CMS QIP Wildfire Exceptions

CMS is granting exceptions under Medicare quality reporting and value-based purchasing programs to renal dialysis facilities located in areas affected by the Oregon Wildfires and designated as emergency disaster areas by FEMA, including Benton, Clackamas, Columbia, Coos, Deschutes, Douglas, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Lincoln, Linn, Marion, Multnomah, Tillamook, Wasco, Washington, and Yamhill Counties.

Impacted facilities in other areas may request exceptions for CMS review on a case-by-case basis.

Request exceptions using the Extraordinary Circumstances Exception (ECE) form at https://qualitynet.cms.gov/files/5d0d36e1764be766b0100cad?filename=HQR_ECE_Req_FormFeb2019.pdf. The ECE form must be signed by the dialysis facility CEO or designee and be submitted via email to the ESRD QIP Mailbox at esrdqip@cms.hhs.gov. This form and corresponding evidence must be submitted within 90 days of the Extraordinary Circumstances event for the ESRD QIP. For further assistance contact the CMS ESRD QIP at esrdqip@cms.hhs.gov.

10/21 NECP Webinar on Funding Emergency Communications

The DHS Cybersecurity and Infrastructure Security Agency’s National Emergency Communications Plan will present an October 21, 2020 webinar on Money Talks: Funding Your Emergency Communications Capabilities. The webinar will help facilities find grant guidance and opportunities, partners to help prioritize needs and coordinate applications for assistance, and diverse funding sources to sustain emergency communications. Find details and register at https://www.cisa.gov/necp-webinars.

Emergency Exercise Exemptions

CMS has updated the Emergency Preparedness Testing Exercise Requirements to accommodate industry impacts from COVID-19, exempting a facility that activates its emergency plan to deal with a real emergency (such as COVID-19) from having to complete the subsequent full-scale community-based exercise or individual facility-based functional exercise. To qualify for the exemption, a facility must complete written documentation of their emergency plan activation. CMS and State Survey Agencies can request a copy of this documentation during survey and certification reviews. Facilities can provide this documentation by completing an After-Action Report (AAR) following the actual emergency.

Information on how to create an AAR can be found in the Network LMS Emergency Preparedness Resource Book or at https://www.kcercoalition.com/en/events/2020/july-2020/dialysis-facilities-the-basics-of-preparing-an-after-action-report-for-an-incident-or-disaster/ .

Find an AAR template at https://s3-us-west-2.amazonaws.com/nwrn.org/files/LMS-O/KCER_Dialysis+Facility+Incident+AAR_FINAL.pdf .

The updated Emergency Preparedness Testing Exercise Requirements can be found at https://www.cms.gov/files/document/qso-20-41-all.pdf .

If you have any questions or need assistance completing the requirements for the exemption, contact your Network.

NW16/OR Medicare Wildfire Assistance

CMS has prepared a press release summarizing the steps that Medicare has taken in Oregon to help make health care available to wildfire victims, including opening special enrollment periods to allow out-of-season initiations or changes to Medicare coverage, various kinds of assistance to healthcare facilities, and help to displaced dialysis patients.  Find the press release at https://www.cms.gov/newsroom/press-releases/cms-offers-comprehensive-support-oregon-due-wildfires.

CDC Evacuation Advice

CDC has launched a new web page on Natural Disasters, Severe Weather, and COVID-19, to provide information on how people can stay safe during and after natural disasters during the COVID-19 response.  The page and a few of its useful links follow:

Understand that your planning and preparation may be different this year because of the need to protect yourself and others from COVID-19.

Give Yourself Time: Give yourself more time than usual to prepare your emergency food, water, and medicine supplies.  Home delivery is the safest choice for buying disaster supplies, but it may not be an option for everyone.  If in-person shopping is your only choice, take steps to protect your and other’s health when running essential errands.

Pack Your Go Kit: If you need to evacuate, prepare a “go kit” with personal items you cannot do without during an emergency.  Include items that can help protect you and others from COVID-19, such as hand sanitizer with at least 60% alcohol, bar or liquid soap, disinfectant wipes (if available), and two masks for each person.  Masks should not be used by children under the age of 2.  They also should not be used by people having trouble breathing, or who are unconscious, incapacitated, or unable to remove the mask without assistance.

Keep Your Distance: When you check on neighbors and friends, be sure to follow social distancing recommendations (staying at least 6 feet from others) and other CDC recommendations to protect yourself and others.

Read more about COVID-19 specific key disaster messages in Hurricane Key Messages: COVID-19 Annex (Spanish), in addition to the Preparedness and Safety Messaging for Hurricanes, Flooding, and Similar Disasters (Spanish).

9/20 ANNA 503 Virtual Fall Workshop

ANNA Chapter 503 will present their 2020 Fall Workshop via Zoom on September 20, 2020 from 10am till noon PDT.  The Workshop will feature Nephrologists Sarah Struthers, MD sharing her experience of working in New Orleans during the coronavirus surge, and Kate Butler, MD sharing her research focus on ethical allocation of limited resources during a pandemic.  Cost is $20 for ANNA members & students, and $35 for non-members.  The course has been approved by the California State Board of Nursing for 2.0 CE’s.  Register, before 11:30 pm PDT September 18, at https://www.eventbrite.com/e/anna-503-virtual-fall-workshop-2020-tickets-114236426226.  Full details follow:

Wildfire Smoke and COVID-19

A recent CDC announcement comments on wildfire smoke:

“Wildfire smoke can irritate your lungs, cause inflammation, affect your immune system, and make you more prone to lung infections, including SARS-CoV-2, the virus that cause COVID-19.  Because of the COVID-19 pandemic, preparing for wildfires might be a little different this year.  Know how wildfire smoke can affect you and your loved ones during the COVID-19 pandemic and what you can do to protect yourselves.”

The rest of the announcement details what you can do about it.  Find it at https://www.cdc.gov/disasters/covid-19/wildfire_smoke_covid-19.html.

NCC COVID-19 Mental Health Handbook

The ESRD National Coordinating Center has published a new 17-page booklet called The COVID-19 Mental Health Toolkit: Helping Renal Professionals Support the Well-Being of the ESRD Community.  It was developed by Network professionals and patient volunteers to serve as a guide for renal healthcare staff to help patients manage their well-being, and includes sections on taking action, increasing awareness, building community capacity, incorporating telemedicine, and getting ahead of the issues.  Find a copy at https://esrdncc.org/contentassets/abe8671eadac49c691c0f40eef52ef18/covid19mhtoolkit07312020508.pdf.

Notify Network of Service Disruptions

CMS requires ESRD Networks to track the status of facility operations and patient access to treatment during emergency events at all facilities, including disruptions due to wildfire, excessive heat, water pollution, or any other natural or man-made event that interrupts your normal schedules.  If the operations of your facility, or ability for patients to have access to dialysis, are impacted by emergency events, please let your Network know right away.

For Washington, Oregon, Idaho, Montana, and Alaska (Network 16), call Lisa Hall at 206-923-0714 or email LHall@Comagine.org.  We also ask that you fill out and submit the Network Disaster Reporting Form at http://www.esrdnetwork18.org/machform/view.php?id=44393.  Network 18 will forward the completed form back to Network 16.

In Southern California (Network 18), call Brianna Smith at 206-923-0714 or email  BSmith2@Comagine.org, and fill out the form at http://www.esrdnetwork18.org/machform/embed.php?id=16298.

Never put PHI or PII in an email or online form.  Examples include patient name or initials, birthdate, SSN, and other identifying information.

Toxic Waters

Now that high summer and higher temperatures have arrived, Harmful Algae Blooms (“HABs”) are an increasing threat to recreational and subsistence uses of bodies of fresh- and salt-water.  HABs can impact, sometimes fatally, harvesting of water- and shoreline-dwelling animals and plants, drinking, swimming, wading, and boating.  Pets and children are particularly vulnerable because they can rush into water before you even realize they’re out of the car.  The Oregon Health Authority advises,

“Don’t go into water that looks foamy, scummy, thick like paint, pea-green, blue-green or brownish red.  A good rule of thumb for you and your pet is: When in Doubt, Stay Out!”  (https://www.oregon.gov/OHA/PH/HealthyEnvironments/Recreation/HarmfulAlgaeBlooms/pages/index.aspx).

Bear in mind that most waters are not monitored for toxicity, so the lack of a warning sign is not enough to assure safe use.  The following websites provide information on identifying and responding to toxic waters and their impacts, and include alerts on the few, most popular, waters that are monitored and posted:

The Washington website is also available in Spanish, Somali, and Viet.  As an example of a posted warning, Odell Lake near Willamette Pass, between Eugene and Klamath Falls OR, has recently been posted; see the Oregon website above.