nursing or nursing management.
– An NLN accredited program leading to a doctoral degree in nursing or nursing management.
– Other; or
- Apply for a scholarship to attend the annual spring conference; or
- Apply for a scholarship to attend the annual Leadership Development Program
Check out the link to our application and scholarship submission criteria on our website. You can also visit our scholarship page on the website at Scholarship – PADONA – Pennsylvania Association of Directors of Nursing Administration for additional information.
Applications must be submitted by January 31, 2023 to the PADONA Board of Directors. Please email applications and supporting documentation to Candace Jones at firstname.lastname@example.org or fax to 856-780-5149.
Centers for Disease Control and Prevention (CDC) Updates “Up to Date” Definition for COVID-19 Vaccines
Centers for Disease Control and Prevention (CDC) Updates “Up to Date” Definition for COVID-19 Vaccines
The Centers for Disease Control and Prevention (CDC) released a statement in November on their website under the COVID-19 information that updates the definition of being “up to date” with vaccines. This information is directly from the CDC website.
When Are You Up to Date?
You are up to date with your COVID-19 vaccines if you have completed a COVID-19 vaccine primary series and received the most recent booster dose recommended for you by CDC.
COVID-19 vaccine recommendations are based on three things:
- Your age
- The vaccine you first received, and
- The length of time since your last dose
People who are moderately or severely immunocompromised have different recommendations for COVID-19 vaccines.
You are still up to date if you receive all COVID-19 vaccine doses recommended for you and then become ill with COVID-19. You do not need to be immediately revaccinated or receive an additional booster.
Pennsylvania State Regulations for Long Term Care Revised
The Pennsylvania state regulations for Long Term Care providers have been revised and have been approved by the Independent regulatory review Commission. Pennsylvania state regulations were last revised by the department of health in 1997. Since that time there have been several revisions and updates to the federal regulations. These revised regulations provide an opportunity to reflect on the increased acuity of long term care residents with the intentions to improve resident quality of care, increase consistency between federal and state regulations, increase the efficiency of the state survey process, eliminate confusion in the application of standards and provide clarification for staffing minimums and ratios.
The revised state regulations are effective July 1, 2023 and can be found at: www.health.pa.gov under nursing homes and then clicking on regulations.
The Centers for Medicaid and Medicaid Services (CMS) has sent an revised memo related to staff vaccinations. There is information from the Pennsylvania Department of health related to staff vaccination and the definition of up to date with COVID-19 vaccinations.
The Centers for Medicare and Medicaid Services (CMS) has revised the Appendix PP of the State Operations Manual (SOM) with the final issue on October 26, 2022. The revised version includes changes in RED. These revisions were effective October 24, 2022. The revisions are important and should be reviewed to ensure compliance with federal regulations.
The Centers for Medicare and Medicaid Services (CMS) has updated the Focused Infection Control survey entrance conference checklist and the survey protocols. These updates are worthwhile reviewing and ensuring your facility is compliant with the requirements and prepared for a Focused Infection Control (FIC) survey.
Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19
At the beginning of the COVID-19 Public Health Emergency (PHE), CMS used emergency waiver authorities and various regulatory authorities to enable flexibilities so providers could rapidly respond to people impacted by COVID-19. CMS has developed a cross-cutting initiative to use a comprehensive, streamlined approach to reestablish certain health and safety standards and other financial and program requirements at the eventual end of the COVID-19 public health emergency.
This CMS cross-cutting initiative aims to evaluate CMS-issued PHE blanket waivers and flexibilities to prepare the health care system for operation after the PHE. This review is being done in three concurrent phases:
- CMS is assessing the need for continuing certain blanket waivers based on the current phase of the PHE. Since the beginning of the PHE, CMS has both added and terminated flexibilities and waivers as needed. In doing so, CMS considered the impacts on communities — including underserved communities — and the potential barriers and opportunities that the flexibilities may address.
- CMS is assessing which flexibilities would be most useful in a future PHE, such as natural and man-made disasters and other emergencies, to ensure a rapid response to future emergencies, both locally and nationally, or to address the unique needs of communities that may experience barriers to accessing health care.
- CMS is continuing to collaborate with federal partners and the health care industry to ensure that the health care system is holistically prepared for addressing future emergencies.
As CMS identifies barriers and opportunities for improvement, the needs of each person and community served will be considered and assessed with a health equity lens to ensure our analysis, stakeholder engagement, and policy decisions account for health equity impacts on members of underserved communities and health care professionals disproportionately serving these communities.
- The Interim Final Rule and waivers can be found at: Current emergencies | CMS
Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1765-F)
On July 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2023. In addition, the final rule includes updates for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program for FY 2023 and future years. CMS is publishing this final rule consistent with the legal requirements to update Medicare payment policies for nursing homes on an annual basis. This fact sheet discusses the major provisions of the final rule.
FY 2023 Updates to the SNF Payment Rates
CMS estimates that the aggregate impact of the payment policies in this final rule would result in an increase of 2.7%, or approximately $904 million, in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022. This estimate reflects a $1.7 billion increase resulting from the 5.1% update to the payment rates, which is based on a 3.9% SNF market basket increase plus a 1.5 percentage point market basket forecast error adjustment and less a 0.3 percentage point productivity adjustment (as required by law), as well as a negative 2.3% (or $780 million decrease) in the FY 2023 SNF PPS rates as a result of the recalibrated parity adjustment, which is being phased in over two years. These impact figures do not incorporate the SNF VBP reductions for certain SNFs. These reductions are estimated to be $186 million in FY 2023.
On June 29, 2022, CMS sent a memo to the State Survey Agency Directors providing revisions, clarifications and new guidance on the Requirements of Participation (RoP) that is effective October 24, 2022.
The revised guidance includes changes to the following:
F600, F607, F608, F609, F610 – all related to the freedom from abuse, neglect and misappropriation;
F622 related to admission, transfer and discharge;
F812 related to food and nutrition;
F689. F740 and F741 – related to mental health and substance use disorder (SUD);
F725 – related to nursing service staffing and specifically sufficient staff;
F61, F557, F563 and F582 – all related to resident rights;
F641, F658, F659 and F758 – related to comprehensive person-centered care plans and potential inaccurate diagnosis and/or assessment;
F755 and F757 related to pharmacy;
F880, F881 and F882 – related to infection control;
F847, F848 and F851 – related to administration;
F940, F941, F944, F945, F946 and F949 – related to training practices including infection prevention training and ethics training;
F910 and F919 related to physical environment;
F699 related to quality of care;
F865, F867, F687, F687, F687 and F868 related to QAPI with multiple additional requirements; and
State Operations Manual Chapter 5 have all been revised, updated or additional material has been added.
Please see details at: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/revised-long-term-care-surveyor-guidance-revisions-surveyor-guidance-phases-2-3-arbitration
The COVID-19 Public Health Emergency (PHE) was extended for another ninety (90) days on Friday, July 15, 2022. The PHE was initially declared on January 27, 2020 and has been renewed continuously since then. The extension of the PHE declaration was made partially because of the recent increase in COVID-19 cases and hospitalizations in the country, as well as in Pennsylvania. Some waivers that were initially implemented with the start of the PHE declaration have been or soon will be terminated. Please check the CMS website for a list of terminated or winding waivers. The waiver for the three day qualifying stay waiver does remain in place.
The Centers for Disease Control (CDC) on Tuesday July 12 released updated guidance on enhanced barrier precautions (EBP) in nursing homes related to the threat of multidrug-resistant organisms (MDRO). The guidance expands the use of gowns and gloves during high-contact resident care activities. Nursing home residents are at high risk for MDRO colonization which places them at high risk for serious illness. The use of EBP should now extend to any resident with an indwelling medical device or wound, regardless of MDRO colonization or infection status. The CDC cautioned that the new guidance does not replace existing recommendations for contact precautions. More information can be found on the CDC website at https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html.
Prevalence high in LTC
Nursing home residents have a high prevalence of MDRO colonization, putting them at risk for becoming seriously ill, according to CDC data. In fact, one large study across nursing homes found that almost 6 in 10 residents in facilities that are not ventilator capable were colonized with an MDRO. In ventilator-capable nursing homes, which care for the most complex residents, that proportion rose to 76%, or nearly 80 in 100 residents colonized with these organisms, according to Kara Jacobs Slifka, M.D., MPH.
Most of these colonizations remain undetected, Slifka, a medical officer with the CDC’s Infection Prevention and Control Response Team, said in a Wednesday nursing home stakeholder call. But transmission of these bugs, which can occur during patient care, contributes to “substantial resident morbidity and mortality” in nursing facilities, the CDC stated in an updated webpage at https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html
Apply EBP broadly
The new implementation guidance addresses this risk by expanding the range of residents for whom EBP use applies. EBP is no longer limited to outbreaks or specific MDROs and should be applied more broadly, Slifka said.
Along with residents who have an infection or colonization with an MDRO, the use of EBP should now extend to any resident with an indwelling medical device or wound, the new guidance stated. For these residents, EBP should be used no matter their MDRO colonization or infection status, and in most situations, EBP should be continued throughout the duration of the resident’s stay. The CDC also expanded the types of MDROs it includes in its EBP recommendations. Details on specific organisms can be found on the updated webpage. The new guidance does not replace existing recommendations on the use of contact precautions for other pathogens in nursing homes such as Clostridioides difficile and norovirus, the agency added.
Getting it right
Staff training and ready supplies are critical to getting these precautions right, the CDC further noted. The updated guidance includes practical suggestions for encouraging awareness of the facility’s expectations and increasing on-the-ground availability of supplies.
“Effective implementation of EBP requires staff training on the proper use of personal protective equipment (PPE) and the availability of PPE and hand hygiene supplies at the point of care,” the CDC stated.
The new guidance can be found on the CDC’s website at https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html
The Centers for Medicare & Medicaid Services has held audiences with skilled nursing providers, made presentations and entertained comments in recent months to assure operators that regulatory actions are being done with best intentions.
But there’s one area that remains a particularly sore spot with nursing home operators, and that point was re-emphasized at the recent NADONA annual meeting in New Orleans.
State surveyors do not have to be vaccinated against COVID-19 to enter any nursing home, the CMS nursing home division chief told dismayed nurse leaders during a live video address last week.
“I can’t go into much of the details. It basically came down to our authority of what we can and can’t do,” said Evan Shulman, director of CMS’ nursing home division, to heads shaking in disappointment. “I understand where you’re coming from, but at the end of the day, this is the direction we had to go in. For you all, you need to let the surveyors in.”
Providers have been incredulous that while the U.S. Supreme Court upheld a CMS requirement that healthcare workers either be vaccinated or receive a waiver, surveyors are under no such obligation. Worse, they could visit multiple facilities in a given week, acting as unknowing, asymptomatic spreaders, as occurred in the very first US outbreaks in Seattle-area long-term care facilities in 2020.
“If you have any concerns about [surveyors], about, for example, wearing PPE, just reach out to the state survey agency,” Shulman advised. “But it’s the direction we need to go in.”
In addition, providers may not require surveyors to be tested for COVID before entering a building, he added. CMS in mid-June rescinded guidance that said surveyors who aren’t fully vaccinated shouldn’t be part of the onsite survey team when inspecting certified providers.
“No, you need to let the surveyor in,” he explained to rising murmurs of dissatisfaction. “If you have concerns, reach out to your state survey agency. You can ask [surveyors to test] but you cannot block them.”
Leaders at LeadingAge received similar responses after inquiring with CMS.
“Providers may inquire about the vaccination status of a surveyor, may offer testing to the surveyor, and may request the surveyor to wear [PPE] such as a respirator for source control,” Jodi Eyigor, LeadingAge’s director of nursing home quality and policy, wrote in a blog post late last week. “Note, however, that the surveyor may refuse these provisions including refusing to disclose vaccination status, refusing testing, or refusing PPE such as a respirator, and other extra precautions.”
Federal data as of mid-June shows 87% of nursing home staff have completed their primary vaccination series, while 87.6% of residents have done the same.
In his NADONA address, Shulman addressed numerous topics that would be more fully and formally introduced in final guidance about the Phase 3 Requirements of Participation that was released the next day.
Another of the touchier topics was the concern some providers have about being able to get temporary nurse aides properly tested by CMS’s Oct. 6 deadline. The agency took away a pandemic-induced aide-training waiver earlier this spring.
“This is a very, very delicate balance, folks, I’m going to be completely candid,” Shulman acknowledged during his long-distance address. “On one hand, we do not want to create barriers for facilities to retain staff. On the other hand, we are seeing significant issues related to staff not being trained and certified. We want to be very careful about how we proceed here. We’re going to try to thread that needle the best we can.”
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