Kasey Stevens | Quality Insights: All righty. It is just now 10'clock, and I know folks are still filtering in here, but we want to go ahead and get started. We a lot of content to cover today.
Kasey Stevens | Quality Insights: So good afternoon and welcome to our webinar. The public health emergency has ended breaking down guidance for cute and continuing care facilities. This is part 2 of a 2 part series by quality insights. Medical Director, Dr. Jean Storm.
Kasey Stevens | Quality Insights: Today's webinar will focus on guidance changes affecting the cute and continuing care facilities. Part one was held yesterday and a recording will be available on our website later this week.
Kasey Stevens | Quality Insights: My name is Casey Stevens, and I am a communication specialist with quality insights.
Kasey Stevens | Quality Insights: Everyone has entered the meeting today on mute. But we have a discussion following the presentation. You have questions or comments. Please submit them, either using the chat or Q. A tool in your menu.
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Kasey Stevens | Quality Insights: So today we're going to discuss that recent guidance, no changes now that the public health emergency has ended. So, Dr. Storm. If you'll advance to the next slide.
Kasey Stevens | Quality Insights: Today's webinar is eligible for free nursing, continuing education credits, you can see details about those credits here. If you're interested in obtaining credit. You'll need to stay for the entire length of the webinar as well as complete, and evaluation and knowledge tech. We'll share the link to the evaluation after today's discussion.
Kasey Stevens | Quality Insights: And now I'd like to present our presenter today. Dr. Jean storm.
Kasey Stevens | Quality Insights: Dr. Storm is a medical director here. Quality insights. She has a background in nursing, home care, internal medicine and healthcare leadership. Most recently she served as an associate medical director for optum slash, united health care. She also served as a regional medical director for 38 long term care facilities in West Virginia.
Kasey Stevens | Quality Insights: She earned her do from Lake Year College, Osteopathic Medicine, and completed her postgraduate training at Mill Creek Community Hospital in Erie, Pennsylvania. Dr. Storm. Thanks for joining us today.
Jean Storm: Thanks so much, Casey.
Jean Storm: So we'll go ahead and get started with the objectives. I just want to say that a lot has happened, obviously during the pandemic. And now we are back in peacetime mode, as the government says so. We really just wanted to remind everyone about what the baseline means, and in order for everybody to kind of stay compliant, which is
Jean Storm: for where we should be. There are a lot of waivers that went into place that allowed providers to effectively
Jean Storm: function during the pandemic with Covid. And so now we're back in our baseline. So we have to be kind of remind ourselves of what that baseline is. So at the end of this webinar, the attendee will be able to identify the changes that all providers across all health care environments must make with the the ending of the health care of the public health emergency.
We're going to be talking about the policies and procedures. The community mental health centers must implement with the ending of the Ph.
Jean Storm: we're also gonna be talking about dialysis, facilities, and what changes those facilities much must make with the ending of the pandemic and the attending will also be able to state the many changes that the hospitals must make regarding patient rights, medical records, medical staff credentialing, discharge, planning, and telemedicine services. I will say some of these changes just involve ending of waivers, meaning that we had federal regulations in place
Jean Storm: prior to the pandemic.
Jean Storm: A waiver was put in place that told health care, facilities and providers that you don't need to worry about that
Jean Storm: Federal regulation during the pandemic. And now that the public health emergency is over, that waiver is ended. So we need to get back into following those federal regulations, though there are some changes that were made during the pandemic
Jean Storm: that are now permanent, or they might be changing a few months from now. So we're going to be talking about all of those as we walk through these changes.
Jean Storm: so ambulatory surgical centers and licensed independent free standing emergency departments during the public health emergency ambulatory surgical centers and license, independent free standing emergency departments could actually function as hospitals
Jean Storm: and Cms waves the requirement that the medical staff pro privilege privileges needed to be periodically replaced, and the scope scope of privileges need to be periodically reviewed. Now that the public health emergency has ended.
Jean Storm: these ambulatory surgical centers can no longer function as hospitals, and can't build Medicare for services as such. If they would like. If ambulatory surgical centers would like to be, would like to function as a hospital. They have to meet certain certification standards or return to their ambulatory surgical center
Jean Storm: status.
Jean Storm: It is 3 years and a hundred days later. that's a really long time, but we are back in peacetime mode. So it's it's been a long time. The pandemic was a long time, so a lot of us is kind of have kind of forgotten about what that baseline status or peacetime mood means.
Jean Storm: So what did the public health emergency mean? On January 30, first, 2,020, the Secretary of Department of Health and human services. Alex Azar declared the Covid outbreak of Public Health Emergency. So in doing so, he was allowed to declare this public Health emergency under Section 3, 19 of the Public Health Service Act.
Jean Storm: because it was. We have a a infectious disease in a virus that was a public health emergency. It can also be declared in in for other reasons, for other outbreaks of infectious disease, a bio terrorist attack or other what other issues?
Jean Storm: So, as I stated, some changes during the public health emergency involve more regulations. We had a vaccine mandate as a result of the public health emergency, but most of the changes resulted in relaxation or suspension temporarily of certain federal regulations that are required by Cms. And so providers were able to focus more. So on
Jean Storm: taking care of covid patients doing what they need to do in the facility health care systems, we're able to change things in order to best care for covid patients and really face the challenges of the pandemic.
Jean Storm: I thought this was a really interesting slide. These were all of the Us. Federal emergency declarations in response to Covid. So as the Public Health Emergency Declaration.
Jean Storm: This allowed for all of these waivers to be undertaken. and then we also. As a result, we had the emergency use authorization declaration. So this enabled for vaccines to get rolled out very quickly. This allowed for therapeutics to get rolled out very quickly, so we had a lot of lives saved as a result of that emergency youth, authorization, declaration.
Jean Storm: And then you can see other
Jean Storm: declarations that were enacted as a response to COVID-19 A lot of individuals were helped and supported through these Federal emergency declarations, and they all have their different timelines.
Jean Storm: This is the document that was released by Cms. Which outlines what is going into effect now that the public health emergency has ended, I would encourage you to look at the document. What if my colleagues look took a look at my slide decks that I put together
Jean Storm: for these webinars about the public Health emergency ended, and she called it the cliff notes of this document, because this document is fairly long.
Jean Storm: I did with each slide as I talked of as I am. As I'm going to discuss each section of the document I linked the Federal regulation
Jean Storm: at the bottom of the slide. So if you're interested in reading the
Jean Storm: Federal regulation that was waved or changed as a result of the public health emergency. I encourage you to go to the link that is in the bottom of the slide.
so guidance for all providers and environments. We all know that on November fifth, 2,021 Cms. Issued an interim final rule requiring Medicare and Medicaid certified providers
Jean Storm: to ensure that all staff were vaccinated against COVID-19.
Jean Storm: These slides I put together
Jean Storm: probably about a month or 2 ago. So
Jean Storm: at the time Cms. Stated in the document
Jean Storm: which outlines all that what is entails at the ending of the public health emergency Cms. Indicated that they would soon end this requirement, and they have indeed ended the vaccine requirement, though I will say Cms included a lot of wording around continued education around the covid vaccine. We know that in, especially in vulnerable populations. The bivalent
Jean Storm: vaccine provides excellent protection with these individuals. Research around covid infection around long Covid has demonstrated that vulnerable individuals are at high risk of mortality and other issues.
Jean Storm: you know, a year following covid infection. So the best course of action is to have individuals get vaccinated for Covid. So the bivalent remains the best protection.
Jean Storm: And that's what Cms indicated in the document.
Jean Storm: And I'm
Jean Storm: more guidance for all providers and environments involves emergency preparedness, training and testing during or after an actual emergency, which is the public health emergency. The emergency preparedness regulations allow for a one year exemption from the requirement for testing exercises. So now we are back to the
Jean Storm: the Public health. Emergency is ended. So inpatient providers and suppliers must conduct a full scale exercise within its annual cycle for 2023,
and an exercise of choice, outpatient providers must conduct either a full scale exercise, or an exercise of choice within its annual cycle for 2023 is scheduled to conduct the full scale exercise within 2023.
Jean Storm: If the provider, the provider supplier, must conduct the exercise of choice if scheduled during the annual cycle for 2023, and then resume the full scale exercise requirement in 2,024. So it alternates, outpatient providers alternate between the full scale and the exercise of choice. And if you are curious about what entails a full scale exercise.
Jean Storm: or an exercise of choice, a full scale exercise is an operations based exercise that typically involves multiple agencies, jurisdictions and disciplines performing functional and integration of operational elements in response to a disaster event. So this is a boots on the ground response, like a hospital treating mock patients and an exercise of choice is a mock disaster drill or a tabletop exercise.
Jean Storm: So community mental health centers during the public health emergency, a a modified copy process was allowed. We know that Copp is really essential in determining what our issues are in a facility and then developing a plan to potentially ameliorate or fix that problem and test it to make sure that it's actually working.
Jean Storm: That process was, was allowed to be partial during the pandemic, to allow for more
Jean Storm: to, for to allow for facilities to really look at infection control and really focus on infection control processes
Jean Storm: and also community mental health centers during the public health emergency could provide partial hospitalization services
Jean Storm: and other community help mental health services in an individual's home. And the 40% rule was waived. So what is a 40% role? The 40% role is that a community Mental health center must provide at least 40% of its items and services to individuals who are not eligible for Medicare. So that rule is back into effect
Jean Storm: also back into effect. The full copy process is required, and no partial hospitalization services can be provided in an individual's home. And if you have any questions you want to read more. I linked to the Federal regulation at the bottom of the slide.
Jean Storm: So we're gonna talk about Esrd facilities.
Jean Storm: So with
Jean Storm: when we are looking at training programs and audits and emergency preparedness for dialysis facilities during the public health emergency Cms waves the requirement for on time periodic audits for operators of the water to isolate the equipment, and the patient care staff maintains current
Jean Storm: certification. So that was all waved during the pandemic.
Jean Storm: Now that we are through the public health. Emergency facilities are required to demonstrate on time periodic audits for operators of the water dial. So it diastly equipment and patient care staff members. They need to have current Cpr certification so that all needs to be complete.
Jean Storm: And again, the Federal regulation is linked at the bottom of the slide
Jean Storm: patient
Jean Storm: within the lab ladder of 30 calendar days or
Jean Storm: 3 dialysis sessions. Beginning with the first outpatient dialysis session, a follow up comprehensive assessment must occur within 3 months after the completion of the initial assessment.
Jean Storm: To then provide, update, and then adjust the patient's plan of care. So those timelines must be followed care, planning, and monthly physician visits during the public health. Emergency
Jean Storm: Cms. Modify the requirements related to care, planning, and physician visits. These Federal regulations are now back into effect. The dialysis facility is required to implement the initial plan of care within the latter of 30 calendar. Days after admission to the dials. This facility or 13 dialysis sessions. Beginning with the first session.
Jean Storm: It is also required for monthly or annual updates of the plan of care within 15 days of the completion of of the additional patient assessments.
Jean Storm: It's also essential that the facility make sure that all dialysis patients are seen by a physician, a nurse, practitioner, a clinical in our specialist or physicians assistant providing Esrd care at least monthly and periodically, while the human dialysis patient is receiving in facility dialysis so just important that the physician comes and sees the patient while they're in the facility.
Jean Storm: Home visits during this is for patients who are receiving home dialysis during the public health, emergency, home visits for not necessary. Now the public health emergency is ended.
Jean Storm: Home visits are essential for A and A are essential for an assessment to for adaptation at home and making to make sure that the home dialysis machine designated and is required to periodically monitor the patient's home adaptation. And this needs to be done by facility personnel.
Jean Storm: And again, I link the Federal regulation at the bottom of the slide
Jean Storm: dialysis, patient care technician. So during the public health emergency certification requirement was modified.
Jean Storm: Now that we are through the ph dialysis, patient care technicians are required to obtain certification under a state certification program or a nationally, commercially available certification program, and this needs to be done within 18 months of being hired as a patient care technician for newly employed patient care, technicians.
Jean Storm: physician credentialing
Jean Storm: during the public health emergency Cms waves the requirement that that was that required credentialing of physicians at each facility. And so this kind of allowed physicians to go to different facilities without being credentialed at each one. So now that the public health emergency has ended, all medical staff appointments and credentialing must be in accordance with State law, including attending physicians, assistants, nurse practitioners, and clinical nurse. Specialists
Jean Storm: have to be credentialed at each facility where they are seeing patients.
Jean Storm: special purpose, dialysis, facilities
Jean Storm: which are furnishing dialysis, services on the main premises so special perfect purpose, dialysis, facilities are are established, and these
Jean Storm: facilities, then.
Jean Storm: will provide services, provide dialysis services in nursing homes, long term care facilities assisted living facilities. And in those types of environments. So these special purpose styles, this facilities were allowed to function during the public health emergency. Now that the public health emergency has ended, these special purpose, facilities can only be deceived.
Jean Storm: established. If there is a determination that there is a lack of access of care and the dialysis facilities need to be to provide services on the main premises. So if
Jean Storm: these facilities can be implemented if there can be a determination of lack of access of care.
Jean Storm: Okay, hospitals. And there's a lot of changes for hospitals.
Jean Storm: So this is one regulation that was changed as a result of the pandemic.
Jean Storm: During the Public Health emergency Cms. Established a cute care hospital, a acute hospital care at home initiative. Which was it? It's really innovative. And this initiative waves the Medicare hospital conditions of participation. And essentially that meant that a nurse needed to be on premise 24 h a day, 7 days a week, and the patient need could have a immediate availability for a registered nurse
Jean Storm: that was waved during the the pandemic to to provide for this acute hospital care at home. So
Jean Storm: this is changed because of the the Public Health Emergency. Section 4, 1, one of the Consolidated Appropriations Act in 2,023 included an extension of waivers and flexibility associated with the Queue Hospital at home initiative.
Jean Storm: So it's going to continue through December 30, first, 2,024. There is explicit criteria and data collection requirement as part of this extension, but I think this will be really interesting to see what's happened if we can move towards this model of a cute hospital care at home
Jean Storm: and see if it's successful
Jean Storm: anesthesia services. So during the public health emergency Cms waves the requirement that a certified, registered nurse anesthetist needs to be under the supervision of a physician, so that was waved during the public health emergency
Jean Storm: after the public health emergency Crnas must be under the supervision of a physician unless certain procedures are followed and then approved by Cms. So the certain procedures are
Jean Storm: the state where the facility is located, needs to submit a letter to Cms. Signed by the Governor.
Jean Storm: Following consultation with the State's Board of Medicine and Nursing, and this needs to request this letter needs to request an exemption from physician supervision of Crna. So if this is not. If this procedure isn't undertaken, the Crna needs to be under the supervision of a physician.
Jean Storm: Emergency medical treatment and Labor Act, also known as M. Talla
Jean Storm: during the public health emergency Cms. Allowed hospitals, psychiatric hospitals, critical access hospitals to see screen patients at a location off site from the hospitals campus. So this allowed
Jean Storm: for the to move patients in order to prevent the spread of COVID-19. And Talla essentially means that if a patient comes into the emergency room comes into the hospital they need to be seen
Jean Storm: assessed and stabilized in that facility the facility hospital cannot decide. Oh, I'm going to just. I'm going to move them to another location. I'm going to move them to a different hospital that is not allowed. But during the public health emergency that was allowed in order to prevent the spread of Covid in into kind of limit. The spread
Jean Storm: Intel is now going to be enforced, and if you are interested in leading learning more. I linked at the bottom of this
Jean Storm: slide
Jean Storm: verbal orders during the public health emergency feedback verification is required for verbal orders, but authentication may occur later than 48 h. So basically, this means that if a physician is called for an order, say, for a seed of Minneapolis, the physician can give the order. I see the Minneapolis.
Jean Storm: We'll have to read back that order, and the physician then, can agree. Yes, that is my order.
Jean Storm: During the public health emergency. The physician then just could give the order. And then physicians then need to go back into the Emr system and actually verify and electronically sign that order at some point during the public health emergency. It was not within 48 h now that we are through the public health emergency, those orders need to be signed within 48 h.
Jean Storm: reporting. So during the public health emergency reporting of deaths associated with sophisticated restraints was waived.
Jean Storm: Now that we are through the public health emergency hospitals are required to report
Jean Storm: patient deaths that occur in an intensive care unit.
Jean Storm: If the death was associated with soft risk, with soft risk, restraint, they required soft risk, restraint, and there was a death of that patient. But it was due to their disease
Jean Storm: that death needs to be reported because it was associated with soft risk restraints. and it needs to be reported no later than the close of business on the next business day.
Jean Storm: So if a patient
Jean Storm: is in the Icu. They have sepsis.
Jean Storm: and they required software restraints to keep from pulling out Iv lines
Jean Storm: or any t-tube, and that patient dies on a Sunday
Jean Storm: that death needs to reported no later than close of business on Monday. So that is, the timeline.
Jean Storm: Patient rights
Jean Storm: are pretty significant. During the public health emergency Cms. Waves the requirements that the patient had right to access their medical records
Jean Storm: if they requested them, and then they could receive them in a form and format requested by the individual.
Jean Storm: The hospital also needs to have written policies and procedures regarding visitation rights of patients, including any restriction or limitation on visitation rights.
Jean Storm: and after 24 h before writing a new order for the use of restraint or seclusion for the management of violent or subject to self-destructive behavior, a physician or other license practitioner who is responsible for the care of the patient authorized to order restraint or seclusion by hospital policy in accordance with State law, must see and assess the patient. Essentially. This means
Jean Storm: that after the public health emergency of her, a patient has a right to request their medical records and receive them in a form and format that they request a hospital has to have written policies and procedures regarding visitation rights and any restriction on visitation rights, and every 24 h. If
Jean Storm: restraint or seclusion is ordered for a patient, that physician, a physician, might must assess and reorder those restraints, or the seclusion, if needed.
Jean Storm: discharge planning during the public health emergency Cms waves the requirement for just detailed discharge planning. Now we know that the detailed discharge planning
Jean Storm: regulation is back in effect and discharge planning really works, and it saves pre admissions. The hospital must have an effective discharge planning process. It has to focus on the patient's goal and treatment preferences, and also include the patient's caregiver, support
Jean Storm: individuals, and must look at the patient's goals of care
Jean Storm: and what their transition is going to be from the hospital.
Jean Storm: And again, this. This is all to reduce preventable hospital readmissions.
Jean Storm: medical staff credentialing during the public health emergency Cms. Waved regulations requiring periodic appraisals of medical staff.
Jean Storm: Now that the public health emergency has ended, the hospital must have an organized medical staff that operates under bylaws approved by the governing body, which is responsible for the quality of medical care provider to patients for the hospital.
Jean Storm: the medical staff must periodically conduct appraisals of its members. The medical staff must examine the credentials of all eligible candidates for medical staff membership, and make recommendations to the governing body on the appointment of those candidates in accordance with State law.
Jean Storm: including scope of practice, law, medical staff by law. So
Jean Storm: now that the public health emergency has ended, there needs to be an organized system for looking at medical staff credentialing and make sure the medical staff is all up to date with its credentialing, and the appropriate individuals are seeing patients.
Jean Storm: medical records, and advanced directives during the public health emergency Cms. Wave medical record requirements as well as requirements to provide advanced directive policies to patients. So the patient self-determination Act
Jean Storm: states that hospitals must provide patients with information revarding their policies on advanced directives that's back into effect and medical record service requirements back into effect.
Jean Storm: Sterile compounding areas during the public health emergency Cms wave requirements to allow use face Max to be removed and retained in the compounding area to be redawned and reused during the same work. Shift in the compounding area. Only
Jean Storm: now use face mask may not be reused in the compounding area, so new mask must be used, and there are a lot of places in healthcare environments where masks needed to be reused during the pandemic
Jean Storm: and so now that in in this. This is to clearly states that use mass may not be reused. In the compounding area.
Jean Storm: There was extensive waivers put into place for the physical environment and hospital, and I'm not going to go into all of them here, because, like I said.
Jean Storm: they are fairly extensive. But most of the physical environment waivers that were
Jean Storm: put into place as a result of the public health emergency, essentially just allowed for hospitals to utilize space which was not routinely used for patient care to to be used for patient care, so there might be a wing that was closed, and hospitals could be able to open up these wings to prep. Provide for care of patients
Jean Storm: with covid for to allow for overflow. Perhaps the tent was set up outside to allow for care of patients with covid. So
Jean Storm: these physical environment requirements were waved during the pandemic to allow for the space to be utilized as such.
Jean Storm: All of those requirements, all those waivers regarding physical environments and hospitals ended, so those spaces cannot be utilized any longer for patient care.
Jean Storm: and I linked the Federal regulation again at the bottom of the slide.
Jean Storm: So telemedicine telemedicine changed a lot during the pandemic. And it's changed a lot as a result of the public health emergency. So during the public health emergency Cms waves, the requirement for written agreements between a hospital and a critical access hospital, you using telemedicine service services and the distance site hospitals or distance site, telemedicine entities furnishing the service. So there was a waiver.
Jean Storm: The waiver of these requirements has ended, however.
Jean Storm: the Consolidated Appropriations Act of 2,023 provided an extension for some telehealth flexibilities for professional services under the physician fee schedule as well as services furnished by rural health clinics
Jean Storm: and federally qualified health centers through December the 30 first 2,024.
Jean Storm: So telehealth is forever changed as a result of the pandemic.
Jean Storm: So if you're interested in learning more about the Telehealth changes. You can
Jean Storm: just click the link at the bottom of the slide once you get the slides.
Jean Storm: So physician services. I thought this was really interesting, but during the public health emergency Cms. Waves the requirement for Medicare patients to be under the care of a physician.
Jean Storm: So that was not a requirement, so, for patients did not need to be under the care of a physician as a Medicare patient. Now that the public health emergency has ended Medicare patients must be under the care of a physician.
Jean Storm: Utilization review utilization review is really important in hospital to determine
Jean Storm: to make sure that the care is correct that patients are being admitted under the right status. So during the public health emergency Cms waves the entire utilization review condition of participation.
Jean Storm: So this utilization review condition of participation required. The hospital has to have a utilization review plan with a utilization review committee that provides for a review services furnished to Medicare and Medicaid beneficiaries.
Jean Storm: So this process needed needs to evaluate medical necessity of admission, duration of stay, and the services provided that entire process was waved during the public health emergency. And it's a really important process, but it and it is back into effect. Now, the federal regulations back into effect for a utilization review process.
Jean Storm: So the hospital has to have a You are plan that is going to review the services provided by the institution
Jean Storm: and by members of the medical staff to patients entitled to benefits under Medicare and Medicaid programs.
Jean Storm: So really important thing that needs to be done just to make sure that if a patient is appropriately admitted as a full admission under observation status.
Jean Storm: their duration of stay making sure the services are performed correctly, do they need to be performed inpatient can they be performed outpatient. So all of those
Jean Storm: emergency preparedness, policies, and copy during the public health emergency Cms. Waves the requirements for the hospital and hospitals and critical access hospitals to development, to develop and implement emergency preparedness policies and procedures and wave requirements which provide details on the incorporation and setting of priorities for the programs performance improvement activities
Jean Storm: and copy programs. So again, copy was waived and the emergency preparedness policies were also waived.
Jean Storm: Now that we are through the public health emergency, the emergency preparedness policies and procedures, performance improvement activities and copy program are required per cms, regulations.
Jean Storm: nursing services. So during the public health emergencies, Cms. Waves, the requirement for nursing, care, plans and nursing care plans did not need to be done, and
Jean Storm: hospitals did not need to have policies outlining what nursing staff was needed in
Jean Storm: outpatient departments.
Jean Storm: Now that we are through the public health emergency nurses are required to develop and keep a current care plan on each patient.
Jean Storm: Also, hospitals have to have policies and procedures in place.
Jean Storm: determining what outpatient
Jean Storm: departments are not required under hospital policy to have a registered nurse present. So there's certain outpatient departments that a hospital can determine does not need to have a registered nurse present, and those policies and procedures need to be written and kept
Jean Storm: food and dietetic services during the public health emergency Cms. Wave requirements for therapeutic diet manuals. They were not required. Now
Jean Storm: we are through the public health, emergency providers are required to have a current therapeutic, manual diet, manual, approved by the dietary, dietitian, and medical staff, and this needs to be readily available to all medical nursing and food service personnel.
Jean Storm: And again I link the Federal regulation at the bottom of the slide
Jean Storm: respiratory services, and these were in demand during the pandemic. During the public health emergency Cms. Waves the requirement
Jean Storm: for hospitals to designate the personnel who are qualified to carry out certain respiratory services. So this means the hospitals didn't need to designate what
Jean Storm: personnel we're going to be doing nebulizer treatments. or instead of spirometry. Or if you're setting up oxygen
Jean Storm: now, after the public health, emergency hospitals must specify which personnel are qualified to perform which respiratory procedures and the amount of supervision required for personnel to carry out certain procedures must be designated in writing.
Jean Storm: so all of that needs to be to be written out for specific respiratory procedures, and I link the Federal regulation at the bottom of the slide. If you'd like to learn more
Jean Storm: hospitals, able to provide care and temporary expansion sites. So this was the the same as the the physical environment. Waiver is very similar as part of the Cms hospital without walls. Initiative during public health emergency hospitals could provide hospital services and other hospitals in site, otherwise would not have been considered a health care, facility, and could set up temporary expansion sites.
Jean Storm: This is no longer, and the end of the public health emergency hospitals are no longer to provide services as temporary expansion sites like tents
Jean Storm: during the public health emergency hospitals. We're allowed to provide swing beds. So
Jean Storm: if a hospital had individuals
Jean Storm: in their facility that need to go to skilled nursing facility, but there is no skilled nursing facilities available that's available. Then the hospital was able to provide swing beds
Jean Storm: payable under the sniff perspective payment system.
Jean Storm: Now this public health emergency has ended. Hospitals must meet those Federal requirements. If they would like to provide, learn long term care services to patients.
Jean Storm: Those swing beds. Patients need then to now to be moved on to a skilled nursing facility as appropriate
Jean Storm: inpatient psychiatric unit patients and inpatient rehab patients during the public health emergency cms, wave requirements that allowed inpatient psychiatric unit patients and inpatient rehab
Jean Storm: rehab rehabilitation unit patients to be cared for in the acute care beds. This is no longer hospitals need to care for in-patient psychiatric unit patients in inpatient
Jean Storm: psychiatric unit beds and in-patient rehabilitation unit patients in inpatient
Jean Storm: rehabilitation unit that's so we can't mix and match
Jean Storm: critical access hospital hospitals. There's a lot of things that have changed as critical access hospitals. Now that the public health emergency has ended.
Jean Storm: critical access hospitals must follow Federal personnel requirements for clinical nurse, specialists, nurse, practitioner and physician assistance. They must have staff who are licensed, certified, and register
Jean Storm: registered accordance with all Federal State and local laws. They must be located in a rural area. They have to limit their number of beds to 25 and the length of stay to 96 h.
Jean Storm: and they must have a doctor of medicine or Osteopathy be physically present to pop, provide medical direction, consultation, and supervision. They cannot operate in any temporary expansion site, and they must comply with M. Talla, meaning, if a patient comes into the er
Jean Storm: or into the hospital, they need to be seen, assessed and stabilized
Jean Storm: intermediate care facilities for individuals with intellectual disabilities. After the public health emergency, these facilities must allow clients to have the opportunity to participate in social religious and community group activities. Obviously, these are ended. These are stopped during the public health emergency. They must also provide each employee with initial and continuing training that enables the employee to perform his or her duties effectively, efficiently and competently
Jean Storm: rural health clinics and federally qualified health clinics after the public health emergency.
Jean Storm: These clinics have to have a physician, a nurse, practitioner, physician, assistant, or certified nurse, midwife, to be available to furnish patient care services at least 50 of the time and again not operate at temporary expansion locations.
Jean Storm: So I wanted to talk a little bit about some compliance timelines that go beyond May 12,
Jean Storm: and the the first one talks about hospices and home health, and we we probably can skip that one. But the compliance timeline for intermediate care, facilities for individuals, intellectual disabilities. This compliance, timeline is in A goes into effect on July 11, 2,023. These facilities are required to ensure
Jean Storm: that each client receives a continuous active treatment program which includes consistent implementation of a program of specialized and generic training treatment health services and related services.
Jean Storm: Again, this is another, a hospice training which needs to be talks about in service training provided during the 12 months I did cover Hospice yesterday. But again, this compliance, timeline is September thirtieth, 2023 for
Jean Storm: Hospice, assessing skills and competence of all individuals furnishing care. If you're interested in reading more about this Federal regulation again, it's linked at the bottom of the slide
Jean Storm: compliance timelines on December 30, first, 2,023. So the
Jean Storm: these I'll just. I'm going to talk about immediate care facilities and fairly qualified health centers.
Jean Storm: but they need to be in compliance, for on December 30, first, 2,023. For these regulations immediate care facilities must provide sufficient direct support staff, so that
Jean Storm: direct care staff are not required to perform support services
Jean Storm: that interfere with direct client care. So the stress here is performing direct care.
Jean Storm: fed a federally qualified health clinics are required to ensure that physicians provide medical direction for the clinics or centers, health care activities and consult consultation for a medical supervision of the health care staff only with respect to medical supervision of nurse practitioners, so they're expected to be in compliance on December 30, first
Jean Storm: acute and continue and care reporting, beginning at the conclusion of the COVID-19 public health emergency and continuing until April thirtieth, 2,02320 24 hospitals and community access hospitals.
Jean Storm: Critical access hospitals are required to provide report data for COVID-19 and seasonal influenza in a standardized format, and as frequency as the term specified by the Secretary.
Jean Storm: Intermediate care facilities are encouraged to report COVID-19 vaccine and therapeutic treatment information in the Cdc's and Hsn.
Jean Storm: And here are some resources available. If you would like to look into them again, you'll be given the slide deck.
Jean Storm: and I think that's it
Kasey Stevens | Quality Insights: fantastic. Thank you so much, Dr. For your great presentation in a moment. Here we're going to begin the Q. A. Portion of the webinar. If you have a question or comment. Please submit them, either using the chat feature or the Q. A. Tool in your zoom, and you can also raise your hand and request to be unmuted to ask your question aloud.
Kasey Stevens | Quality Insights: while we're waiting, I like to go over a few closing items.
Kasey Stevens | Quality Insights: first. I'd like to remind everyone that is wanting. continuing education credits for today's webinar to stick around to the end. So we can direct you to the post Webinar evaluation. Alrighty. We're going to wait to see. if we have any questions coming in here
Jean Storm: so far. None. Dr. Storm.
Jean Storm: Well, if anyone has any questions,
Jean Storm: after the presentation, if you can think of them after you go through the slide deck, don't hesitate to reach out via email. I'd be happy to answer them
Kasey Stevens | Quality Insights: fantastic. Thank you so much, Dr. Storm.
Kasey Stevens | Quality Insights: All righty. In a moment. I'm going to go over the instructions for those of you who are wanting continuing ed credits for nursing. You're not here for continuing. I could please ignore the pop up window with the survey monkey Link. If you get an email from Zoom with a link to evaluation. You can ignore that as well. It's just for people wanting, continuing, add credits.
Kasey Stevens | Quality Insights: if you're not singing around for cease. You can sign off at this time. Thank you so much for joining us today. Dr. Storm, if you will advance to the next slide there.
Kasey Stevens | Quality Insights: All right. So, as you said in the beginning of the webinar, for those of you interested in E credits, you need to complete an evaluation in order to receive those credits on your certificate of completion. You'll need to complete an evaluation and post knowledge. Check.
Kasey Stevens | Quality Insights: Once you successfully complete the post knowledge check, you will be forwarded to your certificate so, as you can see here, we have a few ways. You can do that. you can pull up the evaluation by using the link right there. I'm also going to drop the link in the chat in a moment. You can also scan this QR code by using your camera on your smartphone, and then you can fill out the evaluation right on your cell phone.
Kasey Stevens | Quality Insights: or you can wait until the end of the webinar and a zoom pop-up will know will come up with a link to the evaluation. So you don't have time to complete the evaluation right now. But when I go back and do it later. I'll send an email later this week with the links to the recording, the slides and the evaluation. So please feel free to take it at your convenience. You have question about the CD. Or the certificate.
Kasey Stevens | Quality Insights: feel free to reach out to Andrea. Left K at a left K. At quality insights.org. I'm gonna drop her email address in the chat. And if you have any other questions about today's webinar feel free to reach out to me or Dr. Storm. my email address is K. Stevens at quality insights.org. And I'll put that in the chat. I'll also put Dr. Storm's email in the chat as well.
Kasey Stevens | Quality Insights: thank you so much for joining us today. I'll hang out just here for a few moments so I can get everyone those links in the chat. I hope you have a great rest of your day.