Archive November 2021

All of the articles archived for the month that you have specified are displayed below.

Template COVID Vaccine Policy/Procedure

As we are aware, the Maine Final Rule for Chapter 264: Immunization Requirements for HCWs went into effect on October 1, 2021. In addtion, the CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (IFR) was released with a deadline of January 4th, 2022 for compliance. 
To help providers comply with this requirement, AHCA has developed a template
policy and procedures on the COVID-19 vaccination mandate. AHCA will also host member-only Office Hours on Friday, December 3 at 2 PM ET with AHCA/NCAL Chief Medical Officer Dr. David Gifford and Vice President of Quality and Programs Courtney Bishnoi to discuss the latest available information about the IRF and answer questions. Registration is required and limited.
Additionally, a recording of the AHCA member-only webinar on implementing religious and medical exemptions is
now available. CMS has recently updated its Frequently Asked Questions on the IRF, which AHCA recommends providers review.
Staff Contact:

DLC Memo: Staffing Ratio Waiver Request

On Friday, November 19, 2021 the Maine Division of Licensing and Certification (DLC) released a letter of guidance regarding the waiver of minimum staff-to-resident ratios. In this letter, DLC Director William Montejo indicated that facilities may request a staffing ratio rule waiver for the sole purpose of allowing the facility to assist hospitals with the discharge of residents who are eligible for skilled or nursing home admission.
As a condition of consideration, during the time of such a conditional waiver the facility must submit a weekly report indicating the number of admissions and from which hospital they were admitted. MHCA has created a t
emplate request letter for homes to use when requesting such a waiver. Please note that this waiver is only relevant to the State based staff-to-resident ratio rule and does not waive the requirement for compliance with the federal CMS Conditions of Participation.

Staff Contact:


COVID-19 Vaccine Mandate Update

On November 5th, the Centers for Medicare and Medicaid Services (CMS) published the Interim Final Rule (IFR) requiring Skilled Nursing Facilities, Nursing Facilities, and ICF-IIDs to establish a policy ensuring that all eligible staff be vaccinated for COVID-10 or request a medical or religious exemption.

The implementation dates for this rule are as follows: 
  • Phase 1 – December 6, 2021: Staff must have received at least the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine.
  • Phase 2 – January  , 2022: Staff must be fully vaccinated, except staff who have been granted exemptions, or those whom COVID-19 vaccination must be temporarily delayed as recommended by the CDC due to clinical precautions and considerations. 
Maine long term care providers will likely already be in compliance with many, if not all, of these federal requirements due to Maine’s vaccine mandate.

Who does it apply to?

The CMS rule applies to Medicare and Medicaid certified facilities, such as nursing homes, hospitals, dialysis facilities, ambulatory surgical settings and home health agencies. CMS clarified the rule (federal mandate) does not apply to assisted living.

However, in Maine the vaccine requirement applies to all designated health care facilities: including licensed nursing facilities, residential care facility, ICD-IDD facilities, multi-level facilities, hospitals and home health agencies subject to licensure by the State of Maine, Department of Health and Human Services Division of Licensing and Certification.
There have been lawsuits filed in several districts challenging CMS’ authority and specifically the pathway for how the interim final rule was implemented. MHCA will update members as appropriate.

Staff contact:

OSHA Vaccination Rule for Large Employers on Hold

On November 12th, the US Court of Appeals for the Fifth Circuit granted a motion to stay OSHA’s COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS), published on November 5. The court ordered OSHA to “take no steps to implement or enforce” the ETS until further court order.

In a previous statement from the White House and OSHA, any US company that employed more than 100 people was going to need to have their workforce vaccinated by January 4th or test for COVID-19 on a weekly basis. A summary of the OSHA ETS can be found here.
If implemented, the OSHA rule would cover more than 84 million employees or about 2/34 of the US workforce. The White House is encouraging all workers and businesses to continue to follow the guidance and vaccinate employee even with the legal challenge.
Staff contact:

AHCA Documentary: “Closed Doors, Open Hearts: Nursing Homes and COVID-19”

The American Health Care Association has released its new, short documentary titled, “Closed Doors, Open Hearts: Nursing Homes and COVID-19.”  

The film was produced by the Association in 2021 to bring public attention to the many challenges for long term care residents and families, as well as the heroes that fought to keep residents safe during the COVID-19 pandemic.

It provides an intimate look at the day-to-day reality of the COVID-19 pandemic in two long term care facilities. Ararat Nursing Facility is a non-profit organization founded in 1949 that operates three residential care and nursing facilities on two campuses in Los Angeles and serves as a cultural center for the Armenian community. The Edgewood Centre is a family-owned, 150-bed senior care and rehab facility in Portsmouth, New Hampshire with the mission to provide resident-driven care.

These two providers are different in many ways – from geography to the sheer facility size – but they shared many of the same experiences throughout the course of the pandemic. Despite repeated requests for assistance, long term care residents and staff were not made a priority by public health agencies. Like many providers across the country, Ararat and Edgewood were forced to cope with inadequate and delayed access to testing and a national shortage of personal protective equipment. Yet, facing incredible obstacles, staff continued to care for residents when they were needed most.

“Closed Doors, Open Hearts: Nursing Homes and COVID-19” has a running time of approximately 26 minutes and can be viewed here

You are encouraged to watch the film and share it with residents, families, staff, the community, and local media. AHCA has developed a toolkit to help with media outreach, social media sharing, potential screenings/events, and other communications efforts.

This film is an important part of helping others from outside the profession understand what long term care has truly experienced during the COVID-19 pandemic and the continued support that is necessary. Please reach out to AHCA with any questions.

Staff contact:

Next Week's MHCA Office & E-News Schedule

The MHCA office will be closed next week on Thursday, November 25 and Friday, November 26, and MHCA E-News will take a break from its regular schedule, in observance of the Thanksgiving holiday. MHCA staff sends warm wishes to you and your residents for a safe and happy Thanksgiving!

Staff contact:

AHCA Resilience in Recovery webinar

Our fight against COVID-19 is not over. We must create environments and facilitate behaviors to disrupt the epidemiological transition of this virus and protect our most vulnerable population. On Monday, November 22, join industry leaders and professionals to explore how to prevent your next outbreak by leveraging proactive data integration and technology solutions. World-renowned medical expert and immunologist Dr. Deborah Birx will lead the conversation to explore where we currently stand against the Delta variant and discuss preventative testing and data solutions to keep your facility safe during this upcoming winter. 

  • What: Resilience in Recovery. Prioritize. Prevent. Protect. Webinar
  • When:  Monday, November 22, 2021, at 12 (noon) ET

Staff contact:

CMS releases changes to the COVID-19 survey activities and increased NH oversight

CMS recently released changes to the COVID-19 survey activities and increased oversight in nursing homes. CMS announced steps to assist State Survey Agencies (SAs) in addressing the backlogs of complaint and recertification surveys including: 
  • Revising criteria for conducting Focused Infection Control (FIC) surveys;
  • Guidance for resuming recertification surveys; and
  • Temporary guidance and monitor flexibilities related to complaint investigations.
Focused Infection Control Surveys
  • CMS is no longer requiring a FIC survey to be conducted within three to five days of a nursing home having three or more new COVID-19 confirmed cases or one confirmed resident case in a facility that was previously COVID-19-free. 
  • Each survey agency must continue to perform annual FIC surveys of at least 20 percent of nursing homes. 
  • Prioritization of these surveys should be made to those facilities reporting new cases and low vaccination rates. 
Recertification Surveys
  • SAs should be able to resume recertification surveys on regular basis by establishing new intervals based on each facility’s next survey, not based on the last survey that was conducted prior to COVID-19 public health emergency. 
  • SAs should prioritize recertification surveys according to the potential risk to residents such as facilities with history of noncompliance, or allegations of noncompliance (abuse/neglect, infection control, violations of transfer or discharge requirements, insufficient staffing or competency, special focused facilities and/or SFF candidates, and other quality-of-care issues such as falls and/or pressures, etc.)
  • CMS is temporarily allowing certain mandatory survey protocol tasks to be discretionary or triggered based on concerns identified during offsite preparation activities such as complaints to be investigated during the survey, or those that raise to ombudsman, and pervious patters of citations.
  • Mandatory survey tasks eligible for temporary discretion include Resident Council Meeting, Dining Observation Task, and Medication storage.
Investigating Complaints with the Recertification Survey
  • SAs must utilize the efficiencies built into the long term care survey process software application to investigate complaints with the recertification survey. 
Complaints/Facility Reported Incidents (FRIs)
  • SAs to investigate the backlog of complaints/FRIs according to level of triage and would remain in effect only until States are able to clear any backlogs and resume routine operations. 
  • LTC Complaints and FRIs triaged as IJ or non-IJ High are required to be investigated as soon as possible.
  • LTC Complaints and FRIs triaged as non-IJ Medium may be investigated at next scheduled standard survey if received within one year of the scheduled standard survey date or if the allegation involves staff to resident abuse, neglect, or misappropriation of resident property, regardless of the date received.
  • LTC Complaints and FRIs triaged as non-IJ Low – SAs are not required to investigate backlogged complaints/FRIs at this level and may be closed in ACTS at the next standard survey.  
Increasing Oversight in Nursing Homes
  • Surveying for nurse competency: Ensure temporary nurse aides are competent to perform skills and techniques necessary to care for residents’ needs.  
  • CMS is alerting SAs to pay attention to compliance with the requirements for nursing services regarding sufficient nursing staff with appropriate competencies and skills sets to provide nursing and related services.
  • SAs continue to focus on efforts of identifying inappropriate use of antipsychotic medications and emphasis on non-pharmacological approaches and person-centered care practices.
  • SAs are assessing other care areas.
Staff contact:

COVID-19 vaccine boosters available to all Maine adults; Notify MHCA if your facility needs a clinic

Governor Janet Mills announced yesterday, Wednesday, November 17, 2021 that, effective immediately, all Maine adults age 18 and older are eligible to receive a COVID-19 booster shot, regardless of underlying medical condition. This expansion of booster eligibility will protect the health of Maine people, limit transmission of the deadly Delta variant, and preserve our health care system's capacity which is now overburdened because of a sustained surge of COVID-19 cases. Because of this surge, particularly among unvaccinated individuals, the Maine Center for Disease Control and Prevention has determined that all Maine residents live or work in high-risk settings, justifying the expansion of booster eligibility.

Effective immediately, people ages 18 and over may receive a booster shot in Maine if:
  • They completed the two-dose Pfizer or Moderna vaccine series at least six months ago; OR
  • They received the single-dose Johnson & Johnson vaccine at least two months ago.
At this time, most MHCA members have either completed booster shot clinics or have clinics scheduled. While Maine CDC indicates that the State has sufficient vaccine supply, yesterday’s announcement, along with pediatric immunization, may constrain pharmacies’ ability to timely provide clinics or doses. Please reach out to Nadine Grosso at if you need assistance in this area. MHCA meets routinely with Maine Immunization Program staff to ensure our long term care residents receive boosters.

Staff contact: 

Maine Releases FINAL Rule for Chapter 264: Immunization Requirements for Healthcare Workers

On November 10, 2021 Maine DHHS and CDC adopted routine technical rule changes amending 10-144 CMR chapter 264, Immunization Requirements for Healthcare Workers. The Department is adding COVID-19 to the list of vaccine preventable diseases for which Designated Healthcare Facility employees must show proof of immunization or provide appropriate exemption documentation pursuant to 22 M.R.S. 802(4-B) or as otherwise required by law. The adopted rule reflects changes made following the public comment period for the proposed rule and these include the removal of EMS organizations and dental practices. The Department clarified the definition of "employee" to include independent contractors but to exclude persons who provide ad hoc, non-healthcare services for a Designated Healthcare Facility and have no potential for direct contact with staff, patients, or visitors. Amendments also clarify exclusion and reporting requirements, update the required dosage for Hepatitis B, clarify that no Proof of Immunization is available for Influenza or COVID-19, and specify the manner in which annual survey data must be reported and the manner in which it may be used by the Department.

MHCA strongly encourages all members to carefully read through the final rule. We will be providing a synopsis of this document shortly. Many of the revisions will not change the processes/policies developed by your homes following the emergency rule release. 

Staff Contact:

<< [1] 2 3 4 >>