LTC COVID-19 CALL Wednesday June 3rd, 2020



Here are Care Providers Oklahoma latest updates as of June 3, 2020?????Virtual Spring Convention is LIVE!??27?hours of NAB approved continuing education available for licensed long-term care administrators?and 7.75 hours have been approved for Certified Dietary Managers.??Sessions available for Administration, Nursing, Food Service, Environmental Services, MDS Coordinators, ICF-IID, and Home Care Administration.? Our Virtual Trade Show also offers information on products and services offered to the Long-Term Care Industry.? Our Business Associate Members and vendors have provided information to our attendees via Company Promotional Videos, Podcast Interviews, Article submissions and more.?PLEASE click on the different vendors and view their Videos – Lots of great content!!! ???This virtual convention and trade show will be conducted the whole month of June.? IMPORTANT: Please register on the LMS using the same e-mail address your redemption code was sent to. All codes for those that registered have been issued. If you have not yet received your code, please contact Natashia Mason. You will be able to watch recorded webinars and view vendor information at your leisure.? All webinars and quiz's must be completed, and payment received by July 15 or CEU’s will not be submitted.??We are excited to offer this FIRST EVER virtual convention and trade show and we look forward to receiving feedback.??Each registrant will receive a FREE convention t-shirt! Additional t-shirts will be available for purchase for $15??Registration NOW OPEN!? Register online at?2020-conference??Insurance observers worried about the future of Insure OklahomaThe Oklahoma Health Care Authority has suspended the phaseout of the Insure Oklahoma program as the agency and state leaders work with the Centers for Medicare & Medicaid Services to evaluate available options for delivering quality health care to Oklahomans. An 18-year-old public-private, state health insurance program — on which thousands of small employers in Oklahoma rely to provide health insurance to their low-income workers for as little as $80 a month — may end if Oklahomans vote to expand Medicaid next month. AHCA/NCAL National Quality Award Program Renewal PolicyWhen an applicant becomes an award recipient, the terms and conditions of the renewal policy must be met in order to maintain active recipient status. Active recipients are considered to be performing at a level appropriate to their award designation and maintaining continuous quality improvement within their organization. The conditions to be an active recipient are outlined by award level here.Update on 71st AHCA/NCAL Convention?The?COVID-19 pandemic has presented our profession with extraordinary challenges, and?AHCA/NCAL has?been analyzing the feasibility of continuing to hold?their?convention as planned, factoring in travel bans, social distancing mandates, limits to the size of gatherings, and the uncertainty of the virus numbers in the fall.???ACHA/NCAL recognizes?that you and your staff are on the front lines working tirelessly to protect the residents in your care. This will likely continue until there is an effective vaccine, viable therapeutic, and/or an organized contact tracing program. To protect the health of all attendees, as well as your residents and staff back home, AHCA/NCAL has decided to offer the 71st Convention & Expo as a virtual event.??Although this decision will change the way we gather this year, we know that it is still necessary and important to share experiences and knowledge with each other during this challenging time. AHCA/NCAL is committed to working with you, as well as faculty, sponsors, exhibitors, and other stakeholders, to deliver an impactful, engaging, and valuable experience this fall.??Announcement on National Assisted Living WeekThis year, NALW will take place September 13- 19, 2020. The theme, “Caring is EssentiAL,” is more relevant today than in recent years and highlights the incredible care provided by essential caregivers in assisted living communities across the country. Additional information will be available on NCAL website in the coming weeks, so make sure to visit and continue to check back on the NALW page. Clarifies June 3 Attestation DeadlineHHS has clarified the June 3 Attestation deadline for providers to submit revenue data. Providers who have received a Tranche 1 allocation and are requesting additional Tranche 1 funding must provide their financial information by 6/3/20.AHCA continues to work with HHS to secure additional information. Provider-specific questions or challenges to HHS should be directed to the Provider Hotline at (866) 569-3522.Below is the AHCA Bulletin with additional questions related to each Tranche payment.June 3 Attestation Deadline Applies Only to Medicare FFS Provider Relief Payment?The U.S. Department of Health and Human Services clarified?that the June 3 deadline?for providers to submit revenue data:Is?only for?providers who received a Tranche 1 allocation and would like to submit financial information to receive additional Tranche 1 funding.?Providers would still be required to?ensure?that their General Distribution payment is the lesser of 2% of their provider net revenue or the sum of incurred losses for March and April.Below is the relevant HHS?webpage?text:???ALERT:?Providers need to take action by [TOMORROW,] June 3, 2020 ?Providers must submit revenue information to the?General Distribution Portal?by June 3, 2020?to be considered for an additional payment from the Provider Relief Fund $20 billion General Distribution. Once?providers submit their revenue information by June 3, 2020, if deemed qualified for additional payment, providers will then have 90 days from receipt of payment of the additional General Distribution funds to agree to the program Terms and Conditions.AHCA/NCAL recognizes how challenging the lack of guidance is for members. The Association is working with HHS to secure additional information. ?All?other?questions about the fund should be directed to HHS Hotline at (866) 569-3522. HHS reported on May 22 that the call center now has access to additional data and new HHS guidance to better answer questions.Tranche by Tranche QuestionsTranche 1: HHS as provided the formula and allocation process in its FAQs. The data source for the award amounts was 2019 Medicare Part A Fee-For-Service (FFS) net revenue. ?Tranche 2: As above, HHS has provided?the formula for Tranche 2 in its?FAQs.?Of note, HHS explains why a provider who received a Tranche 1 award may not have received a Tranche 2 award. The data source for Tranche 2 was 2018 Medicare Cost Report. ?Tranche 3 (SNF-Only): All SNFs with Medicare-certified beds should have received an allocation on May 22. If the SNF did not receive an allocation this could be because:it?is a Medicaid-only or private pay only facility; orerrors in HHS’ data source (April 2020 CASPER Report).If the SNF believes they should have received a Tranche 3 award or received the incorrect amount, they should contact the Hotline (above) and have the following information ready:Tax Identification Number(s) (TIN)CMS Certification Number(s) (CCN)Dollar amount in question by building?Also, for Tranche 3, the SNF Allocation, have the number of SNF certified beds (Medicare, Medicaid or both), the amount they received and the amount they believe they should have received. ?At this point, the above information is all HHS has shared. AHCA/NCAL continues to request clarification on Change in Ownership, TINs and reporting window information.?COVID-19 Update #73 | CMS Releases NHSN Data and Guidance on Related Survey ActivityOn June 1, CMS released a memorandum (QSO-20-31-ALL) addressing NHSN data, COVID-19 survey activities, enhanced enforcement, and engagement of Quality Improvement Organizations (QIOs). This guidance is effective immediately and will cease to be in effect when the Secretary determines there is no longer a Public Health Emergency due to COVID-19.Other COVID-19 UpdatesSupporting Your Loved One in a Long-Term Care Facility: CDC released a fact sheet on Supporting Loved Ones in a Long-Term Care Facility providers can share with residents’ families. The fact sheet includes ideas on how to keep in touch and ways providers are supporting communication between residents and their families.SNF Therapy Telehealth Waivers and other Updated COVID-19 Billing FAQ UpdatesCMS provided important updates to coverage and billing guidance impacting SNF related to COVID-19 1135 waivers. AHCA/NCAL has developed therapy telehealth waivers FAQs that address questions that SNF and AL members may have regarding applying these waivers to improveresident mobility care needs.CMS Updates Guidance on Proper Use of COVID-19 Waivers Claim CodesOn June 1, CMS issued updated guidance clarifications for using the “DR” Condition Code and “CR” modifier on Medicare fee-for-service claims for services furnished under COVID-19 Section 1135 waivers such as the SNF specific 3-day stay and spell-of-illness waivers.LTC COVID-19 Informational CallLTC COVID-19 CALL Wednesday June 3rd, 2020 The Oklahoma State Department of Health, Regulation, Prevention and Preparedness will be hosting a COVID-19 webinar on Wednesday, June 3rd?from 1:00 to 2:30. The webinar will include information and discussion of the Novel Coronavirus COVID-19 including current guidance, best practices and questions and answer.? The webinar is open to Owners, Operators, Administrator and Executive Staff of Nursing Homes, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Continuum of Care Facilities, Assisted Living Centers, Residential Care Homes and Adult Day Care Centers.?Access InformationUSA Toll-Free: 888-363-4735Access Code:? 1177868Youth Employment Webinar??FREE?YouthRules?webinar on?Tuesday, June 2, at 11 am.??The program is in cooperation with the Oklahoma Small Business Development Center, and Lester?Claravall?from the Oklahoma Department of Labor & Jessica Parker from the US Department of Labor will be presenting.?????Do you employee summer workers? Learn more about youth employment topics such as rules, duties, and record keeping requirements that will keep your business in compliance and your young workers safe. If you will be hiring youth workers for the summer, or if you know anyone who wants more information about youth employment, register and share this event!?????Registration through OK SBDC is required. Click?here?to sign up!???Get more information about youth employment from?agencies/whd/child-labor?or?.??????PDPM Master Class Series Today! REGISTRATION CLOSES at NOON#6 Care Planning for the Complex Resident Under PDPM Presentation Date: June 2, 2020 (#W2021)Time: 1:30 P.M to 2:45 P.M. CST Cost: Member $56.65/Non-Member $113.30**Facilities are allowed an unlimited number of participants but only 1 person may receive CE credit per registration Webinar payment is by credit card only and MUST be paid prior to the start of the webinar.Presented By: Shelly Maffia, MSN, MBA, RN, LNHA, QCP Director of Regulatory Services Eleisha Wilkes, RN, RAC-CT Clinical Consultant Amie Martin, OTR/L, CHC, RAC-CT Clinical Consultant Kristen Walden, RN, MSN, RAC-CT Clinical Consultant Contact Person: Shelly Maffia 812-719-0452 smaffia@Proactive Medical Review and Consulting Natashia Mason 405-524-8338 natashia@Care Providers Oklahoma Course Description: This session of the PDPM Master Class Series will review regulatory requirements related to Baseline and Comprehensive care planning with focus on developing effective person-centered care plans that address complex care and services provided. This webinar will focus on ensuring appropriate care plan development related to the resident’s SNF admitting diagnosis and PDPM Clinical Category, comorbid conditions, and skilled services provided to promote positive resident outcomes and support coding decisions on the initial Medicare assessment. Learning Objectives:1.Review regulatory requirements related to Baseline and Comprehensive care planning2.Identify potential care planning needs that will address the resident’s SNF admitting diagnosis and PDPM Clinical Category as well as comorbid conditions and services provided3.Develop processes to promote effective baseline care planning and support coding decisions on the initial Medicare assessmentCourse Content:20 minutesOverview of regulatory requirements related to care planning30 minutes Review of PDPM Clinical Categories and care planning considerations for primary diagnosis, comorbidities, and complex conditions20 minutesDiscuss best practices, facility processes, and key strategies to promote effective and accurate care planning to promote positive resident outcomes and support MDS coding5 minutesClosing Comments/Q&ATarget Audience: Administrators, Directors of Nursing, Nursing, QA, MDS, Staff Development, Therapy, Social Services, Board MembersInstructional Level: Intermediate Contact Hours: 1.25REGISTER ON-LINE AT WWW.WEBINARSICD-10 Diagnosis Coding Training (#W2051)???This class will be an in-depth review of intermediate ICD-10 coding process. Training will include practice of coding, to ensure attendees comprehension of objectives reviewed.???Training Objectives:???Review of intermediate ICD-10 principles???Chapter specific guidelines pertinent to the Skilled Nursing Facility setting???“Real World” Coding Examples???When:?June 9, 2020???Where:?Webinar - Online???Class:?9:00am – 12:00pm????Cost:?$77.25 member without CEU’s /$180.25 non-member without CEU’s?????????????? $103.00 member with CEU’s / $206.00 non-member with CEU’s????Speaker:?Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, is the President of Celtic Consulting, LLC and CEO and founder of Care Transitions, LLP; a post discharge care management service provider. Maureen has been a registered nurse for over 30 years with experience as an MDS Coordinator, Director of Nursing, Rehab?Director?and a Medicare Biller. She sits on the Board of Directors for the American Association of Post-Acute Care Nurses (AAPACN) and is an Expert Advisory Panel member for American Association of Nurse Assessment Coordination (AANAC). McCarthy was recently presented with the ACHCA 2018 Education Award, at the ACHCA Annual Convocation & Exposition in Orlando, FL. McCarthy is dually certified in both the resident assessment process and QAPI by nationally recognized organizations and holds Master Teacher status in both.???CEU’s: 3 hours of continuing education for RCAL/NH/ADC Administrators. This program has been approved for Continuing Education for 3 total participant hours by NAB/NCERS –Approval #20210508-3.00-A67285-DL. Care Providers Oklahoma will submit CEU’s to NAB. Only 1 person per registration may receive CEU’s.????Register Online –?Webinars???Back to Basics Webinar Series #5 Fall Prevention and Management (#W2022)Presented by Linda Farrar, LNHADate: June 11, 2020 Time: 2:00PM to 3:15PM CST Cost: Member CEU - $56.65 / Non-Member CEU - $113.30 Course Description: Falls continue to be a major and dominant risk for residents in long term care facilities. A “best practice” fall management program includes appropriate fall risk assessment, appropriate individualized fall prevention care planning, appropriate treatment if a fall occurs, appropriate and effective root cause analysis, and appropriate fall prevention intervention care plan revisions. The key to effective fall prevention is a true Interdisciplinary process. This webinar will focus on all aspects of effective fall prevention and management process Objectives:1.Participants will demonstrate understanding of the fall risk assessment process2.Participants will demonstrate understanding of how to implement effective fall prevention strategies for individual residents3.Participants will demonstrate understanding of how to perform a post-fall investigation after a fall4.Participants will demonstrate understanding of appropriate post-fall care plan revision(s)Target Audience: Administrators, Director of Nursing, Assistant Director of Nursing, Nurse Managers, Quality Improvement Nurses, Registered Nurses, QAPI PersonnelLinda Farrar, LNHA, RN has dedicated her professional career to providing elders in senior living centers with quality of life and quality of care. Linda has served in the roles of Administrator, Executive Director, Executive Management and Chief Operating Officer. In July, 2011, Linda retired from her full-time position to enable her the time to enhance her work with elders in a consulting role. During her career, Linda’s passion has been person-centered/person-directed care. Linda believes that through education of staff, primarily direct-care staff, facilities can provide both quality of care and thus remain regulatory compliant AND provides quality of life, providing enhanced, personal experiences for elders served. CEU’s: 1.25 hours of continuing education for RCAL/NH/ADC Administrators. This program has been approved for Continuing Education for 1.25 total participant hours by NAB/NCERS. Approval # 20210610-1.25-A62673-DL Only those attending the entire call will be awarded education credit. Only 1 person may receive CE credit per registration.REGISTER ON-LINE AT WWW.WEBINARSStimulus and Relief Funds Generated by the CARES Act??Presented by Chris Murphy, CPA & Angie?Tye, CPA??Date:?June 15, 2020??Time:?3:30PM – 4:30PM CST??Cost:?FREE??Course Description:??Stimulus and relief funds generated by the CARES Act have provided both welcome funding?and?significant anxiety for skilled nursing services providers (SNFs).? In this webinar, representatives from BKD will discuss two of the most common sources of COVID-19 funds: The Paycheck Protection Program (PPP) and the Public Health & Social Services Emergency Fund (PHSSEF).? For each program we will discuss the purpose of the funds received, attestation and reporting requirements.? Speakers will also recommend processes for estimating lost revenue, tracking COVID-related expenses, and matching those elements with funds received.??Speakers:??Chris Murphy?a member of BKD National Health Care Group primarily serves as a trusted advisor to health care providers, including post-acute care providers, nursing facilities and other senior services providers, home care agencies,?hospitals?and physicians.?While he currently focuses primarily on operational and Medicare and Medicaid reimbursement consulting services, he has experience with financial statement audits, accounting outsourcing services, Medicare and Medicaid compliance services and Medicaid rate setting. Most recently, Chris has been instrumental in BKD’s thought leadership surrounding Medicare’s Patient-Driven Payment Model (PDPM) which will replace a 20-year old payment system on October 1, 2019.? He has written articles, provided training to provider groups and developed tools to help skilled nursing services providers implement the new program.??Angie?Tye?has more than 23 years of public accounting experience.? She provides tax planning,?compliance?and consulting services to a variety of businesses, primarily in the retail, manufacturing and energy industries, as well as high-wealth individuals.? Angie assists in the training and development of new BKD professionals. Prior to joining BKD, she performed tax accounting with a publicly traded bank for four years. Angie is a member of the American Institute of CPAs and Oklahoma Society of CPAs. She is a board member of Big Brothers Big Sisters of Oklahoma, participates with the Oklahoma Business Ethics Consortium and supports Tulsa Area United Way.? Angie was honored as one of 50 Making a Difference as part of The Journal Record’s Woman of the Year awards program and as a 2015 Woman of Distinction by Tulsa Business & Legal News.? She is a graduate of Leadership Tulsa Class 54. Angie is a graduate of Oklahoma State University, Stillwater, with an?M.Acc. degree and a B.S. degree in accounting.???Register Here:? Insights: Achieve 5-Star in 202010-Part Webinar Series#4 5-Star QM’s: Catheter, UTIPresentation Date: June 17, 2020 (#W2023)Time: 1:30 P.M to 2:45 P.M. CSTCost: Member $56.65/Non-Member $113.30**Facilities are allowed an unlimited number of participants but only 1 person may receive CE credit per registration Webinar payment is by credit card only and MUST be paid prior to the start of the webinar.Presented By: Shelly Maffia, MSN, MBA, RN, LNHA, QCP Director of Regulatory Services Director of Regulatory Services for Proactive Medical Review & Consulting, with over 15 years of leadership and consulting experience, Shelly has held positions as DON, NHA, Corporate Nurse Consultant, and Training Positions. Currently Shelly provides consultation on regulatory compliance to nursing facilities in multiple states. Her expertise includes developing clinical training tools, policies, procedures, protocols and training programs on systems, processes and best practices. Shelly is also a QAPI Certified Professional (QCP) through the American Association of Nurse Assessment Coordinators. Contact Person: Shelly Maffia 812-719-0452 smaffia@ Proactive Medical Review and Consulting Natashia Mason 405-524-8338 natashia@ Care Providers OklahomaCourse Description: This session will review the UTI and catheter insert/left in bladder quality measures that impact the Quality Measure component of the Nursing Home Compare Five-Star Quality Rating system. During the session, we will review how these measures are calculated and how they impact your overall Five-Star Quality Rating. The session will focus on best practices for reducing urinary tract infections and unnecessary catheter use in your facility and how to improve these measures using a QAPI framework with emphasis on reduction of common MDS coding errors and implementation of a facility specific Five Star road map action plan. Learning Objectives:1. Understand how the UTI and catheter insert/left in bladder quality measure are calculated and impact the Five-Star Quality Rating score2.Describe best practices for reducing UTIs and catheter use and improving your Five-Star Quality Rating score3.Describe a process for establishing priority QAPI goals and actions to improve the UTIs and catheter insert/left in bladder quality measureCourse Content: 30 min Review of the UTI and catheter insert/left in bladder quality measures and impact on 5-Star RatingPercent of residents with UTIs or cathetersAcceptable diagnoses for catheter use and effective documentation and monitoring of catheter use and careEnsuring appropriate MDS coding per the RAI manual for UTIReview of an antibiotic stewardship program to assure appropriate use of antibioticsHow to calculate UTI and catheter insert/left in bladder quality measure scores in the 5-Star Rating system20 min Best practices related to infection control and UTI prevention and the new RoP for infection control 20 min Developing a QAPI plan based on antipsychotic medications quality measures data analysisPIP TeamEstablishing goals for implementationIdentification of tools for evaluating and monitoring compliancePlan for monitoring complianceImplementation of changes that will result in 5-Star improvement5 min Closing Comments/ Q&A Target Audience: Director of Nursing, Assistant Director of Nursing, Nurse Managers, Nursing Home Administrators, Nursing staff and leaders, Quality Assurance Director, Social Services, Rehabilitation services Instructional Level: Intermediate Contact Hours: 1.25CEU’s: 1.25 hours of continuing education for RCAL/NH/ADC Administrators. This program has been submitted for Continuing Education for 1.25 total participant hours by NAB/NCERS. Only those attending the entire call will be awarded education credit. Only 1 person may receive CE credit per registration. Proactive will submit CEU’s to NAB.Refunds will only be given if Care Providers Oklahoma is notified prior to the start of the webinar.Webinar registration may be transferred to another individual within the same organization.ProActive will submit CEU’s to NAB. Care Providers Oklahoma will NOT issue certificates of completion for the webinar. You may check your CEU’s through NAB.REGISTER ON-LINE AT WWW.WEBINARSCare Providers Oklahoma NOW OFFERING CMA 8-hour Update class online!???Care Providers Oklahoma is now offering?on demand education?including the?CMA 8-hour update.? The?class is?$55. Simply login to? click Get Started to create an account - search for the course "CMA" to purchase and?complete anywhere - anytime.???????NEWS: State of Oklahoma tests nearly 36,000 long-term care facility residents and staff during month of MayOKLAHOMA CITY (June 2, 2020) – Governor Kevin Stitt announced today the Governor’s Solution Task Force and the Oklahoma State Department of Health tested more than 35,800 residents and staff at 265 nursing homes and long-term care facilities across Oklahoma during the month of May.Ahead of the initial goal of May 31, the State tested all facilities that already had a confirmed case of COVID-19 as well as facilities that had residents and/or staff reporting symptoms.Of this nursing home and long-term care facility population, 3.18% of tests returned with a positive result, equaling to 714 residents and 428 staff members.OSDH expects to conclude testing on the remaining nursing homes and long-term care facilities by the end of the week. “Thanks to hardworking public employees and health care professionals across the state, we were able to quadruple our overall COVID-19 testing in May,” said Gov. Stitt. “They quickly and successfully adapted to this remarkable increase in workload, and we are in the midst of improving our infrastructure and expanding staffing to ensure we can maintain this momentum.”Currently, 91 facilities in Oklahoma have had at least one positive case of COVID-19. Of these facilities, 98% were found to be following CDC guidelines and only two were reported for violations, which have been appropriately documented and partnerships formed to help these facilities adjust practices and enhance services for their residents.The Governor’s Solution Task Force continues to provide PPE to long-term care facilities and is developing a plan for continued surveillance testing. Additionally, teams from the Oklahoma National Guard have partnered with the OSDH to professionally sanitize facilities, and the State has helped some facilities secure alternative locations to isolate and quarantine . Stitt and interim Commissioner Lance Frye provided additional information to Senate Minority Leader Kay Floyd in a letter, which can be found here. CMS Announces Potential Fines Up To $20K For LTC Infection Control DeficienciesMcKnight’s Long Term Care News (6/2, Brown) reports, "Providers struggling to comply with infection control requirements could be looking at fines of up to $20,000 under increased enforcement efforts announced Monday by the Centers for Medicare & Medicaid Services in the wake of the coronavirus pandemic." The "fines increase for providers that consistently perform poorly on infection control measures, according to CMS." AHCA/NCAL president and CEO Mark Parkinson "warned against the effect of punitive actions," saying, "Citations and fines without assistance will not help us keep residents and staff safe from this virus." ??????? Skilled Nursing News (6/1, Spanko) reports, "SNFs that receive an infection control deficiency citation when they have no previous history of citations for infection control will only have to submit a directed plan of correction if the violation is not widespread." Moreover, "SNFs with a similarly spotless infection control history that do have a widespread issue of noncompliance would face both a plan of correction and discretionary denial of payment for new admissions." In addition, "CMS will also use $80 million in CARES Act funding for State Survey Agencies (SSAs) as a carrot and a stick as officials push states to perform 100% of required infection control surveys by the end of July."Weakened immune system leaves elderly prone to the virusAt every stage and in every impacted nation, COVID-19 has struck the elderly hardest.According to the Centers for Disease Control and Prevention, 8 out of every 10 COVID-19 deaths in the U.S. have occurred in adults age 65 and older. This age group also accounts for upward of 70 percent of all coronavirus hospitalizations nationwide.Why? The prevalence of underlying health conditions like diabetes and heart disease as we grow older plays a big role. But experts at the Oklahoma Medical Research Foundation say there’s another culprit that bears part of the blame: our immune system, the biological network whose job is to protect us against foreign invaders like viruses.“The general line of thinking is that immunity falters with normal aging, just like our muscle mass and cognitive function,” said Dr. Hal Scofield, a physician-scientist at OMRF. “You don’t see pro athletes playing after age 50. We have a shelf life physically, and that goes for immunity, too.”That waning immunity leaves older people more prone to serious complications not only from COVID-19 but from seasonal illnesses like the flu.T cells and B cells, special types of white blood cells involved in the immune response, offer clues to why immunity declines with age, according to OMRF immunologist Susan Kovats, Ph.D. “We don’t know all the specifics behind the decline in immune function with aging, but we do know that both T cell and B cell function deteriorates with age,” she said.T cells are made by a small organ in your chest called the thymus, “which slowly shrinks over time and is essentially gone in your adult years,” said Kovats.Meanwhile, she said, “The ability of B cells to produce highly specific antibodies that inactivate viruses also decreases with age.” B cell numbers decline to a greater extent in elderly men, Kovats noted, “which may explain why they are more likely to die from severe COVID-19 disease.”These age-related declines explain why, for example, a virus like shingles tends to emerge from a weakened immune system later in life.“If you’ve had chickenpox, the shingles virus stays in your body forever,” said Scofield, who also serves as associate chief of staff for research at the Oklahoma City VA. “When you’re young, your immune system keeps the virus in check. As you age, your body begins to lose its defenses and that increases your likelihood of getting shingles.”Weakened immunity has also made the annual flu shot less effective in the elderly, with the CDC reporting that only 25 percent of people age 50 and older were protected during the 2018-19 flu season.“The immune responses to vaccines are not as good overall in the elderly, and this is a legitimate concern as COVID-19 vaccines are hurried to the finish line,” said Kovats. “A lot of work is being done to try to understand why the immune response weakens, and significant effort has gone into changing how vaccines are made for this age group in order to solicit better immune responses.”Researchers at OMRF and across the country are investigating the mysteries of aging, as well as the immune system, to better protect a population that now counts more than 50 million Americans over the age of 65.“COVID-19 is unlike anything the body has ever seen before, and older people do not respond well to pathogens or viruses they’ve never been exposed to,” Scofield said. “This is going to be a challenge, but the more we learn about how the immune system works, the better we’ll be at protecting our seniors in future outbreaks.”CMS NEWS: Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection ResultsOn June 2nd, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) unveiled enhanced enforcement for nursing homes with violations of longstanding infection control practices. This announcement builds on the previous actions CMS has taken to ensure the safety and security of America’s nursing homes as the nation battles coronavirus disease 2019 (COVID-19), and is a key step in the Trump Administration’s Guidelines for Opening Up America Again.“The Trump Administration is taking consistent action to protect the vulnerable,” said CMS Administrator Seema Verma. “While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes patients safe, we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements.”The enhanced and targeted accountability measures are based on early trends in the most recent data regarding incidence of COVID-19 in nursing homes, as well as data regarding the results of the agency’s targeted infection control inspections. CMS is increasing enforcement (e.g., civil money penalties (CMPs)) for facilities with persistent infection control violations, and imposing enforcement actions on lower level infection control deficiencies to ensure they are addressed with increased gravity.The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided additional funding to CMS for necessary survey and certification work related to COVID-19, of which $80 million in new resources will be available for states to increase surveys. To ensure effective oversight is achieved, CMS will allocate the CARES Act funding based on performance-based metrics. States that have not completed 100 percent of focused infection control surveys of their nursing home by July 31, 2020 will be required to submit a corrective action plan to their CMS location outlining the strategy for completion of these surveys within 30 days.? If, after the 30-day period, states have still not performed surveys in 100 percent of nursing homes, their CARES Act fiscal year 2021 allocation may be reduced by 10 percent.? Subsequent 30-day extensions could result in an additional 5 percent reduction. These funds would then be redistributed to those states that completed 100 percent of their focused infection control surveys by July 31.Utilizing the CARES Act funding, states will be required to perform on-site surveys of nursing homes with previous COVID-19 outbreaks and will be required to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases.To help nursing homes implement infection control best practices, CMS will provide technical assistance through Quality Improvement Organizations (QIOs). CMS and the Centers for Disease Control and Prevention (CDC) will continue to monitor the data it receives through the new nursing home COVID-19 surveillance system to identify nursing homes with outbreaks and work with Governor’s offices and states to keep nursing home residents safe.Since April 19, 2020, CMS has required nursing homes to inform, residents, their families, and representatives of COVID-19 cases in their facilities. For the first time, nursing homes are required to report COVID-19 cases and deaths directly to the CDC on an ongoing basis as the result of an unprecedented CMS regulatory requirement issued on May 1, 2020. The Trump Administration implemented the new reporting requirement to develop a robust federal disease surveillance system to quickly identify problem areas and inform future infection control actions. The reporting requirement applies to long-term care facilities only (also known as skilled nursing facilities and nursing facilities, and generally as nursing homes). By law, CMS regulates and oversees nursing homes, which are certified to provide Medicare and/or Medicaid skilled nursing facility services. Therefore, the data does not include COVID-19 data from assisted living facilities, which are not regulated at the federal level.As of May 24, 2020, about 12,500 nursing homes – approximately 80 percent of the 15,400 Medicare and Medicaid nursing homes – had reported the required data to the CDC. These facilities reported over 60,000 confirmed COVID-19 cases and almost 26,000 deaths. Of the nursing homes that reported data, approximately one in four facilities had at least one COVID-19 case, and approximately one in five facilities had at least one COVID-19 related death.? Early analysis shows that facilities with a one-star quality rating were more likely to have large numbers of COVID-19 cases than facilities with a five-star quality rating. CMS will take enforcement action against the nursing homes that have not reported data into the CDC as required under CMS participation requirements.CMS will post the underlying CDC-collected data on a link on Nursing Home Compare later this week, so the public can view general information of how COVID-19 has impacted nursing homes in a user-friendly format. The data will be broken down by state, number of residents and number of staff.? The data will be searchable by facility name and will be downloadable so researchers and other stakeholders can perform their own in-depth analysis.? CMS will update the data weekly. CMS will also post a link to the data on the home page of the Nursing Home Compare website so patients, residents, and families can easily find it. Nursing Home Compare is a valuable tool for patients, residents, and families to understand the quality of nursing homes and to support their healthcare decisions. Adding this information only increases its value and reinforces CMS’s commitment to transparency.CMS is ratcheting up penalties for noncompliance with infection control to help prevent backsliding, improve accountability, and ensure prompt compliance. Since February 2020 CMS has provided over 13 guidance documents and facts sheets pertaining to infection control and conducted weekly calls with nursing homes to share best practices from the field. The enhanced enforcement actions will increase penalties for nursing homes have had past infection control deficiencies.As part of CMS’s response to the COVID-19 pandemic, the agency prioritized the types of nursing home inspections that take place. On March 4, 2020 CMS prioritized inspections to allow inspectors to focus on the most serious health and safety threats like infectious diseases and abuse. On March 23, CMS suspended certain inspections to increase our focus on preventing the spread of COVID-19. Since March 4, CMS and its network of state-based inspectors have conducted over 8,300 surveys with the results of a total of 5,700 available today. There is currently wide variation in the number of focused infection control surveys of nursing homes performed by states, between 11.4 percent and 100 percent, with a national average of approximately 54.1 percent. CMS plans to post the results of the inspections later this week, on a monthly basis as they are completed.All of this information are being used to strengthen CMS enforcement action going forward, such that nursing homes are held accountable for resident care. Older Americans are particularly vulnerable to complications arising from the virus and nursing home residents have been uniquely affected. The Trump Administration is intensely focused on protecting this population, but it ultimately falls to the nursing homes themselves to ensure they provide care compliant with essential health and safety requirements.CMS is also providing additional support and technical assistance to low performing nursing homes through its QIOs. QIOs are organizations composed of health quality experts and clinicians that have experience in helping healthcare provider to improve the quality of care delivered to people with Medicare. CMS has now charged the QIOs to focus their efforts on providing education and training to all nursing homes in the country.? This will include weekly National Infection Control Training, which focuses on all aspects of infection control, prevention and management to help nursing homes prevent the transmission of COVID-19.?QIOs are also providing direct assistance to small and rural nursing homes and those serving vulnerable populations in areas where access to care is limited. The QIOs will help them understand and comply with CMS and CDC reporting requirements and, in some cases, they will provide on-site support to help nursing homes that have been identified as having the greatest needs in infection control. CMS will be working with Governors’ offices to direct QIOs to those nursing homes that have significant needs and have had outbreaks. QIOs will help these facilities create an action plan and implement specific steps to establish a strong infection control and surveillance program.Since the beginning of the pandemic, CMS has taken unprecedented and aggressive steps to address the impact of COVID-19.? The importance of ongoing transparency and information sharing has proven to be one of the keys to the battling this pandemic.The full list of CMS Public Health Action for Nursing Homes on COVID-19 to date is in the chart below.?CMS Public Health Action for Nursing Homes on COVID-19 as of June 1, 2020?February 6, 2020CMS took?action?to prepare the nation’s healthcare facilities for the COVID-19 threat.March 4, 2020CMS issued new?guidance?related to the screening of entrants into nursing homes.March 10, 2020CMS issued?guidance?related to the use of personal protective equipment (PPE).March 13, 2020CMS issued?guidance?on the restriction of nonessential medical staff and all visitors except in certain limited situations.March 23, 2020CMS?announced?a suspension of routine inspections, and an exclusive focus on immediate jeopardy situations and infection control inspections.March 30, 2020CMS?announced?that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital – including nursing homes.April 2, 2020CMS issued a?call to action?for nursing homes and state and local governments reinforcing infection control responsibilities and urging leaders to work closely with nursing homes on access to testing and PPE.?April 15, 2020CMS?announced?the agency will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases.April 19, 2020CMS?announced?it will require nursing homes to report cases of COVID-19 to all residents and their families, as well as directly to the CDC. On?May 1, CMS?implemented the proposed policy in an Interim Final Rule.?The rule became effective on May 8.April 30, 2020CMS?announced?the formation of an independent Commission that will conduct a comprehensive assessment of the nursing home response to COVID-19.May 6, 2020CMS released a?memorandum?to State Survey Agency directors providing more details on the new reporting requirements of the Interim Final Rule.May 13, 2020CMS published a new informational toolkit comprised of recommendations and best practices from a variety of front line health care providers, governors’ COVID-19 task forces, associations and other organizations and experts that is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19. Toolkit is found here:?ToolkitMay 18, 2020CMS issued?guidance?for state and local officials on the reopening of nursing homes.June 1, 2020CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes. CMS also issued a letter to Governors.To view the state survey memo, visit: view the letter to the Governors, visit: view a state breakdown of the Nursing Home COVID-19 data, visit: ................
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