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October 2020 QMP Bulletin

Last updated on 10/6/2020

Coronavirus Updates and Resources

COVID-19 has led to outbreaks of respiratory illness in the U.S. and still presents a threat to public health. All types of providers care for some of the most vulnerable Texans and must stay up to date with all guidance and recommendations from the CDC, CMS, HHSC, DSHS, and other reliable sources. Below are key resources for providers.


The CDC has published their Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes. This document provides valuable information for NFs using point-of-care antigen testing for SARS-CoV-2, including:


HHSC has published an overview of the expanded visitation guidelines (PDF) for NF, ALF, ICF/IIF, HCS providers and inpatient hospices. Provider Letter 20-38 COVID-19 Response – Expansion of Reopening Visitation (PDF) gives more guidance for implementing the new emergency rules for expanded visitation. Visit the COVID-19 Provider Information page for more information.


CMS published QSO 20-38-NH (PDF) on Aug. 26, outlining the requirements for COVID-19 testing of staff and residents in NFs, based on certain triggers. NFs must test staff regularly and also follow the requirements for testing based on new outbreaks or people who are symptomatic. Base the frequency of staff testing on the county positivity rate where the facility is located.

NFs may opt to use county positivity rates provided by their local health department, if that information is updated at least as often as that on the CMS website. However, NFs cannot alternate between the data sources. They must use only one to guide their testing frequency.

Quality in Long-Term Care Conference Update

The Quality in Long-Term Care Conference presentations are now available on HHS Learning Portal, and can be viewed through August 2021.

QAPI Update

Implementing best practice is essential to a successful QAPI program. Best practice is based on more than evidence it:

  • Exemplifies the quality that is optimal for practices within the NF.
  • Encompasses all aspects of the organization including clinical care, leadership, human resources, and ancillary services.
  • Is significant because it drives staff to find solutions to identified problems.

There are four basic principles to remember when implementing best practice:

  • Develop a plan to manage change required of staff.
  • Determine how the change in practice will be piloted.
  • Create strategies to engage and excite staff about the change in practice. Get staff on board with new ideas.
  • Design a plan to provide required education to staff. Ensuring staff competency is paramount to a successful change.

The HHS Quality Monitoring Program continues to offer support for NFs as they work on improving their QAPI programs. NFs can also request reviews of their QAPI plans. For individual consultation about your facility’s QAPI program, contact Sheila Shepherd, MSN, RN, by email, by phone at 512-438-5577, or by text at 512-867-8669.

Providing APRN Services in Nursing Facilities - Facility Spotlight

HHSC’s joint Civil Money Penalty project with The University of Texas at Austin School of Nursing, Providing Advanced Practice Registered Nurse Services in Nursing Facilities, involved placing APRNs in five nursing facilities in Central Texas.

Will-O-Bell Skilled Nursing and Rehab in Bartlett was one of the NFs selected to take part in the APRN project. Deborah Blinkhorn AGNP and Summer Alvarez FNP began working on-site in the facility in August 2019, and quickly became key members of the interdisciplinary team.

The facility monitored several quality indicators as part of the project. They saw significant improvements because of having full time APRNs on-site, most notably a dramatic decrease in hospital readmissions.

As COVID-19 cases began to increase in March, some physicians began providing only telemedicine visits to the facility. Ms. Blinkhorn remained on-site at the facility, facilitating the telemedicine visits and supporting the facility staff as they cared for their residents.

The on-site component of the project ended in June 2020. The UT Center for Excellence in Aging Services and Long-Term Care will review data related to the project as part of an ongoing study to determine if the employment of full-time advanced practice nurses, as part of a nursing facility care team, reduces the rate of adverse events in nursing facilities.

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