Archive May 2022

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MHCA and Maine DHHS Strongly Encourage Waiver Requests

On the last ME DHHS/CDC LTC Med Dir’s call, several participants asked about requesting waivers to the upcoming change in CMS regulations (per attached QSO-22-15-NH) that had previously allowed several waivers to CMS regulations related to the Public Health Emergency.  Since that call, we learned that CMS has advised that all provider/facility requests for CMS waivers should be submitted directly to CMS through the “CMS PHE Emergency Web Portal “ outlined in the attached memo and summarized below: 
<<CMS has created an automated 1135 process with a publicly accessible web form.  The form offers standardized, user-friendly submission by requesters.   All 1135 waiver requests and/or inquiries should be directed to the CMS 1135 web portal at: >>
While the state is taking steps to request a state-level waiver, it is important for individual facilities to submit their own requests as that will help reflect the importance of this issue in Maine facilities, and because we have no way of knowing if or when CMS will grant a state-level waiver.  In follow up of discussion on our last call, the state has had discussions with CMS on the possibility of extending the CMS waivers statewide related to the following physician services
• Physician Delegation of Tasks in SNFs - 42 CFR §483.30(e)(4) o CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. This waiver gave physicians the ability to delegate any tasks to a physician assistant, nurse practitioner, or clinical nurse specialist, but specified that any task delegated under this waiver must continue to be under the supervision of the physician.
• Physician Visits - 42 CFR §483.30(c)(3) o CMS waived the requirement that all required physician visits (not already exempted in §483.30(c)(4) and (f)) must be made by the physician personally. The waiver modified this provision to permit physicians to delegate any required physician visit to a nurse practitioner, physician assistant, or clinical nurse specialist who is not an employee of the facility, who is working in collaboration with a physician, and who is licensed by the State and performing within the state’s scope-of-practice laws.
• Physician Visits in Skilled Nursing Facilities/Nursing Facilities - 42 CFR §483.30 o CMS waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.
If we are successful with a statewide extension of the waivers mentioned above, we will send out a notice to this group.  However, as noted, we have no way of knowing if or when a statewide waiver will be granted, and strongly encourage individual facilities to submit their own requests directly through the CMS portal.

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Counterfeit At-Home Over-the-Counter COVID-19 Diagnostic Tests

On May 5, 2022, the U.S. Food and Drug Administration (FDA) issued a warning that counterfeit at-home, over-the-counter (OTC) diagnostic tests for COVID-19 have been distributed or used in the United States.

These counterfeit tests should not be used or distributed.

The FDA will update its
website to list counterfeit at-home OTC COVID-19 diagnostic tests to alert the public, including test users, caregivers, health care providers, and distributors, and to provide information on how to identify counterfeit tests.

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2022 AHCA/NCAL Awards Programs Now Open!

Nominations for the 2022 AHCA/NCAL awards programs are now open! MHCA members are strongly encouraged to nominate those in their community who go above and beyond to provide exceptional service in the long-term care profession. Members may nominate your outstanding staff and volunteers directly to our national affiliates.
AHCA Awards:
The AHCA 2022 Awards Program honors individuals who are committed to improving the quality of life for residents. Award categories include:  Nominations and other information are available on AHCA's website now through July 1, 2022. Please read the full 2022 Award Rules and Guidelines.
NCAL Awards:
The NCAL 2022 Awards Program recognizes assisted living employees from around the country who demonstrate exemplary work within the profession. This program gives awards in four categories:
  • Administrator of the Year
  • Nurse of the Year
  • Noble Caregiver in Assisted Living
  • National Assisted Living Week (2021) Programming
Before submitting your nomination, make sure you have all the necessary components. To nominate, the following items are required:
  • Administrator and Nurse of the Year nominations: 500-word essay and candidate’s resume
  • Noble Caregiver in Assisted Living nominations: 500-word essay
  • National Assisted Living Week Programming nominations: 500-word essay, activity calendar from the week, and pictures from the week.
Please read the full Rules & Guidelines for the 2022 NCAL Awards Program.
Completed nominations for both ACHA and NCAL awards must be submitted no later than Friday, July 1, 2022. Honorees will be recognized at AHCA/NCAL's 73rd Annual Convention & Expo in Nashville October 9-12, 2022. If you have questions or need assistance, please contact Nadine Grosso at 207-623-1146 or
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AHCA/NCAL urges HHS to extend COVID-19 Public Health Emergency

McKnight’s Senior Living (5/12, Bowers) reports that "16 national organizations, including the American Health Care Association / National Center for Assisted Living...asked Health and Human Services Secretary Xavier Becerra to extend the public health emergency related to COVID-19." In a letter to Becerra, the groups said, "We need to be ready should a future variant elude the protection of our current vaccines and ensure that the health care system is prepared as we head into this fall’s flu season." AHCA/NCAL has previously "requested that Becerra extend the PHE through the end of 2022." AHCA/NCAL Senior Vice President of Government Relations Clif Porter said, "We urge the federal government to prioritize long-term care residents and staff by extending the PHE so that providers can continue to offer the most efficient and effective care possible."
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Preti Flaherty resumes 2022 Employment Law breakfast briefings

For the first time in two years, Preti Flaherty's Employment Law Group is excited to offer its annual breakfast briefings in person! Join them on Wednesday, May 18, 2022, from 8:30 - 10:00 a.m. for the kickoff to this year's series: Identifying and Preventing Inappropriate Comments at Work!

Employers are starting to establish a new workplace normal. Employees are often returning to work in an environment that is dramatically different than the one they left two years ago. How we communicate with each other in the workplace is still critical to the success or failure of an organization and its employees. Has the time apart sharpened or dulled our ability to interact with colleagues? What is the impact of isolation, separation and continuing culture wars on inappropriate comments in the workplace, and how can HR best protect employers and employees from the effects of inappropriate comments on people's careers? Michael Messerschmidt and Matt LaMourie will review best practices for employers to reduce legal liabilities.

Register for the event in person at One City Center, Penthouse Floor, Portland ME using this link:
2022 PF Breakfast Briefings LIVE event
Or, register for the virtual option at: PF Breakfast Briefings Webinar Registration - Zoom
Questions? Contact Amber Mann at 207.791.3055 or

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Maine DOL has Workplace Labor Law Posters in Multiple Languages Available To Print for Free

The Maine Department of Labor now has required workplace labor law posters available in these additional languages: Arabic, French, Spanish, Portuguese, Chinese (Mandarin), and Somali.

All posters are available to print/download at no cost on the MDOL website -

We encourage all employers to display posters in the language(s) of their employees.

If you have questions about labor law, please reach out to our Bureau of Labor Standards at 207-623-7900 or
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Mills Administration Launches $1.5 Million Maine Jobs & Recovery Plan Initiative to Promote Health Care Careers

The Mills Administration today announced the launch of twin campaigns aimed at promoting health care careers in Maine, as part of a series of initiatives from the Governor’s Maine Jobs and Recovery Plan to bolster Maine’s health care workforce and attract and retain health care workers.

The Departments of Health and Human Services (DHHS) and Labor (DOL) are collaborating on the campaigns to promote entry-level and other health care jobs as stepping stones to rewarding careers, particularly among young people in Maine.

DHHS has partnered with a number of groups and associations, including MHCA, to launch a social media campaign to highlight entry level positions throughout the healthcare field. Live and Work in Maine is already promoting the website with employers and will launch social media, digital, mobile and TV ads as well as in-person events. Learn more here.

Caring for ME: In a more targeted effort to attract and develop direct care and behavioral health workers in Maine, the administration has launched Caring for ME, a complementary campaign that includes social media advertising, in-person events, and a new website where individuals can explore careers, find job openings from the Maine Department of Labor’s Maine JobLink directory, and read stories that highlight the importance and meaningful nature of direct care and behavioral health work in Maine.

HealthCare Training for ME: Earlier this month, the administration announced the Healthcare Training for ME initiative to connect individuals and employers with training resources, such as adult education, community colleges, and universities. This initiative also includes scholarship programs, career navigators, and student loan relief programs to help people interested in health care careers determine the right career path for them.  

“The pandemic has taken its toll on the health care workforce at a time when more caregivers are needed to meet demand. Maine is at a pivotal time in terms of our response to the staffing crisis,” said Angela Westhoff, President and CEO of the Maine Health Care Association. “These recruitment campaigns rest on the foundation that it takes a special person to be a caregiver and work in the healthcare field. Our caregivers are not only providing an important service, but are often the eyes, ears and voices of those for whom they care. MHCA is pleased to partner with the Administration on tangible recruitment and retention solutions, like the Caring For Me campaign and partnership with Live and Work in Maine, that will encourage more people to enter this noble field and provide clear pathways for advancement as well.”
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REMINDER: CMS Comments on FY 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule (CMS 1765-P) DUE BY June 5th, 2022

At this time, it is critically important that CMS hear from a significant number of providers to understand the impact of the proposed financial impact rule. We need you, and as many people in your organization as possible, to help with this effort. Comments do not have to be overly long, but CMS needs to hear from you in your own words.
There are two key items in the proposed rule to note:
  • A possible delay or phase-in of the proposed parity adjustment to Medicare rates.
    • In the proposed rule, CMS is proposing a $320 million decrease in Medicare Part A payments to SNFs beginning October 1, 2022. CMS has calculated the payment increase it should make to rates, a forecast error adjustment (due to under forecasting inflation), and a required parity adjustment to make sure rates under PDMP are budget neutral with what they would have been under the RUGs model. Absorbing the full parity adjustment in one year would be extremely difficult for SNFs, so providers need to ask for a phase-in of the parity adjustment.
  •  Information on revising the requirements for LTC facilities to establish mandatory minimum staffing levels.
    • This may be the only chance nursing facilities have to weigh in with CMS on staffing minimum proposals before any regulations are written. Comments about your current staffing challenges are needed. Framing concerns about mandatory staffing levels in terms of how this would affect resident care (i.e., access to care, reduced admissions, etc.) will be most impactful.
Below are some helpful hints to organize your comments:
  • Describe Yourself, Your Operation, and Your Commitment to Quality
    • Mention what you do, why you work in LTC, and what your residents mean to you.
    • Describe your building (i.e., location, # of units, profile of your residents).
    • Mention if you are 3-Star or better or have won an AHCA Quality Award; discuss your quality efforts.
  • Discuss How Difficult the Past Two Years Were
    • Describe the sacrifices you and your team have made and the tragedy of the losses.
    • Give a specific example of a team member who has worked tirelessly.
  • Explain the Impact of a 4.6% Reduction
    • Tell CMS how a proposed cut to nursing homes' Medicare rates in FY 2023 would be detrimental to your residents, colleagues, and organization.
    • Ask for the parity adjustment to be phased-in.
    • Explain from your own perspective how a reduction will impact patient care.
    • Explain your loss in census, increased labor costs, and ongoing COVID costs. If you are worried about closing, let them know.
  • Discuss Your Workforce Challenges
    • Let them know how many open positions you have and how hard recruitment is.
    • Discuss your inability to fill shifts, use of agency staff, and related costs.
    • Tell them that a staffing mandate will not create workers—the workers are not out there.
(For more details on the proposed rule, AHCA/NCAL has developed a summary of the greatest impacts on members.)
The deadline to submit comments is 5:00 pm on June 10, 2022. We encourage you to submit your comments as soon as possible. We have provided information below on how to prepare and send your comments.
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AHCA/NCAL Quality Award Program OPEN NOW!

The AHCA/NCAL National Quality Award Program is excited to announce that the 2023 application year is now open. For the first time, application packets are available three months earlier than previous years so that skilled nursing care centers and assisted living communities can begin to prepare.

We encourage members to take advantage of this additional time to download application packets and materials and to begin planning, reviewing, and gathering relevant data.

Start Today!   

The National Quality Award Program is a rigorous three-level process (Bronze, Silver, and Gold) that evaluates an organization's capabilities against nationally recognized standards for excellence. The program provides a pathway to improved outcomes in areas including care, workforce, leadership and operations.

During this year’s fall conference MHCA will be providing the BLUEPRINT FOR QUALITY: BUILDING A FOUNDATION FOR YOUR QUALITY AWARD APPLICATION program. During this session, BRONZE applicant attendees will work with Danielle Watford on the specific requirements to create a successful award application. Trust me when I say you will leave this session with a draft copy of your award application. You all deserve recognition but often we don’t have the time to dedicate to this endeavor. Spend three hours with us the day prior to fall conference and we will get this done!! 93% of prior attendants were awarded their bronze award after participating in this event.

Register Here for the MHCA program!

  • November 10 – Intent to Apply deadline (Indicate that you plan to apply and receive a significant discount)
  • January 26, 2023 – Application deadline
  • Summer 2023 – Bronze, Silver, and Gold Award notifications
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Your latest RESIDENT PROFILE REPORT is available NOW!

This past week, AHCA/NCAL released the first semi-annual edition of Your Resident Profile for 2022 for skilled nursing members. This edition has resident days and episodes for clinical conditions, such as diabetes and schizophrenia, as well as acuity, such as IV feeding and ventilator use. There is data for two timeframes, October 2019 – September 2020 and October 2020 – September 2021, so you can monitor change over time. All data is based off MDS assessments.

Use Your Resident Profile to Update Your Facility Assessment

The facility assessment is a Phase 2 requirement of participation by CMS to receive Medicare reimbursements. Many members use their Resident Profile from LTC Trend Tracker to complete the Facility Assessment Tool developed by the Quality Improvement Organizations (QIOs) and thus meet CMS’s requirement. For more on the elements of the facility assessment requirements, check out this ahcancalED webinar.

Access Your Center’s Resident Profile Today Through LTC Trend Tracker

Your Resident Profile is an exclusive AHCA/NCAL member benefit. Once you are a registered user of LTC Trend Tracker, you will receive an email whenever a new publication is released. If you missed the email on the release date or it got caught in a spam filter, you can always access current and historic Resident Profiles within LTC Trend Tracker.

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