Archive July 2023

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Newly Released Standardized Pressure Injury Prevention Protocols

The National Pressure Injury Advisory Panel has unveiled the second iteration of their Standardized Pressure Injury Prevention Protocol, commonly known as "SPIPP" (pronounced S – PIP). SPIPP is a concise checklist of preventive measures designed for implementation at the bedside, adapted from the 2019 Guidelines on pressure injury prevention. The goal behind creating SPIPP was to develop an evidence-based operational approach to prevention, especially considering that the EPUAP-NPIAP-PPIA guideline had become more extensive.  National Pressure Injury Advisory Panel (NPIAP) and the European Pressure Ulcer Advisory Panel (EPUAP). In the second edition of the guideline, the Pan Pacific Pressure Injury Alliance (PPPIA) joined the NPIAP and EPUAP.
This new version of SPIPP is specifically tailored for patients with significantly impaired mobility, and/or critically ill patients, recognizing that immobility is a key contributing factor to pressure injury development. The primary item on the SPIPP checklist addresses current or anticipated mobility issues as a risk factor. In line with the guidelines, SPIPP emphasizes the use of clinical judgment to refine risk assessment and provides a list of risk factors to aid in identifying additional risks. Furthermore, SPIPP addresses methods to redistribute pressure for patients confined to beds or chairs, such as regularly turning patients every 2-3 hours to a 30-degree lateral angle, using wedges, and shifting the upper leg forward when the patient is lying on their side.
SPIPP 2.0 also acknowledges patients with dark skin tones, considering darkly pigmented skin as a risk factor. The document offers guidance on inspecting darker skin tones to detect pressure injury areas even when the skin remains intact. It also highlights enhanced assessment methods to identify early signs of pressure injury.
Regarding skin care actions, SPIPP promotes managing moisture and incontinence by employing urinary and fecal management systems for high-risk patients, maintaining clean and moisturized skin, and using appropriate low friction textiles, breathable pads, and wicking materials in skin folds. Nutritional interventions are also included, emphasizing the need for a screening assessment for malnutrition upon admission and notifying the dietician when necessary, especially for patients with or at risk for malnutrition, those experiencing decreased food intake, or those with open/ulcerated wounds.
The SPIPP offers a realistic and practical method to ensure pressure injury prevention efforts are provided at the patient's bedside.

The entire SPIPP 2.0 can be downloaded for free on NPIAP's web site HERE.  You will need to register first. 
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iQIES Service Center Hold Times

Due to the Payroll Based Journal (PBJ) quarterly deadline, the iQIES Service Center is projecting an increase in the volume of calls and emails between now and August 14, 2023. 
  • Live phone and email support for the Monday, August 14, 2023, PBJ Deadline will be available until Monday, August 14, 2023, at 8:00 p.m. ET. All files must be submitted by August 14, 2023, at 11:59 p.m. ET. Files for Fiscal Quarter 3 of 2023, with the reporting period of April 1, 2023, through June 30, 2023, will not be accepted after this deadline.  
  • Questions regarding the PBJ policy information should be directed to:
  • If you already have a case open with the Service Center, please have that ticket number ready when a representative comes on the line.
  • If you are having issues with a rejected file or your password, please have your CMS Certification Number (CCN) and QIES User ID available for the representative.
  • For PBJ submission inquiries, please have your staffing summary report, individual daily staffing report, and/or the Submission ID ready to provide to the representative.
  • Use One Method to Report Issues—Due to the anticipated increase in volume at the CCSQ Service Center and to minimize a backlog, please use only one method of reporting for the same issue (phone, email, or CCSQ Support Central). Note: Cases are processed in the order in which they are received, regardless of how the Service Center was contacted. Please allow time for processing.
  • Submit Your Data Early— We encourage you to submit your 2023 PBJ data early during the submission period. The earlier the submission, the more time you allow for Service Center assistance, if necessary. 
For More Information 
Contact the iQIES Service Center at 1-800-339-9313, Monday through Friday, 8:00 a.m.-8:00 p.m. ET, or by email. To create a ticket online or track an existing ticket, please go to CCSQ Support Central.   
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Maine Dept. of Economic and Community Development is Conducting an Employer Talent Attraction Survey

The Maine Department of Economic and Community Development (DECD), in partnership with the Maine Department of Labor, is seeking your input to inform a statewide talent attraction strategy.

This talent attraction strategy is aimed at advancing one of Maine’s long-term goals as outlined in the 10 Year Economic Development Plan: attracting 75,000 to Maine’s talent pool by 2030.

To inform this strategy and action steps, DECD, in partnership with Wallace Economic Advisers, LLC, is conducting an employer survey to better understand the current landscape, challenges and opportunities related to out-of-state recruitment efforts. This survey should take 5-10 minutes to complete and all responses will remain confidential. Contribute your responses to this survey here.

Your participation and responses are paramount in order to draft Maine’s Talent Attraction Strategy. Please respond by August 7, 2023.

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CareerCenter Apprenticeship Lunch & Learn: August 9

Apprenticeship lunch & learn: Join a virtual info session August 9, 2023 at 1 p.m. to learn how apprenticeship can support your recruitment and retention efforts, including for CNAs.

Click here to register.

The Maine Apprenticeship Program assists in setting up structured yet flexible training programs designed to meet the specific needs of Maine employers through on-the-job learning and related classroom instruction. Apprenticeship Programs can be sponsored by employers, employer associations, or labor/management groups that can hire and train in a working situation.

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DHHS Commissioner Lambrew Announces Director for Maine Center for Disease Control and Prevention

DHHS Commissioner Lambrew Announces Director for Maine Center for Disease Control and Prevention 

Dr. Puthiery Va, a graduate of the University of New England, brings broad experience in public health, emergency response, clinical care, and epidemiology   
AUGUSTA— The Maine Department of Health and Human Services announced today that Dr. Puthiery Va will be the next Director of the Maine Center for Disease Control and Prevention (CDC), starting August 28, 2023. Commissioner Jeanne Lambrew appointed Dr. Va following a national search, based on Dr. Va’s extensive range of experience in primary clinical care, epidemiology, and public health emergency response, having most recently led the successful COVID-19 response in the Navajo Nation. Dr. Va will be returning to Maine having received her medical degree from the University of New England.
“I am excited to welcome Dr. Va back to Maine to lead our CDC,” said Governor Janet Mills. “As the last four years have shown, a strong public health system is crucial to protecting and improving the lives, health, and livelihoods of Maine people. Dr. Va’s depth and breadth of experience position her well to assume the helm of the Maine CDC and strengthen our public health infrastructure.” 
“Dr. Va has been a front-line leader – as well as a clinician and epidemiologist – during a global health emergency following a distinguished role as a disease investigator at the U.S. CDC,” said Commissioner Lambrew. “These experiences, alongside managing public health from the Bronx to the Navajo Nation after beginning her medical career here in Maine, gives Dr. Va a deep keel for navigating Maine’s public health challenges.” 
“We look forward to welcoming Dr. Va into the role of director at Maine CDC,” said Maine CDC Acting Director Nancy Beardsley. “The last few years have shown that the work this agency does to protect and promote the health and wellbeing of Maine people is more important than ever and we’re excited to work with Dr. Va at the helm as we continue to move public health in Maine forward.”
"I’m honored to accept the position of director of the Maine CDC and eager to contribute to the well-being of the people of Maine,” said Dr. Va. “I look forward to further strengthening Maine’s public health infrastructure through equitable and community-based services that advance the key initiatives of Governor Mills and Commissioner Lambrew.”
Dr. Va is currently the Director of the Division of Public Health in Chinle, Arizona, serving the population of the Indian Health Service (IHS) Navajo Area Chinle Service Unit. There, she oversees both public health activities and clinical services that include population health, public health nursing, adolescent school health, diabetes, native medicine, health promotion and disease prevention, and clinical and community nutrition programs. Her accomplishments include developing and implementing mobile health clinic services and data science analytics for population health management, contributing significantly to improving health care access for communities. 
“As Division of Public Health Director for the IHS Navajo Area, Dr. Puthiery Va has exhibited exceptional leadership and tireless dedication in her vital work with the Navajo community throughout the COVID-19 pandemic,” said IHS Director Roselyn Tso. “By consistently going above and beyond to provide medical expertise, support, and resources, Dr. Va has been a source of unwavering hope and healing during these challenging times. She has shown exceptional dedication in her work to improve the lives of underserved populations, making her a valuable asset in her new role at the Maine CDC.”
“Dr. Va has consistently shown her dedication and commitment to the Navajo people of the communities we serve,” said Darlene Chee, Chief Executive Officer, Chinle Service Unit, IHS. “She has been focused on improving access to community-based preventive and clinical health care services, continually bringing positive change and health outcomes in her time here.”     
Prior to joining the Indian Health Service, Dr. Va served as an Epidemic Intelligence Service Officer at the U.S. CDC. She led a team examining the impact of dietary sodium intake on health, particularly its connection to chronic diseases. She also played a crucial role in various response teams, including the Zika Virus International Task Force and a mumps outbreak response team in Arkansas. 
She received a medical degree from the University of New England, was Chief Medical Resident at Jacobi Medical Center in the Bronx, N.Y., and served as a Peace Corps volunteer in Burkina Faso.  Her journey to the United States as a child, alongside her family as refugees from Cambodia, adds a valuable dimension to her commitment to public health and humanitarian work.
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131st Legislature Adjourns Sine Die

The 131st Maine Legislature adjourned sine die (i.e., “without day”) around 5:00 am Wednesday morning. This concludes a record-long legislative session lasting over a month longer than statutory adjournment. Notably, the general effective date for nonemergency laws passed during this First Special Session is October 25, 2023. 
There is a lot to celebrate for long term care this session, including:
·        $25 million in supplemental payments (already distributed), and the deadline for use of funds extended to June 30, 2024, for the last two rounds of supplemental funding 
·        $10 million in PNMI-C High Maine Care Utilization
·        $29 million for rate reform 
·        Creation of an Extraordinary Circumstance (ECA) program for at-risk facilities
·        Passage of LD 451, An Act to Ensure Transparent and Accountable Temporary Nurse Agencies
·        Passage of LD 1474, Resolve, Directing the Department of Health and Human Services to Expedite Reimbursement of Nursing Facilities” 
·        Forcing the carry over of LD 1575, An Act to Promote Quality and Innovation in Nursing and Residential Care Facilities
·        This was DHHS’s rate reform bill we had significant concerns with changes in the statutory language without a new rate system in place
·        And much more!
Looking forward, we have begun strategizing for next year’s short session. The cloture (i.e., submission deadline) for bills in the next session is September 29, 2023. 
On behalf of the Maine Health Care Association, thank you to all of the advocates who responded to action alerts, contacted legislators, and collaborated with us on drafting legislation and testimony. It truly takes a village, and I am grateful to the many members who’ve helped improve long term care policies in Maine.

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PBJ: Revised Nursing-Home Level Exclusion Criteria for Administrators

Starting with the July 2023 update, CMS has made changes to the nursing-home level exclusion criteria concerning the number of administrators considered for the administrator turnover measure. Previously, if a nursing home submitted Payroll-Based Journal (PBJ) data and reported administrator hours (PBJ job code 1) for five or more individuals (based on employee IDs in the PBJ system) on 12 or more days during the three-quarter denominator eligibility period, the administrator turnover measure would be excluded.
As of July 2023, the exclusion criteria have been updated. Now, if a nursing home reports administrator hours (PBJ job code 1) for five or more individuals (based on employee IDs) on four or more days in a single quarter within any of the six quarters required for calculating the administrator turnover measure, the administrator turnover measure will be excluded.
For detailed information on these changes, please refer to the Specifications for Staff Turnover Measures section of the  Five-Star Users' Guide 2023 - Updated 7/14/2023 (PDF). The revised sections are highlighted in red and italicized text for easy identification.
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October MDS Changes-Section A

MDS 3.0 version v1.8.11 
To assist members in preparing for the upcoming MDS changes, We will be posting a focus on the nine areas impacted by the changes.
Changes to Section A
The MDS 3.0 version v1.8.11 final item sets and draft RAI guidance were released on April 3, 2023, and substantial changes were made to several sections. 

Changes made to section A include: 
  • Incorporation of the Standardized Patient Assessment Data Elements (SPADES).
  • Race, Ethnicity, and Preferred Language, which allows for standardized data collection across all health care settings. 
  • Two new QRP Measures which capture Transfer of Health (TOH) Information to the provider and to the patient, beginning on October 1, 2023, on all Part A PPS discharges.
AHCA has created an MDS Section A resource document to help providers breakdown the changes. The information in the resource document outlines key changes to MDS Section A, Coding Instructions/RAI Guidelines for each item, and Actions to Consider for implementation across your facility.
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Need resources to help your team through grief and loss?

When the work we do involves supporting others through illness, death, dying, grief and loss, we will undoubtedly be impacted in many ways. Join us for this two-part webinar series to discuss various kinds of grief/loss, common responses, how to assess/evaluate self-care practices and more.
This series – Grief, Loss, Death & Dying: Caring for Ourselves while Caring for Others – will be hosted online (via Zoom) on August 23 & 24, 2023 from 1-3:00pm. For details, including information on how to register, you may click here to access the event page on our website.

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MDS changes are coming Oct 1st. Join us to make sure you're prepared!

The MDS changes coming in October will be the largest, most significant updates to MDS 3.0 since its’ implementation Oct. 1, 2010. These changes will impact data collection, documentation practices, CMS Quality Measures, and more. Don't wait to get your team on board with what's changing.
Join us for the upcoming webinar to learn more.  On August 9, 2023, we will host our webcast – MDS v1.18.11 Updates and the Impact on Quality Measures – via Zoom from 1-2:00pm. For details, including learning objectives and information about how to register, you may click here to access the event page on our website.

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