Earlier this year, WiHPCA fulfilled one of our main organizational goals for 2021 when we began quarterly meetings with the Division of Quality Assurance (DQA) at the Wisconsin Department of Health Services. In addition to building a positive relationship with an important regulatory agency that oversees the hospice and palliative care industry, the specific purpose of the meetings are to review and discuss survey deficiencies, examine avenues for improvement, and seek regulatory guidance from DQA.

The initial meeting held on March 11 was well attended and opened a great line of communication between WiHPCA members and DQA staff. The June 10 second quarter meeting was also successful and provided attendees with a wealth of important regulatory information. Please find below an overview of the June 11 meeting:

Survey Report:

• Number of surveys performed (Oct. 1, 2020-March 31, 2021)

i.      Number of complaint surveys – 14

ii.      Number of recertification surveys performed – 8

Complaint surveys topics – Top 5 concern areas:

iii.      Quality of Care and Treatment

iv.      Patient Rights

v.      Nursing Services

vi.      Admission/Transfer/Discharge Rights

vii.      Infection Control

Question and Answer Overview:

• Will the Public Health Emergency – and the associated COVID-19 waivers (CMS 1135) that apply to hospice care – remain in place until Dec. 31, 2021? While guidance continues to be sought, a 90-day extension of the public health emergency (PHE) was signed effective April 15, 2021. 
• • See: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.  DQA will receive the same notice that providers receive related to an end date for the PHE or any changes to the waivers that occur prior to the end of the PHE. 
  • CMS provided this website for more information about 1135 waivers: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers
• How many new hospice organizations have begun operations in Wisconsin in 2021?
• • One hospice newly licensed in 2021. The Hospice statewide directory is found here: https://www.dhs.wisconsin.gov/guide/hospice.htm.
• How many applications are pending approval?
• • There are currently two hospice applications pending approval.
• Does DQA plan to re-write hospice and facility interface documents or convene a task force to revise the interface in the near future?
• • Jessica Tomczak, the DQA Nurse Consultant for Hospice, is working on this project. Any ideas for updates can be e-mailed to her at: Jessica.Tomczak@dhs.wisconsin.gov.  
• Has there been any coordination of care issues with nursing homes or assisted living in general, or as it specifically relates to infection control?
• • F-774 - The hospice plan of care must identify the care and services that are needed and specifically identify which provider is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. 
  • F-774 was cited one time recently (May 2021) related to the Plans of Care for patients residing in Nursing Homes or Assisted Living Facilities not specifying which provider was responsible for which care areas on the Plan of Care.
• 1135 Waivers will continue through the Feds through 12/31.  This was confirmed through 20-003 for hospices.  We are working with the Biden Administration through NHPCO to look at extending some aspects such as telehealth visits past the PHE.  Will telehealth visits be codified through the state of WI for NP and physicians visits for our palliative care programs?
• • CMS response – Since the PHE is ongoing, CMS has not issued any further information regarding telehealth as it relates to Hospice.  We will update you if we receive any further guidance.
  • WI response – DHS established a temporary telehealth policy to ensure access to health services during the COVID-19 pandemic. The temporary policy flexibilities for telehealth services related to COVID-19 are not tied to the federal or state declaration of a public health emergency. DHS is in the process of drafting emergency and permanent telehealth rules.  The current policy will continue until emergency telehealth rules go into effect.  For Medicare certified providers, please follow the guidance from CMS.
• CMS recently changed their guidance in QSO-20-38-NH to allow to not routinely test staff that have been fully vaccinated.  They did reiterate that unvaccinated staff needed to be tested according to the percent positivity rate in their county.  DHS guidance in the past has been that all routine testing had to be performed a minimum of every 2 weeks.  We have not seen any adjustment to this DHS guidance (unless we missed it) allowing for NOT testing vaccinated staff, etc.  Are we correct in assuming that DHS is allowing this even though their previous guidance was more restrictive? 
• • DHS released updated testing guidance (see attached) on 6/9/21 to align with the guidance provided in CMS QSO Memo 20-38 revised 4/27/21.
  • The current DHS COVID-19: Nursing Home testing guidance links to the revised CMS QSO Memo -20-38 and recommends routine testing of unvaccinated staff based on the county positivity rate in the last week:
  • • Low – Positivity rate of < 5% - Once a month testing
    • Medium – Positivity rate of 5% - 10% - Once a week testing
    • High – Positivity rate of > 10% - Twice a week testing