CMS, in collaboration with the CDC, has issued updated guidance for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency. Facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation.
The updated guidance also emphasizes that “compassionate care” visits should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak. Compassionate care visits include visits for a resident whose health has sharply declined or is experiencing a significant change in circumstances.
The CDC recommends early vaccination of long-term care facility health care personnel and residents. Read their Long-Term Care Facility toolkit to prepare for COVID-19 vaccination and build confidence in the vaccine.
CMS reviewed with States, nursing homes, and other stakeholders the updated COVID 19 Testing and Reporting Requirements based on the recent Interim Final Rule with Comment Period released on August 25, 2020.
In an effort to keep residents safe, strengthen surveillance, and further reduce viral transmission of COVID 19 in nursing homes, CMS Administrator Seema Verma along with Dr. Redfield, Director of the Centers for Disease Control and Prevention and Admiral Giroir, Assistant Secretary for Health at the U.S. Department of Health and Human Services presented the new regulatory requirements, guidance on how facilities can meet those requirements and available resources and technical assistance.
A copy of the presentation can be found here: https://www.cms.gov/files/document/covid-ppt-nh-all-call.pdf
Recordings of the calls will be made available here https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit
In June 2020, the Centers for Medicare and Medicaid Services (CMS) announced the formation of an independent Coronavirus Commission on Safety and Quality in Nursing Homes to review and assess the response to COVID-19. Last week, the commission launched an important opportunity for you to contribute to their work.
• Provide the commission with a publication or other resource to consider in their work (5-page limit).
• Provide perspective (500-word limit) based on your experience with nursing homes.
There are also opportunities to express interest in learning more about the work of the commission, including your support for the well-being of nursing home residents and workers.
Click here for more information: https://sites.mitre.org/nhcovidcomm/public-engagement/
APTA's academies and sections formed the Cross-Academy/Section COVID-19 Core Outcome Measure Task Force to identify a core set of outcome measures for patients diagnosed with COVID-19, across the continuum of care and in all settings. A core set of outcome measures aids in describing the trajectory of recovery from COVID-19 and facilitates research initiatives.
As of June 16, the Centers for Medicare & Medicaid Services (CMS) updated its toolkit to guide states in mitigating the prevalence of COVID-19 within nursing homes. The toolkit is a compilation of information providing detailed quality improvement resources, and addresses issues including infection control, workforce and staffing, and use of telehealth. The agency previously cautioned that the toolkit is provided solely as an “informational product, and is “not intended as guidance from CMS.”
The toolkit includes:
• States actions for COVID-19 management and response;
• Information on telehealth; and
• Organizations available to assist nursing homes.
The toolkit can be found at: https://www.cms.gov/files/document/covid-toolkit-states-mitigate-covid-19-nursing-homes.pdf.
CMS has updated its coronavirus waivers FAQs to add a new section on outpatient therapy and telehealth and announces that outpatient therapy furnished via telehealth can be reported on an institutional claim during the COVID-19 PHE.
Please find below the 3 new FAQs addressing this and two other common questions.
Question: Can outpatient therapy services that are furnished via telehealth and separately paid under Part B be reported on an institutional claim (e.g., UB-04) during the COVID-19 PHE?
Answer: Yes, outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the “-95” modifier applied to the service line.
Question: Can therapy services furnished using telecommunications technology be paid separately in a Medicare Part A skilled nursing facility (SNF) stay?
Answer: Provision of therapy services using telecommunications technology (consistent with applicable state scope of practice laws) does not change rules regarding SNF consolidated billing or bundling. For example, Medicare payment for therapy services is bundled into the SNF Prospective Payment System (PPS) rate during a SNF covered Part A stay, regardless of whether or not they are furnished using telecommunications technology. Therapy services furnished to a SNF resident, whether in person or as telehealth services, during a non-covered SNF stay (Part A benefits exhausted, SNF level of care requirement not met, etc.) must be billed to Part B by the SNF itself using bill type 22X, regardless of whether or not they are furnished using telecommunications technology.
Question: Can outpatient therapy services be furnished and paid separately for patients receiving Medicare home health services?
Answer: No. For patients under a home health plan of care, payment for therapy services (unless provided by physicians/non-physician practitioners) is included or bundled into Medicare’s payment to the HHA, and those services must be billed by the HHA under the HHA consolidated billing rules. Patients should first be assessed for whether they are eligible to receive therapy services under the home health benefit prior to initiating outpatient therapy services. Receiving therapy services under the home health benefit may be in the best interest of the patient as there is no applicable coinsurance, copay, or deductible for such services (with the exception of negative pressure wound therapy using a disposable device), and the patient may also have a need for skilled nursing services, home health aide services, or medical social services under the home health benefit. However, if the patient is not eligible for home health care, including when it is not possible to provide in-person therapy services in the patient’s home (i.e., the patient is not under a home health plan of care), then outpatient therapy furnished via telehealth under Part B could be an appropriate alternative and separately billed, assuming all applicable requirements are otherwise met.
Begins on page 70: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
WEBINAR - COVID-19 Expert Panel: You've Got Clinical Questions, Let's See if We Have Answers
MAY 23, 2020
COVID-19 has changed many things in our day-to-day lives, including how we interact with patients. Different practice settings face unique challenges in meeting the needs of this patient population and the COVID-19 disease process itself continues to evolve. Physical therapists and physical therapist assistants must continue to change as well. Join our group of content experts for a Q&A session to discuss solutions and lessons learned during this pandemic.
Objectives for this webinar:
• Participants will be able to describe skin challenges and interventions unique to the patient with COID-19.
• Participants will discuss issues around staffing and PPE usage.
• Participants will describe clinical challenges raised by COVID-19 in clinical practice, including ways practicing clinicians have addressed these various challenges.
• Participants will describe aspects of physical reconditioning of the COVID patient, including problems and strategies.
View the recording here: https://attendee.gotowebinar.com/recording/7334248739717670927
APTA's COVID-19 Hub Community is now open to all APTA members to share resources and communicate with other members related to COVID-19. Subject matter experts from APTA sections intend to help provide general guidance to questions posted.
Members are encouraged to share clinical content they find on other websites or in their practice.
CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.
The pandemic has raised the pressing question of how society should allocate scarce resources during a crisis. This is the question experts addressed today in a new position statement published by the American Geriatrics Society (AGS) in the Journal of the American Geriatrics Society (DOI: 10.1111/jgs.16537). The statement focuses primarily on whether age should be considered when making decisions to allocate scarce resources. Read more here: https://www.americangeriatrics.org/media-center/news/new-ags-position-statement-addresses-one-health-cares-most-difficult-issues
Check out these excellent evidence-based resources to help you motivate older adults to engage in physical activity during the coronavirus pandemic and directives for social distancing and sheltering in place. Prepared by the Health Promotion and Wellness Special Interest Group. Download the PDF.
WCPT COVID-19 Information Hub
WCPT is a global hub for information and resources about COVID-19 relevant to the physiotherapy profession.
Geriatric Considerations is part of the PACER Project (Post-Acute COVID19 Exercise & Rehabilitation). This video, co-sponsored by APTA Geriatrics, is available for free CEUs on the APTA Learning Center for both APTA and non-APTA members.
The Alzheimer’s Association is offering new guidance to help ensure the delivery of high-quality care for people living with Alzheimer’s and all dementia in long-term care and community-based settings during the current COVID-19 crisis.
The document released today is in collaboration with 34 long-term care and community-based care providers and affiliated associations. It identifies important care considerations and incorporates evidence-based strategies from the Alzheimer’s Association Dementia Care Recommendations to assist staff in long-term and community-based care settings during emergency situations. Many of the groups supporting the guidance document participate in the Alzheimer’s Association Dementia Care Provider Roundtable (AADCPR), a consortium of thought leaders from the dementia care provider industry including nursing homes, assisted living, and home and community-based services.
“The COVID-19 pandemic threatens the health of millions, but it presents unique challenges for the more than 5 million America's living with Alzheimer's, especially those in long-term and community-based care, who are often the most frail and vulnerable,” said Doug Pace, NHA, director, mission partnerships, Alzheimer’s Association. “This document is aimed at helping providers who may face staffing shortages deliver high-quality dementia care during an emergency situation.”
The new document provides care tips and guidance in several key areas, including:
“In emergency situations, long-term and community-based care providers may experience staffing shortages or have to use non-clinical staff to assist with care,” Pace said. “This document can be used to focus staff very quickly on the most important considerations in caring for persons with dementia. It emphasizes person-centered care, which is the essential starting point for delivering optimal care. Individuals living with dementia thrive best with a consistent routine and with person-centered approaches. During emergency situations these practices are even more important.”
Thought leaders and organizations representing nursing homes, assisted living, and home and community-based services are supporting the guidance document and will be sharing it with their staff and employees across the country.
“The document outlines the most important dementia care considerations in the current environment,” said Letitia Jackson, senior vice president, Senior Star and chair, AADCPR. “Person-centered care is something the Roundtable members strive for to support those living with dementia every day. This document serves as an important reminder that this remains the goal even during a crisis.”
According to the 2020 Alzheimer’s Disease Facts and Figures report, 48% percent of nursing home residents are living with Alzheimer’s or other dementias. Among older adults in residential facilities, including assisted living, 42% or more have some form of Alzheimer’s or other dementias. In addition, many individuals with Alzheimer’s or other dementias receive community-based services, including 32% of individuals using home health services and 31% using adult day services.
“The COVID-19 crisis is creating anxiety and disruption for all Americans,” said Patrick Doyle, Ph.D., Regional Vice President of Operations, Brightview Senior Living, and vice-chair, AADCPR. “People living with dementia are especially vulnerable because they cannot adapt easily to the current realities. Providing guidance to help care and support people living with dementia during this challenging time is really beneficial.” “The Alzheimer’s Association is very appreciative of all of the organizations that have collaborated with us and are supporting this important guidance,” Pace said. “Having consensus on these important care considerations will help in the delivery of high-quality dementia care even during this uncertain time.”
About the Alzheimer’s Association: The Alzheimer’s Association leads the way to end Alzheimer’s and all other dementia – by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer's and all other dementia. Visit alz.org or call 800.272.3900.
CMS has issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS over the last week in response to the National Health Emergency. Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.
The toolkit can be accessed here: https://www.cms.gov/files/document/covid-19-nursing-home-telehealth-toolkit.pdf
A new set of recommendations for provision of physical therapist services related to COVID-19 in the acute hospital setting acknowledges the necessity of involvement of PTs well-trained in respiratory physical therapy, but cautions that facilities should be judicious in their use. Read more here.
APTA's Interactive Audio and Video Telecommunications System Matrix - This is a telehealth platform spread sheet which lists several quality platforms along with descriptions and costs so that the reader can compare. This is not an endorsement of any one platform and was a collaborative effort between APTA Regulatory Affairs, FIRST Council and HPA Tech SIG. The link is currently at the bottom of the HPA COVID 19 page.
This is a big share for anyone who may need to access EHR record of a pt. (Post acute care and private practice may be very interested) - more complete information with links on HPA COVID -19 page about a quarter way down on the page: https://www.aptahpa.org/general/custom.asp?page=COVID19#InteractiveAudio
Kno2 is making their portal available for purposes of On Demand Patient Record Retrieval Service available at NO CHARGE (during the state of emergency) to all of post-acute including LTACs, IRFs, Skilled Nursing, Homecare/Home Health, Therapy Providers, etc. This provides an opportunity to access the most recent patient records of other providers in the community as we treat patients during this public health crisis.
The International Association of Physical Therapists Working with Older People (IPTOP), a component of the World Confederation of Physical Therapy (WCPT) of which APTA Geriatrics is a member organization, has compiled a list of available resources and social media links to support physiotherapists and older adults during this time. It is available to IPTOP members and colleagues here:https://drive.google.com/file/d/
APTA released a Statement on Patient Care and Practice Management During COVID-19 Outbreak, discussing how to use the CDC guidance in making patient care determinations.
The Centers for Medicare and Medicaid Services released the Guidance for Infection Control and Prevention of Coronavirus Disease 2019.
The American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) have shared their Guidance for Therapy Personnel in LTC Facilities During COVID-19 Pandemic. These are based on the CDC guidelines for LTC facilities (including skilled nursing centers and assisted living communities), and recommend individualized care plans and goals for each resident assessed to determine which therapies are essential at this time.
From the Journal of Geriatric Emergency Medicine: Guidance on COVID 19 in Older Adults: Key Points for Emergency Department Providers
Broad River Rehab recorded the following webinar: Staying Close to the Ones You Love with Televisits