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Friday, March 30, 2018

Clarification on CMS Emergency Preparedness Rule Regarding 1135 Waivers

CMS has been receiving 1135 waiver requests from some facilities that received deficiencies under the Emergency Preparedness Rule deficiency for: failure to develop an emergency preparedness policy to address the facility's role under an 1135 waiver. 

An 1135 waiver can only be considered when the following has occurred: 
1. The President declares a disaster or emergency under the Stafford Act or National Emergencies Act 
2. The Health and Human Services Secretary declares a public health emergency under Section 319 of the Public Health Service Act 

In a disaster, these waivers are meant to prevent gaps in access to care - to allow reimbursement during an emergency or disaster even if providers can't comply with certain requirements that would under normal circumstances bar Medicare, Medicaid or CHIP payment.

To meet the emergency preparedness rule requirement - to develop an emergency preparedness policy to address the facility’s role under an 1135 waiver, the facility should be able to demonstrate, in your policies and procedures, an awareness of the 1135 waiver process and what may be required in the event of needing an 1135 waiver (which the provider would request through the state and regional office). 

If a facility were to request an 1135 waiver in the event of this type of a disaster, it is helpful to clearly state, in any format the facility chooses, information that will address the scope of the issue and the impact of the disaster including the following basic information: 
- Provider name/type 
- Full address (including county/city/town/state) CCN (Medicare provider number). 
- Contact person and his or her contact information for follow-up questions should the Region need additional clarification. 
- Brief summary of why the waiver is needed. For example: 
Our critical access hospital (CAH) is the sole community provider without reasonable transfer options during the emergency event (e.g. flooding, tornado, fires, or flu outbreak). CAH needs a waiver to exceed its bed limit by X number of beds for Y days/weeks (be specific). 
- Consideration - Type of relief your facility is seeking from regulatory requirements or regulatory reference that the requestor is seeking to be waived.

In a disaster event health, a facility wanting to request an 1135 waiver, should submit your request to the Health Facilities and Emergency Medical Services Division. There is no specific form or template to use when submitting a request. The request should be sent to:
Thom Miller
Branch Chief, Certification, Licensing, Enforcement and Records
ThomasLMiller@state.co.us 
Telephone: 303-692-4978 
Fax: 303-753-76214

For reference materials, please review the guidance on the CMS website, particularly, www.cms.gov/emergency and www.phe.gov/emergency. Both sites contain examples of the most recently approved 1135 waivers, for example, hurricanes Maria, Harvey and IRMA. 

Additional information on 1135 waivers can also be found at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers.html. Facilities may want to include these websites and some of the materials you'll find there as resources in your emergency preparedness plan. 

If you have questions about the regulations, please contact Melanie Roth at Melanie.Roth-Lawson@state.co.us or 303-692-2819.

TB Update and Skin Testing Practicum for Health Care Providers

Medical Directors and Directors of Nursing

The Denver Metro TB Clinic and CDPHE Tuberculosis Program 

SPACE STILL AVAILABLE!!!

The Denver Metro TB Clinic and the CDPHE Tuberculosis Program invite nurses and other health care providers from home health agencies, clinics, and long-term care facilities to attend a tuberculosis update and skin testing practicum on Thursday April 26th from 12:15 PM to 5 PM in the Public Health Auditorium, 2nd floor at Denver Public Health (605 Bannock Street, Denver). 

Course Objectives are: 
- Express an increased and updated knowledge of TB infection and TB disease
- Demonstrate their skill in placing and reading the TST

For more details and a link to register go to: http://www.denverhealth.org/public-health-and-wellness/public-health/clinics-and-services/tuberculosis-clinic/for-providers/tb-education 

Or 

http://denverpublichealth.org/home/clinics-and-services/tuberculosis-clinic/for-providers/tb-education.

Registration cost is $60 
Space is very limited so please register early. 

For more information please contact Carolyn Bargman at 303-602-7243 cbargman@dhha.org with any questions. 

TB Practicum Flyer

TB Update and Skin Testing Practicum for Health Care Providers

Medical Directors and Directors of Nursing

The Denver Metro TB Clinic and CDPHE Tuberculosis Program 

SPACE STILL AVAILABLE!!!

The Denver Metro TB Clinic and the CDPHE Tuberculosis Program invite nurses and other health care providers from home health agencies, clinics, and long-term care facilities to attend a tuberculosis update and skin testing practicum on Thursday April 26th from 12:15 PM to 5 PM in the Public Health Auditorium, 2nd floor at Denver Public Health (605 Bannock Street, Denver). 

Course Objectives are: 
- Express an increased and updated knowledge of TB infection and TB disease
- Demonstrate their skill in placing and reading the TST

For more details and a link to register go to: http://www.denverhealth.org/public-health-and-wellness/public-health/clinics-and-services/tuberculosis-clinic/for-providers/tb-education 

Or 

http://denverpublichealth.org/home/clinics-and-services/tuberculosis-clinic/for-providers/tb-education.

Registration cost is $60 
Space is very limited so please register early. 

For more information please contact Carolyn Bargman at 303-602-7243 cbargman@dhha.org with any questions. 

TB Practicum Flyer

Thursday, March 29, 2018

LTC (NF) IDR Committee Meeting

The LTC (NF) IDR Committee will meet April 3, 2018 at 1:30 p.m. at the Department. The public is welcome to observe or listen to the committee discussion by calling 1.712.775.8968 and entering conference code 339028.

Information on the location of the meeting will be available at the security desk in building A.

Elaine Sabyan

Assisted Living Residences (ALR) Rules Update

The Department has been working with members of the Assisted Living Residences community as well as legislators and members of the Assisted Living Advisory Committee. As a result of input from a number of individuals and organizations, we are making some specific modifications to the proposed ALR regulations. Specifically;

1. Minimum requirements for ALR administrators is modified to require one (1) year of personal care supervisory experience, be 21 years old, high school diploma or equivalent and successfully complete the ALR administrator course. Other requirement options, and the administrator course content requirements remain unchanged.

2. ALR's with 10 or less beds will be exempt from FGI guidelines related to parking spaces, elevators and bathroom requirements. All existing facilities are grandfathered unless renovations are performed. FGI requirements are not effective for new ALRs until 6/1/19 and are not effective for ALRs undergoing renovation until 12/1/19.

3. Reduction of the initial licensure fee for 3-8 bed ALRs from $7300.00 to $6300.00. All other fees in proposed draft remain unchanged. 

4. Night check requirements modified to require one night check of consenting residents between the hours of 10 pm and 6 am. Residents may opt-out of night checks. Please note, no changes in the requirements for awake staff in dementia care units are being made in the draft.

Below is a fact sheet that contains information specific to 9 issues that have been raised across the ALR community over the past few weeks. Hopefully, this fact sheet provides clarifications regarding the actual content of the regulations and will further inform the community. Please feel free to share this fact sheet with anyone who might have questions, etc. regarding the proposed ALR licensing requirements. 

Please feel free to contact Randy Kuykendall or Elaine McManis if you have any questions or require further information. 

Legislative Fact Sheet 

Public Hearing on the ALR Rules
Date: April 18, 2018 Time: 10:00 AM 

The public hearing on the ALR rules will be held in the Sabin-Cleere conference room on the first floor of Building A at the Department's main campus at 4300 Cherry Creek Drive South. Please check in with the security guard as you enter the building for further direction to the room. There is visitor parking to the west of Building A as well as to the south and east of Building C. A campus map is available below for your convenience.

CDPHE Main Campus Map

Meeting information

At the Colorado Department of Public Health and Environment, we work hard to protect and promote your health and the environment. If you're planning a visit to our campus and want to ride your bike here, we won't take a second look at your helmet head, and if the bus you're taking is running a little late, we won't worry. We want you to be your healthiest you, and we appreciate your efforts to reduce pollution.

If you're coming to our campus:
Our campus is located at 4300 Cherry Creek Drive South, Denver, 80246.
- If you're riding your bike: Our campus is located just south of the Cherry Creek bike trail. Bicycle parking is available at multiple locations on the main campus. Covered bicycle parking also is available at several locations, as well as on the ground floor of the parking structure on Birch Street, which is just east of the main campus 
- If you're riding the bus: RTD's Trip Planner is a great way to find the fastest route.
- If you're driving: Visitor parking is conveniently located in front of all of our buildings. Please check in with security in Building A so you can get a visitor badge.

You might also want to know:
- We care about your health, so our campus is tobacco free.
- We are located just east of Glendale's City Set, where there are several restaurants.
Lactation Rooms are available on the first floors of buildings A and B. 

REMINDER: FACILITIES THAT REPORT ANNUAL HEALTH CARE WORKER FLU VACCINE DATA THROUGH THE HEALTH FACILITIES PORTAL MUST REPORT BY MARCH 31, 2018

In February 2012, the Colorado Board of Health (BOH) passed rule 6 CCR 1011-1 Chapter 2 regarding influenza vaccination of employees in licensed healthcare facilities. Healthcare facilities are required to report data each spring. For the 2017-2018 influenza season, at least 90% of your employees should be immunized with the influenza vaccine.

To report these data, you can use either the Colorado Health Facility Portal (HF Portal) or the National Health Safety Network (NHSN). Data should be submitted through only one of these electronic systems. Reporting to either system will meet the reporting requirement.

Reminder: If a facility has its own license and location, it must report separately, even if affiliated with a single hospital, or home health agencies, assisted living residences, or nursing homes that have multiple sites. Home health agencies may have separate licenses based on different functions but are in the same location with the same staff so these facilities would report only once. 

Below are guidelines to report 2017 - 2018 healthcare worker influenza data. 

HF Portal: 
- Timeframe to count employees for denominator: October 1, 2017 - December 31, 2017.
- Number of days employees must work to be counted in denominator: 1 day.
- Deadline to submit data through portal: March 31, 2018.
- If you have trouble reporting data, call 303-692-2836.

NHSN: 
- Timeframe to count employees for denominator: October 1, 2017 - March 31, 2018.
- Number of days employees must work to be counted in denominator: 1 day.
- Deadline to submit data through portal: May 15, 2018
- If you have trouble reporting data, call 303-692-2923 or send an email to NHSN@cdc.gov and in the subject line include "2017 - 2018 HCW Flu Reporting."

Important: Acute care hospitals, cancer hospitals, ambulatory surgery centers, outpatient dialysis facilities, and inpatient psychiatric facilities already using NHSN to report state reportable infections or healthcare worker influenza vaccination data for Medicare/Medicaid reimbursement should only report their data once through NHSN. Healthcare worker influenza vaccination data reported into NHSN, as required by the Centers for Medicaid and Medicare Services, also fulfills state influenza vaccination reporting requirements. 

Note: If you report healthcare worker influenza vaccination data through NHSN, please ensure that you have joined the Colorado Influenza Reporting Group and conferred rights; otherwise your data cannot be seen/accessed by the CDPHE. This can be down as follows:
1. In NHSN, use the left hand blue navigation bar, click Group and Join
2. Enter 27648 for both the group id and joining password 
3. Click Join Group
4. At the Confer Rights page, scroll to the bottom of page and hit accept. 

For other questions regarding the BOH rule, 303-692-2789. 

April 25 Training For Denver Healthcare Facilities Only: Emergency Planning Workshop for CMS Requirements

The Denver Office of Emergency Management; Denver Department of Public Health and Environment; Denver Health Paramedic Division; Denver Public Health; and the Metro Foothills Healthcare Coalition have teamed up to provide a healthcare facility emergency planning workshop. The workshop will address Centers for Medicare and Medicaid Services (CMS) emergency preparedness (EP) rule requirements and include an overview of risks, a review of the CMS requirements, a discussion of planning tools for healthcare facilities, and a panel of representatives for discussion and Q&A.

Details are below and in the Denver Healthcare Facility Emergency Planning Workshop flyer.

Event: Denver Healthcare Facility Emergency Planning Workshop

Date/Time: April 25, 2018, 8:30 a.m. - 12:30 p.m.

Location:
Denver Post Auditorium
101 W. Colfax Ave
Denver, CO 80202

Target Audience:
Anyone subject to the CMS emergency preparedness rule, including but not limited to:
- Ambulatory Surgical Centers
- Long-Term Care 
- Behavioral Health
- Clinics
- End Stage Renal Disease
- Home Health Agencies
- Hospitals
- Hospices
- Organ Procurement
- Transplant Centers

Cost: FREE

Registration: www.co.train.org. Course ID # 1076532
Contact: Tim Reutiman at: timothy.reutiman@denvergov.org

Notes:
Registration is prioritized for Denver agencies; other organizations will be accommodated if space permits. Parking is not provided, but is available in nearby lots and garages. Light refreshments will be available

April 25 Training For Denver Healthcare Facilities Only: Emergency Planning Workshop for CMS Requirements


The Denver Office of Emergency Management; Denver Department of Public Health and Environment; Denver Health Paramedic Division; Denver Public Health; and the Metro Foothills Healthcare Coalition have teamed up to provide a healthcare facility emergency planning workshop. The workshop will address Centers for Medicare and Medicaid Services (CMS) emergency preparedness (EP) rule requirements and include an overview of risks, a review of the CMS requirements, a discussion of planning tools for healthcare facilities, and a panel of representatives for discussion and Q&A.

Details are below and in the Denver Healthcare Facility Emergency Planning Workshop flyer.

Event: Denver Healthcare Facility Emergency Planning Workshop

Date/Time: April 25, 2018, 8:30 a.m. - 12:30 p.m.

Location:
Denver Post Auditorium
101 W. Colfax Ave
Denver, CO 80202

Target Audience:
Anyone subject to the CMS emergency preparedness rule, including but not limited to:
- Ambulatory Surgical Centers
- Long-Term Care 
- Behavioral Health
- Clinics
- End Stage Renal Disease
- Home Health Agencies
- Hospitals
- Hospices
- Organ Procurement
- Transplant Centers

Cost: FREE

Registration: www.co.train.org. Course ID # 1076532
Contact: Tim Reutiman at: timothy.reutiman@denvergov.org

Notes:
Registration is prioritized for Denver agencies; other organizations will be accommodated if space permits. Parking is not provided, but is available in nearby lots and garages. Light refreshments will be available

Wednesday, March 21, 2018

Newborn Screening (NBS) Updates: 1) Notice of Trend in Reporting Errors Caused by Healthcare Facilities Manually Entering NBS Results into Electronic Records and 2) List of Contracted Medical Experts

The Colorado Department of Public Health and Environment (CDPHE) administers the metabolic (dried blood spot testing) portion of the Colorado Newborn Screening (NBS) Program.

A trend in reporting errors for NBS results has been noticed due to manual typing of NBS results into facility electronic records. Be aware that the contents of CDPHE's NBS reports are dynamic, and reports should be reviewed completely and carefully before being entered manually into an electronic record system.

CDPHE provides contracted follow-up consultation services for the metabolic portion of the CO NBS Program with the following medical experts:
Hemoglobinopathies-CU Medicine/Colorado Sickle Cell Center 
Severe Combined Immunodeficiency (SCID)-CU Medicine/Children's Hospital Colorado
Congenital Hypothyroidism-Rocky Mountain Pediatric Endocrinology
Cystic Fibrosis (CF)-CU Medicine
Congenital Adrenal Hyperplasia (CAH)-CU Medicine
Inherited Metabolic Diseases-CU Medicine

These are the only clinical consultants contracted by CDPHE to serve in follow-up roles for blood spot testing. A physician from one of these groups will contact a child's primary care provider or a physician from the submitting institution when screening results suggest risk of an underlying medical condition.

Contact the Colorado Newborn Screening Program Manager, Dr. Darren Michael, at darren.michael@state.co.us or 303-692-3673 with any questions about these issues related to reporting of NBS results or contracted services.

Friday, March 16, 2018

Dialysis Continuing Medical Education Opportunity Webinar, March 29

Please join the Nephrologists Transforming Dialysis Safety (NTDS) Initiative for a free CME webinar Thursday, March 29 12:00pm-1:00pm EST. This webinar will review the reporting actions that are necessary when an infectious disease outbreak occurs in a dialysis facility. The session will also explore a real-world case involving an outbreak, and discuss the responsibilities and benefits of the dialysis facility team establishing a relationship with State Healthcare-Associated Infection (HAI) professionals.

To register for this webinar, go to: https://www.asn-online.org/store/webinar.aspx?evt_key=a0b4c536-49fe-4d75-9310-9e76d65785bb&g2w_key=623273947782262530.


You can contact your Colorado State Healthcare-Associated Infection (HAI) professionals at 303-692-2700. 

Thursday, March 15, 2018

ALR IDR Committee Meeting

The ALR IDR Committee will not meet on 3/22/18 as no IDR requests have been received for review.

Elaine Sabyan

HHA IDR Committee Meeting

The HHA IDR Committee will be not be meeting March 20, 2018 as no requests have been received for committee review.

Elaine Sabyan

OASIS C2 Classes *FREE*

ETA will offer classes on specific OASIS topics in Northglenn, Pueblo, La Junta and Colorado Springs. You may choose to take them all at once or individually as your interest and needs dictate. All registration is first-come, first-served, even for sessions within a specific facility.

ETA reserves the right to cancel classes with low registration. Early registration is helpful.

OASIS C2 Basics (One Session): Course ID 1066908
This beginning three-hour class is how to get started with OASIS C2.

OASIS C2 Item-by-Item (2 Sessions): Course ID 1066909
This practical application class reviews item-by-item data set completion. We will follow Mrs. Green’s assessment, which will require two sessions to complete. Attendance at both sessions is required to complete this class.

OASIS C2 Quality Measures (One Session): Course ID 1066910
This course assumes familiarity with the OASIS C2 Item Set, covering more advanced content and application.

To see additional session details and register for on-site attendance for one of these offerings:
1. Go to http://www.train.org/ 
2. Log in to your existing TRAIN account, or new users click "Create an Account"
3. Once you've logged in, or created an account, Search (top right) for the appropriate Course ID. (See above for desired training)
4. Click link for desired course.
5. Click the "Registration" tab.
6. Click the "Register" button for the session you wish to attend.
7. Remember to register separately for each desired course.

A detailed example of the above process (if needed)

Questions?: Please email betty.metz@state.co.us

MDS 3.0 Classes *FREE*

Classes on specific MDS topics in Loveland, Pueblo, La Junta, Colorado Springs and Denver are available. You may choose to take them all at once or individually as your interest and needs dictate. All registration is first-come first-serve, even with sessions held within a host facility site.

ETA reserves the right to cancel classes with low registration. Early registration is helpful.

MDS Basics (One Session): Course ID 1066903
This beginning three-hour class is how to get started with MDS.

MDS Item By Item (2 Sessions): Course ID 1066907
This practical application class reviews item-by-item data set completion. We will follow Miss Scarlett’s assessment, which will require two sessions to complete. Attendance at both sessions on subsequent days is required to complete this class.

MDS Quality Measures (One Session): Course ID 1066904
This course assumes familiarity with the MDS Item Set, covering more advanced content and application.

To see additional session details and register for on-site attendance for one of these offerings:
1. Go to http://www.train.org/ 
2. Log in to your existing CO.TRAIN account, or new users click "Create an Account".
3. Once you've logged in, or created an account, Search (top right) for the appropriate Course ID. (See above for desired training)
4. Click link for desired course. Note open session options.
5. Click the "Register" button for the session you wish to attend.
6. Remember to register separately for each desired course.

Detailed Instructions for Using Train.org (if needed) 

Questions?: Please email betty.metz@state.co.us

Thursday, March 1, 2018

LTC (NF) IDR Committee Meeting

The LTC (NF) IDR Committee will meet March 6 th at 1:30 p.m. at the Department. The public is welcome to observe or listen to the committee discussion by calling 1.712.775.8968 and entering conference code 339028.

Information on the location of the meeting will be available at the security desk in building A.

Elaine Sabyan

Chapter 7 Proposed Revisions – Public Hearing Notice

The Board of Health has scheduled a public hearing regarding adoption of the proposed revisions for April 18, 2018. The public hearing notice may be viewed here: https://www.colorado.gov/pacific/cdphe/draft-regulations

For additional information, please contact Laurie Schoder at 303-692-2832, laurie.schoder@state.co.us 

MDS 3.0 Classes *FREE*

Classes on specific MDS topics in Loveland, Pueblo and La Junta are available. You may choose to take them all at once or individually as your interest and needs dictate. All registration is first-come first-serve, even with sessions held within a host facility site.

ETA reserves the right to cancel classes with low registration. Early registration is helpful.

MDS Basics (One Session): Course ID 1066903
This beginning three-hour class is how to get started with MDS.

MDS Item By Item (2 Sessions): Course ID 1066907
This practical application class reviews item-by-item data set completion. We will follow Miss Scarlett's assessment, which will require two sessions to complete. Attendance at both sessions on subsequent days is required to complete this class.

MDS Quality Measures (One Session): Course ID 1066904
This course assumes familiarity with the MDS Item Set, covering more advanced content and application.

To see additional session details and register for on-site attendance for one of these offerings:
1. Go to https://www.train.org/colorado/welcome
2. Log in to your existing CO.TRAIN account, or new users click "Create an Account".
3. Once you've logged in, or created an account, Search (top right) for the appropriate Course ID. (See above for desired training)
4. Click link for desired course. Note open session options.
5. Click the "Register" button for the session you wish to attend.
6. Remember to register separately for each desired course.

Detailed Instructions for using Train.org (if needed) 

Questions?: Please email betty.metz@state.co.us

CMDA Conference and March LTC Advisory meeting

The next Long Term Care Advisory meeting will be held on Tuesday, March 6, 2018 at 9:30 in the Sabin/Cleere conference rooms. Please see attached agenda.

The registration form for the April 27, 2018 CMDA conference is also attached. 

LTCA Agenda March 6, 2018

CMDA Conference Flyer