The Centers for Medicare & Medicaid Services (CMS) has released a memo (QSO-20-28-NH) with updates on Nursing Home Compare (NHC), Five-Star Quality Rating System, public staffing information, and a list of frequently asked questions (FAQs). 

Included in the new information, CMS said it will temporarily hold constant the inspection domain of Five-Star to prevent an unequal impact on the rating for those facilities that receive a survey during this time of the COVID-19 pandemic. This freeze will begin with the scheduled Nursing Home Compare update on April 29, 2020. 

CMS will post the results of any health inspections conducted on or after March 4, 2020, on the landing page of Nursing Home Compare, but they will not be used to calculate a center’s Five-Star inspection rating, the agency said.

The Quality Measure and Staffing domains of Five-Star will be updated on April 29 as they are not impacted by the 
CMS blanket waivers because they rely on data from before March 1, 2020, according to a summary of the changes by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

In other developments, CMS said it will use Payroll-Based Journal staffing data to publicly report the average number of staff on site at each nursing facility each day (both nursing staff and total staff) and will also post aggregated data at a state and national level. The publicly posted information will include all staff listed in section 2.3, Table 1 of the PBJ Policy Manual, AHCA/NCAL said. 

This information will be based on data submitted for the fourth quarter of 2019. CMS says this information can be used to help local, state, and federal agencies plan for how much personal protective equipment (PPE), testing, and other resources providers may need. Providers can also use this information along with the 
CDC PPE burn rate calculator

The CMS memo also includes a FAQ document that addresses CMS guidance in the areas of visitation, surveys, waivers, and more. The FAQs provide information on topics including: 

--Individuals entering and leaving the nursing center, including visits by health care personnel, visitation for compassionate care situations, and residents who want to leave the facility against medical advice;

--Surveys and infection control self-assessment, including the ongoing suspension of standard surveys and the recommended use of the infection control-focused survey protocol for self-assessment on infection control practices and preparedness;

--Waivers of federal requirements, including those related to in-facility and inter-facility cohorting; and

--Additional information on resident cohorting, separation, and admission.

AHCA/NCAL noted that CMS reminds providers that a negative test for COVID-19 is not a prerequisite for discharging a resident to a nursing facility from the hospital; however, consistent with current guidance, admissions decisions should be made based on the resident’s clinical status and the ability of the accepting facility to meet their care needs and infection control requirements.

Providers that can’t meet the needs of the residents due to PPE, staffing, or other issues should not accept the person. 

CMS is allowing civil money penalty (CMP) funds to be used for purchasing devices such as tablets or web-cams, as well as accessories, with a maximum of $3,000 allowed per facility to help with communications between residents and their families or friends, the association said. To apply to receive CMP funds for this purpose, contact the 
state agency’s CMP contact

For questions related to the Nursing Home Compare website and the Five-Star Quality Rating System, CMS said to email

For questions related to the FAQs, email

On other issues, AHCA/NCAL said providers must know that even as states begin to lift their stay-at-home orders, nursing facilities must continue to maintain current restrictions on visitors. As a reminder, CMS released guidance on March 13 that required all nursing centers to significantly restrict visitors and nonessential personnel, as well as restrict communal activities.

The CMS guidance indicates that individuals other than essential health care staff and visits for end-of-life situations should no longer enter nursing facilities until further notice.

Even though certain states may be lifting their individual stay-at-home orders, nursing facilities must continue to follow this directive from CMS until new guidance is received. For help communicating these policies, please see AHCA/NCAL’s 
sample letter to families on restricting visitors.
Assisted living communities must follow any applicable state guidance. If no state guidance is issued, the association recommends they follow 
AHCA/NCAL guidance and continue restricting the number of people entering the facility.

For all long term care communities, these restrictions remain critical safeguards to help protect against the spread of COVID-19, AHCA/NCAL said.

Finally, on April 23, CMS updated its 41-page COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (​FFS) Billing guidance. This guidance is directed to all providers of Medicare Part A and Part B services, including skilled nursing facilities.

A general billing requirements FAQ related to using the “DR” condition code and “CR” modifier on claims to indicate that the Medicare payment is conditioned on the presence of a “formal waiver” has been updated and should be reviewed by billing staff, AHCA/NCAL said.

The SNF-specific FAQs are on pages 34-35 and have not changed since last updated on April 10, the association said.