Archive November 2022

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Half of Mainers over 65 have received Covid boosters

Director of Maine CDC Dr. Nirav Shah announced Maine is the first state where greater than 50% of residents 65 and older received the bivalent COVID-19 vaccine booster. This great news coincides with the Biden Administration's 6-week campaign to improve COVID-19 boosters in communities hardest hit by the pandemic, including nursing homes. 

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Biden Administration Announces Campaign To Boost COVID-19 Vaccination Rate Among Nursing Home Residents

On Tuesday, November 22, the Biden Administration announced a six-week campaign to raise the COVID-19 vaccination rate among nursing home residents. 

In response, AHCA/NCAL President and CEO Mark Parkinson and LeadingAge President and CEO Katie Smith Sloan said, "Nursing homes have done a remarkable job at vaccinating residents, but we have work to do with the most recent booster [...] We all share the same goal: ensuring the health and well-being of older adults. We believe we can continue to increase that booster rate, and to do so requires a shared commitment from the government and other health care providers." 

To help ensure accurate vaccination reporting, consider attending the CDC’s refresher training on NHSN reporting on Tuesday, 11/29, at 1:30 ET. Register here.

Nursing Facility Services: Bariatric Care Reimbursement

MaineCare is issuing this guidance to nursing facilities regarding the process for facilities to request durable medical equipment (DME) and/or authorization for reimbursement to meet extra staffing needs for residents with bariatric care needs. 

To request reimbursement for extra staffing for bariatric care needs, the facility must submit a prior authorization (PA) request via the HealthPAS online portal, or by fax at 1-866-598-3963, or U.S. Mail: PA Unit, Office of MaineCare Services, 11 State House Station, Augusta, ME 04333. The request must include a supporting letter of medical necessity and clinical documentation from the treating provider. The letter of medical necessity must document:  

1) The extent of the member's ability to participate in their own care (e.g. can the member weight-bear or perform any of their own activities of daily living independently or with assistance). 

2) Whether the member requires a one-, two-, or three-person assist and why this level of assist is necessary.

3) The unique physical characteristics of the member that require the additional assistance (e.g. distribution of member’s weight).

4) The hourly rate being requested, including documentation of employee type and anticipated wages and labor hours that justify the requested rate. 

To request DME to meet a resident’s bariatric care needs, nursing facilities should contact a DME provider. If providers need assistance finding a DME dealer, contact the DME Provider Relations Specialist Shannon Beggs by email or phone at (207) 624-4012. The DME provider will submit a PA request to MaineCare via the HealthPAS online portal, or by fax at 1-866-598-3963, or U.S. Mail: PA Unit, Office of MaineCare Services, 11 State House Station, Augusta, ME 04333. MaineCare may approve bariatric equipment for a member residing in a Nursing Facility at an amount higher than the facility’s rate of reimbursement if the member meets the two criteria below. Any DME that MaineCare approves for a resident is that resident’s property. 

1) The member meets the definition of being bariatric size specific to the requested equipment.

2) The DME provider can demonstrate that the requested equipment meets medical necessity requirements for the member.  

For more information, please contact Provider Relations Specialist Bruce Cosgrove at

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CMS Posts Medicare Program Integrity Manual Updates: Changes Affect SNF Enrollment, CHOWs, and Reenrollment Beginning January 2023

CMS posted a display copy of updates to the calendar year (CY) Final Rule for the 2023 Medicare Physician Fee Schedule (PFS), other Medicare Part B policies, and Medicare and Medicaid provider enrollment policies. Many of these updates impact skilled nursing providers. 

Most notably – effective January 6, 2023 – SNFs that are initially enrolling or undergoing a change in ownership (CHOW) fall within the “high” screening category under 42 CFR § 424.518. SNF revalidations are processed at the “moderate” screening level. These changes include the addition of site visits for all SNF providers and fingerprint-based criminal background checks for 5 percent or greater direct and indirect owners at specific times. 

The Federal Register version of the Final Rule will be posted on November 18.

AHCA/NCAL has developed a detailed summary of the changes impacting SNF provider enrollment, revalidation, CHOW, and reenrollment. Note: A member log-in is required to view the summary. 
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Temporary Occupancy Penalty Waiver for Nursing Facility Providers

On November 15th, the Office of MaineCare Services announced it is temporarily waiving the minimum occupancy penalty for nursing facilities, found in Chapter III, Section 67, principle 18.9, through the end of the federal Public Health Emergency (PHE). The waiver applies to facilities with at least one month of service delivery under the PHE, starting with fiscal year ending June 30, 2020.
Additionally, the Department is temporarily waiving the minimum occupancy penalty for Residential Care Facilities, Private Non-Medical Institution Appendix C facilities, found in DHHS Rule Chapter 115, Principles of Reimbursement for Residential Care Facilities - Room and Board Costs, principle 34.3, through the end of the federal PHE. The waiver applies to facilities with at least one month of service delivery under the PHE, starting with fiscal year ending June 30, 2020. The Chapter 115 rules are not part of the MaineCare Program, and these costs are not reimbursed by Medicaid; however, we are including this information in this message for clarity.
The Division of Audit will apply this temporary waiver at time of annual audit for the period which includes the federal PHE. Nursing facility providers do not need to submit revised cost reports for reports already filed. For questions, please contact Trisha White at with “Temporary Occupancy Penalty Waiver for NF Providers” in the subject line.
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Preparations underway for Direct Care Summit roadshow, seats still available, register today!

Excitement is building as the date of our first Direct Care Worker Summit is less than two weeks away! Space is still available in each of four in-person sites, Presque Isle, Brewer, Augusta, and Portland, as well as the virtual session. Each day will include educational sessions on leadership, quality of care, self-care, and mentorship. Attendees will enjoy lunch as well as receive some fun treats from MHCA. We hope these opportunities serve as a well-deserved respite for your hardworking front line team members as well as an opportunity for professional development. As a reminder, all programs are free to attend, as a result of MHCA securing Maine Community College Workforce Compact grant funds. For full details and to register yourself or your team members, please click here.

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Registration now open for AHCA/NCAL Population Health Management Summit

Learn how to lead and grow in today’s challenging environment—so that you won’t be left behind! Attend the PHM Summit and learn from nationally renowned industry experts and innovators sharing how to not only survive but thrive by focusing on population health and value-based care. Come network with your peers and glean as much knowledge as you can from our collective brain trust of leaders in the field. If you are a leader in long term or post-acute care, join AHCA/NCAL for the 2022 Population Health Management (PHM) Summit!

For more information and to register, please click here. 

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Due November 15: AHCA/NCAL National Quality Award Intent to Apply

Next Tuesday, November 15, is the Intent to Apply (ITA) deadline for the 2023 AHCA/NCAL National Quality Award Program. This deadline is the first major milestone in the Quality Award journey.
All ITA submissions are due by 8pm ET on November 15 in the Quality Award Portal. The ITA submission takes only a few minutes to complete!
Information about how to submit an Intent to Apply, resources to support the application process, and more can be found online at the Quality Award website.

2022 Election Day Recap

The 2022 election results are mainly in, and the Democratic Party will maintain control of the Legislative and Executive Branches. Governor Mills secured her second term, Senate President Troy Jackson narrowly defeated his opponent, and the House will still host a Democrat majority. Maine legislators will swear into the 131st Legislature on December 7th.

The MHCA Legislative Committee has been meeting and is finalizing a list of priorities to improve long term care in Maine. As always, we will update our members through our E-News and Action Alerts. Stay tuned! 

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Reducing Respiratory Viral Infections this Winter

Respiratory viruses are more common during the winter months. In a recent AHCA/NCAL article describes how elderly residents, particularly those with multiple medical conditions, are at risk for developing serious illnesses or exacerbations of their other illnesses, being hospitalized, or even dying. Increases in Influenza, RSV, COVID-19, and other respiratory viruses are occurring in the general population, with some hospitals in communities nearing or at capacity. There are several key steps to help reduce the impact on residents from viral infections this winter.
  1. Get your flu shot and COVID-19 bivalent booster.
    If residents get a breakthrough infection, these vaccines will significantly reduce their risk of getting severely ill, hospitalized, or dying. Learn more at
  2. Start antiviral treatment as soon as symptoms develop.
    Effective antiviral treatments are available for both Influenza and COVID-19. Start residents on antivirals early in their course of infection; even if they are vaccinated or symptoms seem mild, because they greatly reduce the risk of getting seriously ill, hospitalized, or dying. Talk to your Medical Director or Consultant Pharmacist about how to get residents started on these medications quickly. 
  3. Stay home if you are sick.
    Staff and family members should stay home and/or postpone visits with loved ones if they are feeling sick with what could be a respiratory virus until symptoms have resolved. 
  4. Follow CDC guidance on infection control for respiratory viruses. 
    The spread of respiratory viruses can be reduced by following core infection prevention & control practices. CDC has specific guidance including for Influenza and COVID-19.
  5. Maintain airflow in your building. 
    Check that your HVAC is working properly and using appropriate filters. Also, the EPA has a fact sheet?? with strategies to improve indoor air quality.
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