November is National Home Care and Hospice Month!

Hello, everyone!

Here are some home health related updates for this week:

AMITY’S NEWS

If you missed this week’s webinar, Top Methods for Driving Employee Retention: Technology and Professional Development, hosted by ACHCU, Amity Healthcare Group, and AlayaCare and would like to learn more about the impact of employee training and professional development and use of latest technology tools on staff retention, please go to: https://register.gotowebinar.com/register/4258259417454764043?source=website

REGISTER NOW

Amity Healthcare Group Consulting Services

Amity Healthcare Group is providing continuous support to home health providers.  We have been closely monitoring the events and information associated with COVID -19 vaccination mandates. If  you need assistance with developing Policies & Procedures  related to Mandatory COVID-19 Vaccination Requirements, please call 303-690-2749 or email at ig@amityhealthcaregroup.com

We also provide assistance with:

• Medicare Certification/Accreditation Survey preparation
• Regulatory and clinical compliance review
• QAPI implementation and analysis
• Emergency Preparedness

Do not forget to schedule your in-person and/or virtual competencies at https://amityhealthcaregroup.com/virtual-nursing-competency/

NATIONAL NEWS

CMS Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers

As you may know  by now, on November 4, 2021, CMS issued an interim final rule related to COIVD-19 vaccination for staff at health care facilities that participate in the Medicare and Medicaid programs (Omnibus COVID-19 Health Care Staff Vaccination). The purpose of the regulation is to create a consistent standard within Medicare and Medicaid while giving patients assurance of the vaccination status of those delivering care. This requirement will apply to approximately 76,000 providers and cover over 17 million health care workers across the country.

Amity Healthcare Group was able to join the CMS  National Stakeholder Call on November 4^th and would like to provide you with a brief summary/key points of the call (please see below):

As per CMS, the three basic requirements of the Omnibus COVID-19 Health Care Staff Vaccination rule that facilities must complete are:

• Have a process  or plan for vaccinating eligible staff
• Have a process or plan for providing exemptions and accommodations for those who are exempt
• Have a process  or plan for tracking and documenting staff vaccinations

The above processes or plans must be in place  within 30-days from today (by December 5, 2021)

In addition, all eligible  staff are required to receive 1^st dose of vaccination by December 5^th, 2021 and be fully vaccinated by January 4, 2022

CMS indicated that vaccination is the only option, and as the result, the rule does not include a testing option for unvaccinated staff (providers are, however, encouraged to voluntarily institute testing alongside other infection prevention measures).

CMS also made it very clear that this regulation pre-empts any state law.

When asked how will CMS check compliance with the above requirements, it was indicated that CMS will work directly with the State  Survey Agencies and Accrediting Organizations to regularly review compliance with Medicare/Medicaid regulations and expects the survey agencies to conduct compliance review  for the above requirements during recertification/renewal surveys and complaint surveys.  Surveyors will be instructed to check on the following:

• Having a process in place for vaccinating eligible staff
• Having a process in place for providing exemptions and accommodations for those who are exempt
• Having a process in place  for tracking and documenting staff vaccinations

Surveyors will also be instructed to cite facilities based on the level of severity of the noncompliance.

The conditions of participation for home health agencies at § 484.70, Infection Prevention & Control, would be modified to include the additions below.

(d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff is considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multidose vaccine.

(1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients:

(i) HHA employees;

(ii) Licensed practitioners;

(iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangements.

(2) The policies and procedures of this section do not apply to the following HHA staff:

(i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and

(ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section.

(3) The policies and procedures must include, at a minimum, the following components:

(i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients;

(ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations;

(iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19;

(iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section;

(v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC;

(vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (

vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements;

(viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains

(A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and

(B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA’s COVID-19 vaccination requirements for staff based on the recognized clinical contraindications;

(ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and

(x) Contingency plans for staff who are not fully vaccinated for COVID-19.

To read the full Omnibus COVID-19 Health Care Staff Vaccination rule, please go to: https://public-inspection.federalregister.gov/2021-23831.pdf

National Association for Home Care and Hospice has done a tremendous job in providing analysis of the Omnibus COVID-19 Health Care Staff Vaccination rule. To access the full analysis, please go to: https://www.nahc.org/resources-services/coronavirus-resources/cms-vaccine-mandate-for-home-health-hospice-other-providers/

OSHA Issues Mandatory COVID-19 Vaccination Emergency Temporary Standard(ETS)

In compliment to Omnibus COVID-19 Health Care Staff Vaccination rule issued by CMS on November 4, 2021, OSHA issued a mandatory COVID-19 Vaccine Emergency Temporary Standard (ETS) on the same day as well.

Please note that the requirements of this ETS apply to all employers with a total of 100 or more employees at any time this ETS is in effect. It does not apply to:

“settings where any employee provides healthcare services or healthcare support services when subject to the requirements of 29 CFR 1910.502 (i.e., the Healthcare ETS)”

In conjunction with CMS Omnibus COVID-19 Health Care Staff Vaccination rule, it is important to understand that the CMS rule directly applies only to the Medicare-and Medicaid-certified providers and suppliers listed in the rule and includes Medicare and Medicaid certified  home health agencies. It does not directly apply to other health care entities, such as private duty agencies or HCBS providers that are not regulated by CMS. Entities not covered by the CMS rule may be subject to the Occupational Safety and Health Administration (OSHA) ETS issued on November 4, 2021(if the entity has a total of 100 or more employees) as well as to other State or Federal COVID-19 vaccination requirements, as may be applicable.

At this time, we would like to provide you with the link to the video from the Department of Labor (DOL) stakeholder briefing held on November 4, 2021 (https://www.youtube.com/watch?v=ixxkn3Y8z6g) as well as the link  for OSHA ETS on Vaccination and Testing  tools and resources at  https://www.osha.gov/coronavirus/ets2

U.S. Equal Employment Opportunity Commission (EEOC) Issues Updated COVID-19 Technical Assistance

As we are focusing on COVID-19 vaccination rules and mandates in this newsletter, it will be very appropriate to continue our conversation with a discussion on how to address accommodations for religious exemptions. The U.S. Equal Employment Opportunity Commission (EEOC) posted updated and expanded technical assistance related to the COVID-19 pandemic from the perspective of the EEO laws.

Please review the expanded technical assistance for information about how Title VII of the Civil Rights Act of 1964 applies when an applicant or employee requests an exception from an employer’s COVID-19 vaccination requirement that conflicts with their sincerely held religious beliefs, practices, or observances.

According to EEOC, several key points to be aware of when considering religious accommodations are:

• Title VII requires employers to consider requests for religious accommodations but does not protect social, political, or economic views, or personal preferences of employees who seek exceptions to a COVID-19 vaccination requirement.
• Employers that demonstrate “undue hardship” are not required to accommodate an employee’s request for a religious accommodation.

Additionally, the EEOC made its own internal religious accommodation request form (https://www.eeoc.gov/sites/default/files/2021-10/EEOC%20Religious%20Accommodation%20Request%20Form%20-%20for%20web.pdf) available to the public for reference.

The Calendar Year 2022 Home Health Final Rule

The CY 2022 Home Health Final Rule is expected to be officially published in the Federal Register on November 9, 2021. CMS announced that the next Home Health, Hospice & DME Open Door Forum will take place on November 10, 2021.  The agenda will  include the following:

•  Announcements & Updates
• CY 2022 Home Health Final Rule Update
• Home Health Claims Processing update
• Home Health Quality Reporting Program updates
  • • • • • • Provider Enrollment Revalidation
            • COVID-19 PE FAQs

Home Health Quality Reporting

As you know, HHQR non-compliance notifications were distributed by the Medicare Administrative Contractors (MACs) and were placed into HHAs’ My Reports folders in iQIES on October 8, 2021.  Facilities that received a letter of non-compliance could submit a request for reconsideration to CMS via email by  11:59 pm, November 10, 2021. Please note that due to a technical issue with email, CMS is extending the reconsideration period related to compliance determinations with the Home Health Quality Reporting Program until Nov.17, 2021.  

Please remember that HHAs may file for reconsideration if they believe the CMS finding of non-compliance is in error, or they have evidence of the impact of extraordinary circumstances which prevented timely submission of data.

Targeted Probe and Educate

For the providers working with CGS, please note that CGS announced that as “part of the Targeted Probe and Educate (TPE) process, CGS may request and accept new documentation from providers/suppliers when easily curable errors are identified at any time during the current round of probe reviews.”

As a reminder, the primary focus of TPE reviews is to determine whether the medical necessity of the services billed is supported by the medical record documentation per Medicare guidelines.

Please also note that CGS added a new Home Health TPE edit to the Medical Review Activity Log (please see below):

COLORADO NEWS

Vaccination Reporting

1. COVID -19 Vaccination Reporting: Several of you might have received a deficiency notification from CDPHE for a failure to report COVID-19 vaccination rates. Please remember that reports are due in COHFI portal by the 1^st and 15^th of each month. If you were cited a deficiency and were given a directed plan of correction, please assure that you follow the plan of correction as instructed to avoid repeat citations.

2022. Flu Vaccination Reporting: Please note that Flu vaccination reporting has not been eliminated  and is still required. Forthe 2021-2022 Influenza Season, data collection should occur from October 1, 2021 – March 31, 2022. Your final data needs to be reported by May 15, 2022. To report healthcare worker influenza data, go to www.cohfi.colorado.gov/COHFI/. Go to “Vaccination Reporting” and click on “Flu Vaccination Reporting.”

Private Duty Nursing and Pediatric Long-Term Home Health PARs

Just a reminder that effective November 1, 2021, providers are able to submit private duty nursing and pediatric long-term home health Prior Authorization Requests (PAR) to the new utilization management (UM) vendor, Kepro, via the online PAR portal, Atrezzo.

Amity’s Friday emails (newsletters) will be archived on Amity’s Healthcare Group website at https://amityhealthcaregroup.com/resources/  under Weekly Newsletter section.

Please do not hesitate to reach out for any assistance or questions via email, phone or website at  https://amityhealthcaregroup.com/resources/

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Thank you,

Irina Gorovaya, RN BSN, MBA

Amity Healthcare Group, LLC

Home Health Consulting, Education and Outsourcing Services

720-353-7249 (cell)   303-690-2749 (office)   720-398-6200 (fax)

www.amityhealthcaregroup.com