COVID-19 Update April 9, 2021

April 12, 2021

Long-Term Care Health Surveys—Resumption

On April 12, 2021, the Indiana Department of Health (IDH), Division of Long-term Care will resume federal and state health surveys for both nursing homes and residential care facilities.

Nursing Home Facilities: All surveyors have been updated with the Long-term Care Survey Process (LTCSP) Procedure Guide that was effective February 6, 2021. Surveyors will review facility information 12 months prior to the survey entrance date, unless there is a need related to complaint or other concerns that would require information past the 12-month time frame.

CMS Information—Nursing Home Surveys

Residential Facilities: A new Residential Survey Procedure Guide will be available soon by the IDH. The Residential Survey will include an infection control review.

Federal Waivers on Transfer Notices, Care Planning, and MDS Assessments to Expire on May 10, 2021

On April 8, 2021, the federal Centers for Medicare & Medicaid Services (CMS) issued QSO 21-17, announcing that it will end the following federal emergency blanket waivers for nursing facilities as of May 10, 2021:

Transfer and Discharge Notification Requirements (42 CFR §483.15(e)(4)(ii));
Resident Room or Roommate Changes (42 CFR §483.10(e)(6));
Care Planning Requirements (§483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i)); and
Minimum Data Set Timeframe Requirements (42 CFR §483.20).

CMS also provided clarification regarding the training and certification of Certified Nurse Aides (CNA), without ending the waiver that allows individuals to perform CNA tasks for more than four (4) months (but no more than eight (8) months as required under the state waiver), as outlined in more detail below.

As of May 10, the corresponding state waivers for nursing facilities will no longer be applicable. IHCA/INCAL expects the Indiana Department of Health (IDH) to discontinue the corresponding residential care facility waivers that are addressed in this article at that time as well but will continue to keep you updated.

Travel Guidance for Health Care Personnel - IDH's Clarification

Please Note: On April 8, 2021, the IDH clarified during IHCA/INCAL’s weekly webinar that the term “travel” does not include commuting to work via public transportation or carpooling, which was confirmed in writing via the LTC Newsletter issued on April 12. Accordingly, the below Travel Guidance for Health Care Personnel does not apply to commuting to work via public transportation or carpooling.

On April 7, 2021, the IDH released updated Travel Guidance for Health Care Personnel based on the CDC’s Travel Guidance. The CDC defines travel as the use of public transportation (i.e., airplane, bus, train); although not specified in IDH’s Travel Guidance for Health Care Personnel, the activities at the location should also be taken into account even if the individual does not take public transportation to the location. However, traveling to work via public transportation or carpooling is not subject to this Travel Guidance for Health Care Personnel.

CMS Issues FY 2022 SNF Proposed Payment Rule

On April 8, 2021, the federal CMS issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2022 update.

The proposed rule includes a net market basket increase of 1.3 percent. CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $444 million in FY 2022. The 3.2 percent net market basket is the result of statutorily-mandated adjustments.

Civil Money Penalty Project Applications Still Open

First started in the summer of 2020, the IDH announced it will still accept applications for Communicative Technology (CT) and In-Person Visitation Aids (VA). Approximately 430 facilities have been approved for the CT funds and 180 facilities have been approved for VA funds. Below are the instructions and application for these projects.

Communicative Technology Application

In-Person Visitation Aids Application

Email questions or completed applications to Nancy Adams or Lisa Hensley.

[NEW UPDATES] IDH Releases Updated Guidelines on Visitation, New Admissions, Excursions and More for LTCFs

On April 7, 2021, we updated this resource to reflect recent changes to the Visitation Guidelines, which now specify that fully vaccinated residents may participate in excursions over 24 hours in duration without having to be placed in transmission-based precautions for 14 days upon return if they remain asymptomatic and did not engage in high-risk exposure during the excursion that was over 24 hours in length.

The updated Visitation Guidelines also clarify that visitation for compassionate care visits includes Essential Family Caregivers, and such visits should continue even if indoor visitation is otherwise restricted, regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak, even if the resident is in transmission-based precautions (i.e., Yellow or Red Unit).

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Upcoming Webinar: Weekly Webinar for Long-Term Care Providers with IHCA/INCAL | April 15, 2021 from 12-1 p.m. EST

As of April 15, 2021, the IDH team will be unable to participate in the webinars on a weekly basis. However, IHCA/INCAL staff will continue to host the webinars to answer your questions and provide guidance.

IHCA/INCAL will engage IDH on issues that cannot be answered during each webinar and also plan with IDH on the times that they can participate in some of the webinars.

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Other COVID-19 Updates & Resources