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Category Archives: CMS Memo

ICD-10 Implementation Delayed

You may visit the CMS ICD-10 website for the latest news at www.cms.gov/Medicare/Coding/ICD10/index.html.

CMS Proposes Adoption of Updated Life Safety Code

The Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule on the adoption of updated life safety code (LSC) that CMS would use in its ongoing work to ensure the health and safety of all patients, family, and staff in every provider and supplier setting.  The updated code contains new provisions that are vital to the health and safety of all patients and staff.

A key priority of CMS is to ensure that patients and staff continue to experience the highest degree of safety possible, including fire safety.  CMS intends to adopt the National Fire Protection Association’s (NFPA) 2012 editions of the (LSC) and the Health Care Facilities Code (HCFC).  This would reduce burden on health care providers, as the 2012 edition of the LSC also is aligned with the international building codes and would make compliance across codes much simpler for Medicare and Medicaid-participating facilities.

PUBLIC INPUT INVITED:

The proposed rule is currently on display at http://ofr.gov/inspection.aspx and will be published in the April 16, 2014 Federal Register.  The deadline to submit comments is June 16, 2014.

To view the proposed rule you may also visit www.federalregister.gov/articles/2014/04/16/2014-08602/medicare-and-medicaid-programs-fire-safety-requirements-for-certain-health-care-facilities.  PDF format is available for download in the right-hand column or click here.

To view the complete announcement from CMS, please visit www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-04-14.html.

Antipsychotic Drug use in Nursing Homes: Trend Update

CMS is tracking the progress of the Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported MDS quality measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington’s Disease or Tourette’s Syndrome.

Since the Partnership began in 2012, this data indicates Missouri’s percentage rates have dropped every quarter, with an overall decrease of 9.17 percent. This is encouraging and shows that Missouri is making improvements towards decreasing the use of antipsychotic medications for residents with dementia when their use is not indicated or appropriate. Please view the trend update here: CMS Trend Update – Antipsychotic Drug Use in Nursing Homes.

Cardiopulmonary Resuscitation (CPR) in Nursing Homes – Guidance Clarification Update

Guidance Clarification Update February 21, 2014

CMS Memo S&C: 14-01-NH

The Section for Long-Term Care Regulation (SLCR) wants to make certified providers aware that updated guidance from CMS (S&C: 14-01-NH) now requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  Previously, if a question arose during a federal regulatory process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically was not necessary.

This most recent memo states that “certification” of some staff members is mandatory, but the memo does not clarify which certifying agencies are acceptable (i.e., American Heart Association).  SLCR and the Kansas City Regional CMS office requested a clarification of this point.

We have now received guidance indicating that the purpose of this memo was to, “…ensure that facilities do not implement facility-wide ‘no CPR’ policies and that facilities have CPR-certified staff available at all times,” but that CMS does not intend to review or approve all certification agencies.

A wide range of organizations offer CPR certification – some are based online and some are conducted in-person.  To this point, CMS has clarified that while S&C: 14-01-NH does not require the use of any specific certifying agency, there are two components that are required with regard to CPR certification:

  • The certification must be designed for healthcare providers (therefore, CPR courses for laypersons which teach chest compressions, but not mouth breathing, are not sufficient); and
  • Nursing home policies should address how staff members should maintain and document their CPR certification.

The American Heart Association certification is acceptable under this guidance, but it is not the only acceptable certification.  Many homes in Missouri are currently obtaining CPR certification through the American Safety & Health Institute (ASHI), which is also acceptable, as are others, as long as they are designed for professional healthcare providers.

You may view the memo here: CMS Memo S&C: 14-01-NH, or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

Safety Reminders: Holiday Decorations

It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations.  Residents and staff in your care home also look forward to festivities and enjoy holiday decorations.  It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.

The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.

Fires or other accidents are not something anyone wants! 

Safe decorations include:

  • Artificial Christmas trees, and decorations that are non-combustible or flame retardant.
  • UL approved decorative lighting (use in supervised areas and turn off when not in use).
  • UL approved outdoor lighting.
  • Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*

*Any combustible decorations hung from doors or walls in corridors may be used with a waiver.  Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.

SLCR published an article regarding holiday decorating in the winter 2011 edition of the quarterly newsletter.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements.  Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances.  Never hang decorations from fire sprinkler heads or pipes.

NFPA 101, Section 19.7.5.4:  Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.

NFPA 101, Section 7.1.10.1:  Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

NFPA 101, Section 7.1.10.2.1:  No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.

 

Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).

 

  • F323:  Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance.  Electrical equipment such as electrical cords can become tripping hazards.  Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment.  The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.

 

 

  • Can candles be used in nursing homes under supervision, in sprinklered facilities?

CMS Memo S&C-07-07:  Nursing Home Culture Change Regulatory Compliance Questions and Answers

Answer: Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings.  Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted.  Lighted candles are not to be handled by residents due to the risk of fire and burns.

This holiday season, consider using battery-operated flameless candles.  They look and smell real!  Learn more about candle fire safety from the U.S. Fire Administration at www.usfa.fema.gov/citizens/home_fire_prev/holiday-seasonal/holiday.shtm.

If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8524.  We wish you a wonderful and safe holiday season.