Harmony Healthcare International (HHI) Blog

Top 20 Regulatory Updates for the Nursing Home Industry



Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency • Survey

Kris Presenting Montana-1

Skilled Nursing Facilities are accustomed to the inordinate amount of regulatory oversight and changes that occur in the industry on a regular basis.  

HHI, Harmony Healthcare International (HHI), helps Nursing Homes understand and implement the rules of engagement via monthly site visits, medical record reviews, education and analysis.   This blog highlights most of the recent and upcoming changes that Nursing Homes need to assimilate and implement.

HHI, Harmony Healthcare International (HHI), reinforces the importance of ensuring that the Skilled Nursing Facility is diligent in safeguarding that below directives are not only executed, but that there is documentation present to support compliance within each of these areas (i.e., blanket waivers, flexibilities, regulations and guidance related to this pandemic).

The Top 20 Regulatory Updates for the Nursing Home Industry areas include:

  1. Final MDS 3.0 Item Sets (version 1.7.2) and data specifications released for October 2020

  2. CMS Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVD-19 Cases Among Residents and Staff in Nursing Homes (QSO-20-29-NH)

  3. CMS Updated FAQs

  4. CMS Prioritization of Survey Activities

  5. CMS Guidance for Infection Control and Focused Infection Control Surveys

  6. CMS Reopening Recommendations for State and Local Officials (QSO-20-30-NH)

  7. CMS clarification for therapy minutes to include time spent donning and duffing of Personal Protective Equipment (PPE) as set-up time

  8. COVID-19 Emergency Declaration Blanket Waivers including the 3 Day Qualifying Hospital Stay

  9. OIG Updated Work Plan

  10. OIG Stark Law Flexibilities

  11. CDC Guidance on PPE, strategies for Optimizing the Supply, N95 Fit Testing, Burn Rate Calculator

  12. Provider Relief Fund (from CARES Act) allocation of 4.9 billion to certified skilled nursing centers

  13. S. Department of Labor’s Occupational Safety and Health Administration (OSHA) revised policies for enforcing COVID-19 requirements effective 5/26/20

  14. Updated Coronavirus Frequently Asked Questions dated 5/27/20 that announces (on pages 70-71) CMS will allow Institutional Settings including SNFs to furnish and bill for outpatient therapy using telehealth during the COVID-19 Public Health Emergency.
  15. National Healthcare Safety Network (NHSN) Data on COVID-19 cases and State Survey Data is available at https://www.cms.gov/files/document/6120-nursing-home-covid-19-data.pdf
    1. CMS began posting individual facility data related to COVID-19 and Focused Infection Control Surveys to Nursing Home Compare on June 4, 2020 under the Spotlight section with links to data.cms.gov.
    2. If you identify issues in the COVID-19 data for your facility, corrections to NHSN Data can be made:
      1. Log into the NHSN COVID-19 LTCF Module
      2. Use the calendar feature to select the relevant data
      3. Edit the data that is not accurate
      4. Click “SAVE”
    3. NHSN submits data to CMS every Monday morning and then CMS will update revised data with the next update of Nursing Home Compare.
    4. CMS has posted FAQs regarding COVID-19 data at: https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/faq-cms-datarelease-508.pdf
  16. Increased Civil Monetary Penalties for nursing homes with patterns of infection control deficiencies (up to $20,000)
    1. “Ratcheting up penalties with non-compliance to infection control” per Seema Verma
  17. COVID-19 Survey activities expanded
    1. CARES Act funds can be used by states for strike teams, enhanced surveillance and monitoring of NHs
    2. CMS funding to states for surveys tied to the number of inspections they perform
      1. States without 100% of their focused infection control surveys completed by July 31 must submit an action plan to CMS
      2. States must perform on-site surveys of NHs with previous COVID outbreaks (3 criteria) and within 3-5 days of any NH that has COVID and has 3 or more new cases (suspected or confirmed) or a COVID negative NH with 1 confirmed resident case.
    3. When states enter Phase 3 of the re-opening process, states can expand survey activity to include revisit surveys, complaint surveys that are not immediate jeopardy and others 
  18. Quality Improvement Organizations (QIOs) refocus to provide support on infection control
    1. Weekly National Infection Control Training to prevent the spread of COVID-19 – see https://qioprogram.org/nursing-home-trainings
    2. States may request QIO technical assistance for a specific nursing home(s) with an outbreak.
  19. New Flexibilities for Centers for Medicare & Medicaid Innovation (CMMI)models were released with the model adjustments available in a table that can be accessed at https://www.cms.gov/files/document/covid-innovation-model-flexibilities.pdf
  20. Therapy CPT Codes were updated for communication technology based services (CBTS) that are available at http://www.cms.gov/Medicare/Billing/TherapyServices/index.html.
  21. CMS posted seven FAQs on Nursing Home Visitation expanding on their March memo with further guidance and clarity related to compassionate care, steps to take before reopening to visitors, ombudsman visits, communal activities and other topics. See https://www.cms.gov/files/document/covid-visitation-nursing-home-residents.pdf
  22. The ABN, Form CMS-R-131, and the instructions for this form have been approved by the Office of Management and Budget (OMB) for renewal.  The use of the form with the expiration date of 06/30/2023 will be mandatory as of 8/31/2020. Forms and the instructions can be accessed at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.
  23. SNF Quality Reporting Data (QRP) Exceptions and Extensions in the MLN Newsletter on 3.27.20, was applicable for Quarter 4 of 2019, and Quarters 1 & 2 of 2020. Providers are expected to meet QRP requirements for Quarter 3, starting July 1, 2020.  See https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Spotlights-and-Announcements
  24. The Payroll Based Journal (PBJ) waiver is ending with reporting required for staffing data Calendar Year 2020 Quarter 2 (April – June) due August 14, 2020. PBJ submission for Calendar Year 2020 Quarter 1 (January – March) is not required.  CMS addressed star ratings that will be held constant except for facilities with one star ratings that will have their ratings temporarily suppressed.  Quality Measures based on the data collection period ending 12.31.19 will be held constant.  A facility’s quality measure rating can still be updated by a quality measure with underlying data that is earlier than 12.31.19.  See the QSO 20-34-NH memo from 6.25.20 at https://www.cms.gov/files/document/qso-20-34-nh.pdf
  25. The MLN Matters SE20011 on Medicare FFS Response to the Public Health Emergency (PHE) on the Coronavirus (COVID-19) was revised 6.19.20 stating that CMS has instructed the Medicare Administrative Contractors (MACs) and notified Medicare Advantage plans to cover diagnostic COVID-19 laboratory tests for nursing home residents and patients starting 7.6.20 and for the duration of the PHE.

Please do not hesitate to reach out to HHI, Harmony Healthcare International (HHI), for further information on these or other regulatory updates





Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

 harmony20 October 29-30 2020 Encore Boston Harbor

Topics: Regulatory

Kris Mastrangelo, OTR/L, LNHA, MBA


Kris Mastrangelo, OTR/L, LNHA, MBA

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