New CDC MMWR on Coronavirus, Billing Code

CDC has issued an MMWR on the current coronavirus threat.  It says,

“COVID-19 is a serious public health threat.  Cases of COVID-19 have been diagnosed in the United States, primarily in travelers from China and quarantined repatriates, and also in two close contacts of COVID-19 patients.  Currently, COVID-19 is not recognized to be spreading in U.S. communities.  If sustained transmission in U.S. communities is identified, the U.S. response strategy will enhance implementation of actions to slow spread in communities.  Implementation of basic precautions of infection control and prevention, including staying home when ill and practicing respiratory and hand hygiene will become increasingly important.”

Find the full report at https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6908e1-H.pdf?deliveryName=USCDC_921-DM20815.

However, the Washington Post tells us today that ” ‘Ultimately, we expect we will see community spread in the United States,’ Nancy Messonnier, a top official at the Centers for Disease Control and Prevention, told reporters.  ‘It’s not a question of if this will happen but when this will happen and how many people in this country will have severe illnesses.’ ”

CMS has also created a new billing code specific to testing for the COVID-19 virus.  For details see https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-20#_Toc32923423.

>2/21 Revised CMS State Operations Manual

CMS has published revisions to the State Operations Manual, including Appendix H – ESRD Facilities, Appendix X – Organ Transplant Program, and Appendix Z – Emergency Preparedness.  Find the revised Manual, which is effective as of February 21, 2020, at https://www.cms.gov/files/document/r200soma.pdf.  The 700-page manual lacks page numbers or other indications of which appendix you’re reading, but online PDF readers provide page counts in the upper left-hand corner, or at the top of the screen.  Changes include:

  • pp. 175ff: Appendix H – ESRD Facilities.  Guidance to Surveyors in Appendix H is extensively revised throughout, including updates to the regulatory text based on requirements set forth in the 2008 Conditions for Coverage and revisions based on recent Federal Fire Safety Requirements.
  • pp. 614ff: Appendix X – Organ Transplant Programs.  Revisions include Survey Protocol Tasks, and occasional other revisions scattered throughout.
  • pp. 657ff: Appendix Z – Emergency Preparedness.   Major revisions are included throughout.

2/21+ EQRS and HARP

The EQRS End-Stage Renal Disease Quality Reporting System will be unavailable due to system maintenance from 5pm PST on February 21, 2020 until 5am PST on February 24, 2020.  Effective February 24, 2020, HARP (HCQIS Access Role and Profile) credentials will be required to access EQRS.  Access EQRS at https://eqrs.cms.gov/globalapp.  HARP resources including training materials, Quick Start Guides, Frequently Asked Questions, and instructional videos can be found at https://mycrownweb.org/harp-training/.  The QualityNet Service Desk is available to provide assistance and answer questions, via email at qnetsupport-esrd@hcqis.org or telephone at 1-866-288-8912.

Infection Control Tools

The National Forum of ESRD Networks Medical Advisory Council Vaccination Toolkit (Revised 2020) was updated in January 2020.  Find it at https://esrdnetworks.org/resources/toolkits/mac-toolkits-1/vaccination-toolkit/vaccination-toolkit-revised-2020/view.

The Centers for Disease Control and Prevention (CDC) and the ASN Nephrologists Transforming Dialysis Safety (NTDS) group have partnered to develop a new online learning module, Managing Infection in an Outpatient Dialysis Facility.  Find it at https://www.asn-online.org/ntds/olm.aspx.

A new MEI online continuing-education course on Include Dialysis Patients in your Facility Culture of Safety focuses on effective systems and teamwork – including patients – to accomplish the mutual goal of safe, high-quality patient care.  When something goes wrong, the focus is on what, rather than who, is the problem, with the intent to bring process failures and system issues to light and solve them in a non-biased, non-threatening way.  Find the course at https://course.wcea.education/app/mei/elearning/nurse/medical-education-institute/194758/include-dialysis-patients-in-your-facility-culture-of-safety.

CMS reviews where we are with the “ordinary” flu, and what we need to do about it, at https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-13#_Toc32395783.

And last but certainly not least, you can find CDC’s nexus page on the Coronavirus that began in Wuhan, China, which the WHO has named “Covid-19,” at https://www.cdc.gov/coronavirus/2019-ncov/index.html.  The WHO’s central page on Covid-19 is located at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

NHSN 2020 News and Deadlines

Current NHSN Dialysis Component BugsContrary to the software’s response, Denominator Data is not actually saved after making updates.  CMS analysis reports within NHSN are not functioning as expected.  On February 11, 2020, NHSN reported that “our technical team is working to resolve [these issues] as soon as possible.  We will provide an update shortly.”  Find the NHSN Current Defects List at https://www.cdc.gov/nhsn/releasemgt/index.html.

The 2020 Outpatient Dialysis Center Practices SurveyBeginning February 8, 2020, users with administrative rights will be able to complete and save this survey by using the ‘Save as Complete’ button.  Facilities must complete the Outpatient Dialysis Center Practices Survey by May 1, 2020 in order to be allowed to enter data into the NHSN Dialysis Component.  Completion by February 28 is recommended.  For convenience, a paper version of the 2020 annual survey can be found at https://www.cdc.gov/nhsn/forms/57.500_OutpatientDialysisSurv_BLANK.pdf.  Enter the information online after you log in to NHSN for your facility.

2020 NHSN Data Deadlines for QIP Credit:  To receive QIP credit, NHSN data for your facility must be entered and corrected by the deadlines in the following table.  For QIA purposes, your Network may require earlier due dates.
  • Data for October-December 2019 must be entered and corrected by March 31, 2020.
  • Data for January-March 2020 must be entered and corrected by June 30, 2020.
  • Data for April-June 2020 must be entered and corrected by September 30, 2020.
  • Data for July-September 2020 must be entered and corrected by December 31, 2020.

Before each QIP deadline, to insure proper credit, each facility should:

Paper versions of all NHSN forms can be found under the ‘Data Collection Forms’ section of https://www.cdc.gov/nhsn/dialysis/event/index.html.  For complete NHSN Dialysis Component specifications, see https://www.cdc.gov/nhsn/dialysis/event/index.html.

Medicaid Waivers for Home Patients

The Medical Education Institute has published a Home Dialysis Central blog post on Medicare Waivers: The Best Kept Secret in Dialysis Home Health Care, which describes a program that allows people who don’t normally qualify for Medicaid, but who have fragile health, to get Medicaid funding for home care anyway.  The program doesn’t cover dialysis itself, but it does cover home health care aides and other useful services.  State agencies administer waiver programs that help seniors and people with disabilities, to ensure that these vulnerable populations can live independently in their homes and communities, and/or age in place.  Thanks to these waivers, states can provide services to their residents that wouldn’t usually be covered by Medicaid.  If you are eligible for both Medicare and Medicaid, you can have and use both for the services you need.  The services they cover are not always the same.  For example, Medicaid offers coverage for things like personal care services while Medicare does not.  Find the MEI blog post at https://homedialysis.org/news-and-research/blog/346-medicare-waivers-the-best-kept-secret-in-dialysis-home-health-care.

Winter 2020 Patient Newsletters

We’ve published our Patient Newsletters for Winter 2020.  They feature articles on treatment options, flu shots, grievances, access to care, how to stay informed by the Network, and how to help the Network improve patient care.  Find them at: