Archive September 2022

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CMS/CDC Guidance Changes Summary

Summary of CMS and CDC Guidance Changes (09/23/22)

DISCLAIMER: The CMS intent behind the guidance updates was to align with that CDC guidance updates so that both CDC and CMS are speaking in the same language. CDC and CMS acknowledged the need to relax some of the practices that are not indicated at this point in the pandemic and in particular CMS followed CDC in having guidance for testing and quarantine that is no longer based on whether a resident or staff is up to date with their vaccinations.

Previous guidance has been archived and no longer exists in the current guidance for healthcare settings. It is important to note that you need to check your local and state guidance while CDC and CMS have changed their guidance and brought these reliefs described there may be guidance from your local and state health departments which is more restrictive. MHCA has contacted the Maine DHHS Division of Licensing and confirmed with Bill Montejo that they DO NOT anticipate releasing any additional memos regarding these changes.

Key Infection Prevention and Control Updates:
  • Routine testing of staff is no longer required. You do not need to test your staff on any sort of routine basis any longer. Facilities can opt to perform this at their discretion, but you're no longer required by CMS or CDC to do any kind of routine testing of your staff.
  • You still need to test based on exposure, but you no longer need to test asymptomatic staff.
Outbreak Definition:
  • Outbreak definition largely remains the same, the one change is that a resident who is admitted to transmission-based precautions would not qualify as an outbreak. In addition, if a resident is admitted directly to transmission-based precautions /with COVID or a known exposure and develops COVID while in transmission-based precautions an outbreak is not triggered.
Reminders on testing:
  • You should be instructing all your staff, regardless of vaccination status to report any of the following criteria to occupational health, infection preventionists or another facility point of contact to be properly managed. This would include a positive COVID test, symptoms, or a higher risk exposure.
  • You should be testing residents or staff with symptoms or signs of COVID immediately regardless of vaccination status as soon as possible but no earlier than 24 hours if it's an exposure that's being tested.
  • For residents or staff who test positive, facilities should follow CDC guidance that states residents should be based placed on transmission-based precautions or work restrictions until the CDC criteria to discontinue has been met.
  • Requirement for outbreak testing hasn't changed. You should be performing testing for all residents and staff regardless of vaccination status. Testing is recommended immediately but not earlier than 24 hours after exposure. If they're negative, you will test again 48 hours after the first negative test and if again 48 hours after the second negative test so this will be typically be on day one (1) day three (3) and day five (5).
There are two approaches to outbreak testing. You can choose to have a contact tracing approach or a broad-based approach.
  • Contact tracing approach may be more challenging because it requires you to identify all potential contacts within the organization where a broad-based approach is preferred if you can't identify all potential contacts or manage them.
  • A broad-based approach would mean testing on an entire unit, floor or facility based on where the outbreak is.
Additionally, when you're in outbreak you must require face masks of all staff and residents.
Refusal of Testing:
  • Facilities must have procedures in place to address staff or residents who refuse testing.
  • For staff who have signs or symptoms of COVID-19 and refused testing are prohibited from entering the building until the return-to-work criteria are met. If outbreak testing has been triggered and a staff member refuses to be tested, they should be restricted from the building until the outbreak testing has been completed and the facility should follow its occupational health and local jurisdiction policies with respect to any asymptomatic staff who refuse testing during an outbreak.
  • For residents who want to exercise their right to decline testing for COVID-19 facilities should have procedures in place that ensure that those residents who refuse testing are managed in accordance with the CDC guidance for the use of transmission-based precautions. In discussing testing with residents, CMS/CDC recommends that you use person centered approaches when explaining the importance of testing and understanding why the resident might be refusing testing.
Testing is not generally recommended for asymptomatic people who've recovered from COVID-19 within the last 30 day. That is a change that has been made recently from the CDC based on this new omicron variant. It's now recommended that you don't test people who are asymptomatic within 30 days of recovery, but you should consider testing those who were recovered in the prior 31 to 90 days and perform an antigen test versus a nucleic acid amplification.
Antigen Testing:
  • CMS released a new QSO memo that rescinds what was previously an enforcement discretion for the use of COVID tests on asymptomatic individuals outside of the test instructions.  By way of background, in December of 2020 when HHS and the administration started sending out antigen tests to nursing homes one of the problems, we encountered was that a lot of those antigen tests were only recommended for people with symptoms and at the time there were actually being sent for the screening testing of staff, so this posed a problem for facilities performing this testing under their clia waiver.
  • Fast forward to September of 2022, most antigen tests are now recommended for serial testing of asymptomatic staff so if you're using them on people who are asymptomatic you can use them as long as you're testing at a frequency defined on the test. It's usually every couple days for three test periods and that means that you're using the test within it's instructive use so it can be used on someone who's asymptomatic as long as it's recommended for serial testing. So since this is now rescinded when you're performing tests in your facility under that clia waiver you need to make sure that you understand the manufacturers use for the test that you're using. The FDA website has a list of all antigen tests that have been approved by the FDA and what they're approved for.
  • It's very easy to find what they're approved for and again most of them are approved for testing on symptomatic people within a certain number of days as well as serial testing of asymptomatic people there are some that are only recommended for symptomatic people so you do need to make sure that you understand the manufacturer’s instructions for use when you're using these tasks.
New Admissions:
  • New admissions no longer must be quarantined or isolated unless they have confirmed or suspected COVID-19. The new guidance is based on your current community transmission levels though so if community transmission is high testing is recommended at admission and if negative again test 48 hours after the first test and if negative again test 48 hours up in the second test and again. Admissions should be advised to wear source control for 10 days following their admission and we recommend that facilities develop and follow policies for new admissions and what they can do during this testing protocol.
  • If community transmission levels are NOT high:
    • Testing and source control is at the discretion of the facility. You are not required to test or use source control upon resident admission. Source control is of course recommended for individuals who have suspected or confirmed COVID-19 infection, had close contact with someone with COVID-19 within the last 10 days or if the facility is experiencing outbreak.
  • CDC clearly states that residents who leave the facility for less than 24 hours do not need to quarantine except in certain situation described in the CDC's transmission-based precaution guidance such as having symptoms.  If they leave from more than 24 hours they should be then managed as a new admission using the criteria above.
  • CDC and CMsS have offered several guidance reliefs around visitation the biggest being that they removed references to up-to-date vaccination status from the visitation guidance entirely so the visitation guidance no longer hinges on whether or not a resident has been vaccinated and boosted.
  • They also removed the requirement to screen all who enter the facility but they've added the guidance that facilities are now required to post guidance signs at entrances regarding recommendations for visitors who have had a positive viral test for COVID-19 symptoms or if had close contact with someone with COVID-19.
  • In terms of additional reliefs that were provided in the visitation guidance for face coverings and masks again it hinges on community transmission level. If you're in a county with high community transmission everyone should wear face coverings or masks in the facility.
  • If the community transmission levels are not high, face coverings and masks are optional. It is still the safest practice.
  • Face masks are required during an outbreak.
  • During an outbreak resident and their visitors when alone in the resident’s room or visitation area are not required to mask and they may have physical contact. That applies within high low moderate substantial community transmission.
  • When a roommate is present during a visit it's always safest for the visitor to wear a face covering or mask.
  • Facilities policies regarding face coverings and masks must be based on recommendations from the CDC and state and local health departments (Maine CDC) as well as individual facility circumstances. Make sure that you're checking your state and local health requirements so that you’re following those requirements in addition to the federal requirements.  
Reminders on visitation:
  • As laid out in the visitation memo by CMS facilities should provide guidance such as posted signs at entrances regarding the recommended actions for visitors who had a positive test, symptoms or close contact. Visitors with confirmed infection or symptoms should defer non urgent visitation until they have met CDC criteria for healthcare settings to end isolation.
  • Should a resident choose to leave the facility you should remind them that the resident in any of the individual accompanied them should follow all recommended infection prevention control practices such as wearing a face covering or mask or performing hand hygiene and this is especially important for those individuals at higher risk for severe illness and when community transmission is high.
  • Visitation and activities during an outbreak investigation are allowed. You have to allow visitors during an outbreak, but you can recommend that deferring visitation is the safest option. Visitors should be made aware of the potential risk of visitation during an outbreak investigation and adhere to the core principles of infection prevention control.
Source control and masking guidance reliefs
  • Guidance changes for CDC include two categories for consideration: 1) community transmission levels that are high and 2) community transmission levels are not high.
  • If community transmission levels are high everyone should wear source control. CMS refers to this as face coverings and masks. Healthcare personnel could choose not to wear source control when in areas restricted from patient access so those examples are your offices or break rooms or places that patients don't come into.
  • If community transmission levels are not high source control is only recommended for individuals who have suspected or confirmed respiratory infection, had close contact with someone with COVID-19 and  for 10 days after that contact, reside or work in areas of the facility experiencing a COVID-19 outbreak or have otherwise had source control recommended by public health.
Additional PPE guidance
  • When the community transmission levels are high everyone in those areas where the healthcare professional can encounter residents should wear source control. N95s are only used in select situations such as when aerosol generating procedures such as nebulizer treatments are used or during care of patients with COVID-19 or in area or units where there is an outbreak. Eye protection is used during
Notifications to residents and families:
  • We continue to work on advocating for CMS to bring relief to that but your facilities are still required to make those notifications according to the time frame that specified in regulation.  
Vaccine mandate:
  • The vaccine mandate is still in effect and if you recall on the vaccine mandate required staff to have at least the primary series which is considered fully vaccinated never in the vaccine mandate was there the component to be up to date or have your booster while it did indicate that you had to track individuals vaccination statuses for up to date and so on it did not require staff to be up to date.
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CMS Rescinds enforcement discretion for use of non-FDA approved POC Antigen tests

The Centers for Medicare & Medicaid Services (CMS) released an update to QSO Memo QSO-22-25-CLIA which rescinds enforcement discretion for the use of SARS-CoV-2 tests not FDA approved for use among asymptomatic individuals outside of the test’s instructions for use.
At the start of the pandemic, some but not all of the SARS-CoV-2 Point-of-Care (POC) Antigen (Ag) tests were limited to use on individuals who are symptomatic. Thus, in December 2020, CMS released a memo saying it would use enforcement discretion to allow providers with CLIA Certificate of Waiver to use these tests outside of the FDA approved manufacturer’s use. CMS has now rescinded this memo as many POC Ag tests are now approved for both symptomatic patients AND serial screening of asymptomatic patients making the waiver no longer necessary. 
AHCA/NCAL recommends that all LTC providers operating with a CLIA Certificate of Waiver using SARS-CoV-2 POC Ag tests check the manufacturer’s instructions for the tests they have on hand to ensure they FDA approved for both symptomatic and asymptomatic individuals. If not, they must restrict the use of the tests to situations consist?ent with FDA approval. Providers should check the FDA
list for allowed uses of existing antigen tests and use them consistent with the FDA and manufacturer’s approval. Providers that violate the manufacturer’s use may be subject to enforcement actions related to the facility’s CLIA Certificate of Waiver.
Most Ag tests are currently approved for testing among individuals with symptoms of COVID-19 or serial testing on asymptomatic individuals (e.g. tested twice over three days with at least 24 hours (and no more than 48 hours) between tests). The FDA website has a list of all manufacturers with Ag tests where facilities can find the manufacturer’s instructions for use. Providers may want to consider purchasing Ag tests that can be used in all situations to avoid inadvertently misusing antigen tests.

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Ever wondered about the Quality Award Program?

Here is what other providers are saying about their experience.    
Below are three ways in which you can get involved with the Quality Award Program: 
  1. National Quality Award Intent to Apply - November 15: Applicants who submit an Intent to Apply will save money on their overall application fee. No paperwork or application is needed. You can access help documents for the Quality Award Portal here.  Submit your ITA payment by logging in to the Quality Award Portal.
  2. Examiner Application - November 10: One of the best ways to understand the demands of the criteria is to serve as an Examiner. The Quality Award Program is looking for individuals interested in learning more about quality improvement and performance excellence to serve as Examiners. Benefits of volunteering with the program include in-person and online training on the Baldrige Performance Excellence Criteria, CEUs, opportunities for professional development, and networking with other industry professionals. Click here to learn more.
  3. Quality Award Board Nominations – November 10: The Quality Award Board is seeking self-nominations for their upcoming election process. The 12-member board has oversight over key functions and the strategic direction of the program. For more information, please visit the board website
For questions, please contact the AHCA Quality Award Team at  

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Remind: Invitation for Nov. 9th Stakeholder Group to Explore Additional LPN Programs

The Maine Department of Labor is a partner in a collaborative effort with the Department of Health Human Services, Education, Maine Community College System, and the University of Maine System to coordinate access to and support for healthcare training via a consolidated website and training funds—Healthcare Training For ME.

They have recently received a tremendous number of requests for LPN training from both employees and employers.
Last month, they brought together the education stakeholders to learn more about barriers to scaling LPN training programs. The group created an impressive list of both challenges (space, staff capacity, etc.) and solutions (hybrid training models, weekend lab capacity, faculty sharing, etc.).

We would like to invite industry stakeholders to join this group to explore these opportunities to build the capacity of training programs together. They are scheduled to meet via Zoom on November 9th from 10:30 to noonIf you are interested/available please register here.

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HCS Assisted Living Study Underway

Participation is open for the Assisted Living Salary & Benefits study. The national study is supported by the National Center for Assisted Living (NCAL). This year marks their 25th year of publication! Below is a brief overview on the study:
•         Deadline for data submission: November 7th
•         Report published January 2023
•         Participant pre-paid rate is $185; billed rate is $205
Hospital & Healthcare Compensation Service (HCS) is conducting its annual Assisted Living Salary & Benefits Study and requests your participation. Assisted Living providers are asked to complete the study’s questionnaire by November 7th.  There is no cost to participate. Participants may purchase the results at the reduced price of $185, versus the $375 nonparticipant rate. Questionnaires may be downloaded at:
For any questions, contact Rich Cioffe at, (201) 405-0075, ext. 10, or to request a deadline extension if needed.
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MHCA and LTCOP present 2022 Excellence in Long Term Care Awards

The Maine Long Term Care Ombudsman Program and MHCA presented the 2022 Excellence in Long Term Care Awards earlier this week at Maple Hill Farm in Hallowell. Dr. Nirav Shah, Director of the Maine CDC, delivered an address in which he thanked caregivers for their commitment to providing quality care to Maine’s elders and disabled citizens throughout the pandemic. Join us in congratulating this year’s honorees:
Excellence in Long Term Care Awards 2022
  • Shirley Bonefant, Laundry, Forest Hill
  • Katie Dudley, Personal Support Specialist, Compassionate Caregivers for ME, LLC
  • Penny James, Personal Support Specialist, Seniors/Domestics Home Care Agency
  • Lisa Johnson, Housekeeping Aide, Maine Veterans’ Home – Machias
  • George Johnson, Care Aide, Certified Residential Medication Aide, 75 State Street
  • Melody Knox, Certified Nursing Assistant, St. Andre Health Care
  • Betty Kubera, Certified Nursing Assistant, Katahdin Health Care
  • Cathy Lincoln, Certified Nursing Assistant-M Level III, Rehab Aide, Maine Veterans’ Home – Augusta
  • Holly Martin, Registered Nurse, Orchard Park Rehab & Living Center
  • Mei Ramirez, Certified Residential Medication Aide, DLTC Healthcare Hall-Dale Manor
  • Emily Skyers, Certified Residential Medication Aide, The Landing at Cape Elizabeth
  • Joshua Stevens, Nurse Manager, Barron Center
  • Kelly Williams, Certified Nursing Assistant, Mid Coast Senior Health Center
  • Lifetime Achievement Award, Faith Stilphen, RN, The Landing at Cape Elizabeth
We thank this year's judges for their time and expertise. They are:
  • Trinity Baker, Maine Long Term Care Ombudsman Program
  • Jeanne Delicata, Barron Center
  • Nadine Grosso, formerly of Maine Health Care Association
We also would like to thank our event sponsors for their generous support. They are:
  • DLTC Healthcare
  • First Atlantic Healthcare
  • Maine Veterans’ Homes
  • North Country Associates
  • Geriatric Medical
  • MHCA Worker’s Comp Fund
As a reminder, recipients of the AHCA/NCAL national quality awards will be recognized with a state award and recognition on stage at MHCA’s Fall Conference on Thursday, October 20th at 8 am during the opening session.
To view the program booklet and live stream event broadcast,
please click here.

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RAC-CT program offered virtually November 16-18, 2022

Increase your knowledge of clinical assessment and care planning, completion of the MDS, the regulations surrounding the RAI/MDS process, and managing the PDPM by attending an AAPACN Resident Assessment Coordinator—Certified (RAC-CT) certification workshop. Having the RAC-CT credential behind your name shows that you are a knowledgeable and capable MDS professional.

This certification is the most widely-recognized and respected MDS 3.0 certification available in the long-term care profession, as well as the mark of nurses who understand more than a paper form—they understand resident assessment.

When: November 16, 17, and 18, 2022, 8:00am-5:00pm
Where: Zoom Virtual Platform
Instructor: Andrea Otis-Higgins, MBA, RN, MLNHA, RAC-MT, CHC

For more information and to register, please visit the website. Please reach out to Ashley Ellis, Director of Education with any questions.

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CMS revises SOM to reflect recent changes to QSO-20-38 and QSO-20-39

CMS has revised the CMS 20054 Infection Prevention, Control & Immunization Critical Element Pathway to comport with the revised recommendations and changes QSO-20-38-NH-Revised (testing) and QSO-20-39-NH-Revised (visitation). The revised pathway can be found in the Survey Resource folder on CMS'  nursing home webpage.

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AHCA Offers Webinar to provider overview of recent CDC/CMS changes

Join Holly Harmon and other senior members of the AHCA Quality & Regulatory Team for a review of recent updates to COVID-19 guidance for nursing homes. This webinar is available to AHCA/NCAL members only. The webinar will be recorded and available for access after the live event.
Follow the Instructions Below to Register:
  • To avoid technical problems, use Google Chrome.
  • Members will need to log in using their existing email and password first.
  • Once you are logged in to the website you will be able to register by clicking the green register button at the top of the page.
  • If you have forgotten your password click here.

If you are new to the site, you can create an account here. Answer all fields on the create an account page- especially locating your company name. You can search by name or zip code. After creating an account, you will be able to register for the webinar.

Email if you need assistance with registering.

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MMSF Golf Tournament Fundraiser: Register to Play and/or Sponsor by October 6!

Join us for the annual Mike McNeil Scholarship Fund Golf Tournament fundraiser on October 18, 2022, at the Samoset Resort, Rockport, Maine. Prizes include individual and team awards PLUS a chance to win $10,000 for a Hole in One!
We have the following sponsorship opportunities:
  • Workforce Champion: Event Sponsor - $2,500 SOLD
  • Workforce Patron: Swag Bag Sponsor - $1,500 / 1 available
  • Workforce Partner: Hole in One Sponsor - $1,000 / 1 available
  • Workforce Supporter: Hole Sponsor - $500 / 13 of 15 available
  • Raffle Prize Donations
Our thanks to BerryDunn and DLTC Healthcare for their Workforce Champion/Event sponsorships and Harmony Healthcare International (HHI) and Preferred Therapy Solutions for their Workforce Supporter/Hole sponsorships!
The Mike McNeil Scholarship Fund promotes careers in long term care through scholarships for individuals affiliated with MHCA long term care facilities. Scholarships are open to MHCA member facility employees, their immediate family members and volunteers wishing to pursue post-secondary education and training in the areas of Nursing, Physical or Occupational Therapy, Speech Pathology, Social Work, Activities and Food Service. To date, the Fund has awarded $74,000 to more than 120 students pursuing careers in long term care.
For more information, register to play and/or sponsor the event, click here.
Questions? Contact Dianne Chicoine, Tournament Coordinator (207.623.1146, ext. 201)
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