Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert | July 2, 2020

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  1. CMS Liberalizes Visitation to Nursing Homes. . . A Little
  2. Special Report – Nursing Homes Cited With Immediate Jeopardy Deficiencies During Pandemic: Poor Health Inspection Results, Low Staffing Levels
  3. Oklahoma Medicaid Updates
  4. COVID-19: An Advocates Guide to Beneficiary Related Medicare Changes

CMS Liberalizes Visitation to Nursing Homes. . . A Little

The Centers for Medicare & Medicaid Services (CMS) recently revised its guidance on visitations to nursing facilities during the COVID-19 pandemic via seven Frequently Asked Questions.[1] CMS is authorizing additional, more flexible guidance on visitation, while reiterating the need for screening, social distancing, hand hygiene, and face coverings during all visits.

CMS provides additional examples of “compassionate care situations” that allow visitation in more than end-of-life situations (Question 2). It recommends “creative means” and flexibility for allowing visitation, including visits outdoors (Question 3). CMS confirms that residents can participate in group activities, if they are able to maintain necessary precautions (Question 4).

Recognizing the importance of the ombudsman program, CMS confirms that facilities must provide ombudsman with immediate access to residents, even if ombudsmen cannot visit in-person due to COVID-19 (Question 7). 

Finally, facilities must comply with all discharge requirements, except for discharges for purposes of cohorting (grouping resident by COVID status). Facilities must send a copy of all discharge notices to the state ombudsman. 

States have already begun liberalizing visitation rules. This will be a welcome change for many residents and families.

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[1] CMS, “Frequently Asked Questions (FAQs) on Nursing Home Visitation” (Jun. 23, 2020), https://www.cms.gov/files/document/covid-visitation-nursing-home-residents.pdf.

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    Special Report – Nursing Homes Cited With Immediate Jeopardy Deficiencies During Pandemic: Poor Health Inspection Results, Low Staffing Levels

    Since March 2020, the Centers for Medicare & Medicaid Services (CMS) has limited surveys of nursing facilities to two types: complaints and facility-reported incidents that states triage as immediate jeopardy and targeted infection control surveys.[1]  The Center for Medicare Advocacy analyzed the 5700+ surveys publicly reported on June 4, 2020[2] and issued two reports about the targeted infection control surveys.[3]  This report describes the 20 nursing facilities nationwide, publicly reported on June 4, 2020, that were cited with immediate jeopardy deficiencies. Data shows facilities cited with immediate jeopardy deficiencies generally have poor survey histories and low nurse staffing levels, are more likely to be operated on a for-profit basis, and had civil money penalties imposed in the prior three years.

    To read the full report, please go to: https://medicareadvocacy.org/wp-content/uploads/2020/07/Immediate-Jeopardy-Report.pdf

    The Center will continue to analyze the targeted infection control and immediate jeopardy surveys that CMS releases.

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    [1]CMS, “Prioritization of Survey Activities,” QSO-20-20-All (Mar. 23, 2020), https://www.cms.gov/files/document/qso-20-20-all.pdf.
    [2] CMS, “Nursing Home COVID-19 Data and Inspection Results Available on Nursing Home Compare” (Press Release, Jun. 4, 2020), https://www.cms.gov/newsroom/press-releases/nursing-home-covid-19-data-and-inspections-results-available-nursing-home-compare.
    [3] “Special Report: Infection Control Surveys at Nursing Facilities: CMS Data are Not Plausible” (Jun. 21 2020),  https://medicareadvocacy.org/wp-content/uploads/2020/06/Infection-Control-Surveys-Report.pdf; “Special Report: Nursing Homes Cited with Infection Control Deficiencies during the Pandemic: Poor Results in Health Inspections, Low Staffing Levels” (Jun. 17, 2020), https://medicareadvocacy.org/wp-content/uploads/2020/06/Coronavirus-Report-Infection-Control-Deficiencies-NHC.pdf.

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      Oklahoma Medicaid Updates 

      On April 20, 2020, Oklahoma submitted an application to the Centers for Medicare & Medicaid Services (CMS) for an 1115 waiver to restructure their Medicaid program through capped funding, also placing additional limits on access to Medicaid benefits.

      The Center for Medicare Advocacy submitted comments in response in June 2020, stating in part:

      We urge HHS to reject this proposal because of the harms it would cause those who rely on Medicaid to access health care and long-term services and supports, including older adults and people with disabilities who are dually eligible for Medicare and Medicaid. The proposal would jeopardize coverage and set a harmful precedent for other states and the Medicaid program as a whole. The Center strongly opposes capped funding of any sort as it would fundamentally alter the Medicaid program, threatening Sooner Care and the integrity of the Medicaid program nationwide.

      On June 30, 2020, Oklahomans rejected such efforts to limit Medicaid, when voters approved a ballot measure to extend Medicaid to an estimated 200,000 poor adults. This makes Oklahoma the first state to expand Medicaid during the COVID-19 pandemic. The measure passed with nearly 50.5% of the vote. It initiates a state constitutional amendment to provide Medicaid to those with incomes at or below 138% of the poverty level. The amendment requires the Oklahoma Health Care Authority to submit a State Plan Amendment and other necessary documents to CMS within 90 days of the ballot measure’s approval, and for expansion coverage to begin no later than July 1, 2021. According to Kaiser Family Foundation analysis, language in the approved ballot measure prohibits the imposition of any additional burdens or restrictions on eligibility or enrollment for the expansion population.

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      Center for Medicare Advocacy Releases Issue Brief  Regarding Medicare and Family Caregivers

      The Center for Medicare Advocacy has written an Issue Brief, Medicare and Family Caregivers, as part of collaborative work to advance the RAISE Family Caregivers Act, Public Law 115-119 (1/22/2018). The RAISE Act directs the Department of Health and Human Services to develop and maintain a national family caregiver strategy that identifies actions and support for family caregivers in the United States. The Center’s Issue Brief explores the role Medicare does, and could, play in supporting older and disabled beneficiaries and their caregivers. The Issue Brief was written with support from The John A. Hartford Foundation.

      Over 62 million Americans who are 65 or older, and certain younger people with significant disabilities, rely on Medicare for health care coverage and access to care. Many Medicare beneficiaries depend on family members to provide or supplement their care. As the population ages, and lives longer with chronic conditions, the need for family caregiving, and support for caregivers, is increasing. Concurrently, however, access to Medicare-covered home health aide care continues to decline. This is often true even for individuals who meet the Medicare law’s qualifying criteria.

      In order to better meet the needs of Medicare beneficiaries and their caregivers, the Center for Medicare Advocacy’s Issue Brief makes several recommendations, including:

      1. Ensure the scope of current Medicare home health benefits, generally, and home health aides, specifically, are actually provided. Simply put, ensure that current law is followed; 
      2. Create a new stand-alone home health aide benefit that would provide coverage without the current skilled care or homebound requirements, using Medicare’s existing infrastructure as the vehicle for the new coverage; and 
      3. Identify other opportunities for further exploration within and without the Medicare program, including additional Medicare revisions, demonstrations, and initiatives overseen by the Center for Medicare and Medicaid Innovation (CMMI).

      The Medicare and Family Caregivers Issue Brief is available here: https://medicareadvocacy.org/wp-content/uploads/2020/06/Medicare-and-Family-Caregivers-June-2020.pdf

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