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The End of the Public Health Emergency + MDS RAI Manual Updates, & More!

Kelly Cooney, Regulatory Strategist, weighs in on the Public Health Emergency (PHE) ending and shares guidance.  

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Question: The Public Health Emergency (PHE) is finally coming to an end. Can you share your perspective on the transition that will take place May 11? 

Cooney: Managing the upcoming changes associated with the PHE termination will require providers to stay on their toes! It will be critically important to understand the many details and updates from CMS, as well as think strategically about how the transition will impact patients and providers at all levels of the care continuum.


Question: The devil is in the details, so please start by sharing specific guidance providers need to know about the PHE. 

Cooney: First, the Qualifying Health Stay (QHS) waiver is still in play, so HealthPRO Heritage recommends providers continue to skill in place, direct admit & accept with less than 3-day hospital stay as appropriate until May 11. Please know CMS clarified that patients covered by Medicare Part A who are admitted prior to May 11 via the waiver can indeed complete their benefit period without a QHS.  

Also, we anticipate the transition will give rise to scenarios that may cause confusion. For example, consider the situation where a SNF patient -- who is covered by Medicare Part A via the waiver and does not have a QHS -- is discharged home on May 9. If the patient needs to return to the SNF within a 30-day window outside an interrupted stay timeframe, the patient can only come back via Part A if they have a QHS. Another possible scenario involves a SNF patient -- who is covered by Medicare Part A via the waiver and does not have a QHS -- is discharged to the hospital on May 9. If the patient is not admitted right away, exceeds the interrupted stay window, and does not get three midnights, this would not be an interrupted stay and a subsequent SNF stay would require a QHS. 

HealthPRO Heritage is encouraging our clients to mitigate frustration during the transition by contacting our experts for guidance and support. 

Lastly, COVID NHSN reporting and notification requirements are extended through December 31, so providers must remain diligent and fortify reporting process and have a back-up plan for staffing shifts. Also, I suggest a helpful reference from CMS here: Waivers & Flexibilities for Skilled Nursing Facilities.


Question:  After May 11, Medicare Part A patients will again be required to have a 3-day QHS to be admitted for skilled services. What’s your position on the return to pre-pandemic terms?  

Cooney: NARA and HealthPRO Heritage strongly encourage providers to continue to advocate for permanent elimination of the QHS. Contact HealthPRO Heritage and organizations such as AHCA and LeadingAge to voice an opinion, provide feedback, and share outcomes. 


Question: Can you share guidance for how providers can optimize their current and future market position in consideration of the May 11 transition? 

Cooney: Patients and providers across all care settings will be affected by the PHE termination. With HealthPRO Heritage’s Envision Everything principle at the heart of everything we do, our experts will be evaluating closely the impact of this major change on behalf of clients and our 11K+ therapists nationwide.  

Our team knows from experience that opportunities always arise with change. As such, we advise clients to approach the PHE termination with a proactive, strategic mindset. For example, skilled providers are well-advised to redouble occupancy & network/partnership development initiatives. Stay connected with home health and physician groups to strategize/educate on direct admission processes, mitigating unnecessary hospital readmissions, and best practices for collaborative transitional care management. Also, now may be an ideal time to implement campaigns to boost/measure satisfaction scores and/or execute clinical initiatives (such as Grand Rounding, respite/restorative programming, group/concurrent engagement, etc.) Finally, reimbursement accuracy (as with PDPM and CMI) should be a top priority (if it is not already!) to fortify revenue streams by ensuring all care provided is being reimbursed. 

Additionally, consider that many managed care products may waive QHS requirements permanently. As such, it will be important for providers to understand pre-authorization requirements and contract terms for all managed care products so as to leverage opportunity to continue to skill in place, direct admit & accept with less than 3-day hospital stay as appropriate for enrolled beneficiaries. (For those providers who did not take advantage of the 1135 waiver throughout the pandemic, it’s not too late to develop a process for managed care beneficiaries; contact HealthPRO Heritage for guidance.) 

Lastly, let's not forget about Medicaid changes associated with ending the PHE. Keep in mind that states will redetermine all Medicaid recipients before May 2024, so disenrollment notices will likely deploy in April. While extensive protections and some waivers may exist in some cases, providers should be aware and work with patients and families to mitigate situations that may significantly impact revenue. 


Question: You always have your ear to the ground. What additional updates & insights can you share? 

Cooney: Please remember that failure to register and assign at least one facility staff person as the Provider Security Official (PSO) for Internet Quality Improvement and Evaluation System (iQIES) by April 17 will impact your ability to submit MDS records and track data. For information, instructions and to register for an iQIES account, please visit this site. 

Also, CMS training for the updated MDS 3.0 RAI User’s Manual 1.18.11 (to be posted August 2023; implemented October 1) will take place as follows:

  •   Part 1: May (video recordings)
  • Part 2: Late June/July (live webinars) 

Facilities must prepare interdisciplinary teams to attend training, because multiple MDS sections will be updated. Case mix states that will utilize the OSA item set (draft to be posted April/May 2023) for Medicaid reimbursement must prepare for in-depth training

Lastly, I suggest providers refer to SNF QRP Spotlights and Announcements for important dates, guidance, data and more from CMS.

 (Interviewer’s Note: Dates outlined above are planned timelines provided by CMS and are subject to change.) 


HealthPRO Heritage is privileged to serve the senior care industry for more than 20 years. We pledge our continued support, resources, tools and industry insights for peers and partners in service to our industry and patients. Stay tuned for more intel and advice from our Envision Everything Regulatory Experts again soon! In the interim, contact Regulatory Strategy Experts, such as Kelly Cooney, with questions, insights or feedback anytime!