COVID Update #237

HFAM Update and Reminders
HFAM Update


Thank you for all you and your teams are doing to provide quality care to Marylanders in need and to save lives. I know from the road we have traveled together over the last year that you and your teams remain vigilant. I also understand how frustrating it is to emerge from outbreak status (a single COVID-19 case, per CMS and CDC) and begin indoor visitation only to have a single positive case halt indoor visitation per federal guidelines. Again, this is frustrating for family, for residents, for you, and for all of us; we will get through it together. Going forward, I see more family compassionate care visits and the government pushing our sector for such visits while following infectious disease protocols.
Vaccination and Cohorting
We are partnering, serving as a resource, and advocating in every way possible with Maryland Department of Health (MDH) leaders on operationalizing vaccination in our sector as the federal vaccination program via Walgreens/CVS concludes. The truth is we have been advocating for weeks. On just the skilled nursing and rehabilitation side, CVS/Walgreens has administered over 90,000 doses since December 23, 2020. Amid this crisis, one of my dominant memories will remain watching the administration of those first vaccine doses in December alongside Governor Hogan. On vaccination, among other points, we are advocating:
  • It would be ideal for the large institutional pharmacies (Remedi and Omnicare) in our sector to be allocated Moderna or Pfizer, ideally via federal allocation, but perhaps via state allocation.

  • We would still need contingencies for about 25 percent of the sector that is not served by Remedi or Omnicare.

  • There are also a fair number of very small assisted living operators in Maryland, typically serving disadvantaged communities, that we must not forget. Perhaps we can partner with hospitals or physician practices on this front – it is important.

  • Every two to three weeks, the institutional pharmacies would dispatch the vaccine to a specific skilled nursing and rehabilitation center, perhaps to include assisted living centers located on the same campus (similar to the cycles of the federal clinics).

  • The institutional pharmacies would enter the vaccine data into the federal database.

  • Upon receiving the vaccines onsite, staff from the center would administer the vaccine to new residents, patients, and employees (like the traditional flu vaccine).
MDH’s February 11, 2021 amended orders helped on the visitation front, and on a related note, eased restrictions on Maryland hospitals performing non-COVID and non-emergency procedures. However, these orders did not ease cohorting requirements that were put in place during a surge and before the vast majority of residents and patients were vaccinated. There is a public policy disconnect between allowing hospitals to perform more procedures and then limiting rehab admission into our setting due to these strict cohorting requirements. We are advocating for cohorting to be linked to a more specific testing regime of POC and PCR testing and for cohorting requirements to be linked to the surrounding community positivity rates, in addition to taking vaccination in to consideration.
  • AHCA/NCAL will present to federal government leaders, media, advocacy groups, and the public on quality reforms linked to a significant and long-term increase in the state FMAP increases. It is AHCA/NCAL's proposal and intent that states would only get the increased federal match if they agreed to the measures, and they would be required to pass the increased FMAP rates to providers in our sector upon those providers meeting specific criteria.
  • We do expect Congress to pass and President Biden to sign a stimulus bill in March. That bill does not include additional aid to our sector; MOST IMPORTANTLY, it does include significant support to state budgets to protect Medicaid and other state priorities.
NOTE: When HFAM last met with the National Association of State Budget Officers (NASBO) in December 2020, they were VERY concerned about state budgets. Now even in advance of a federal stimulus that includes $350 billion in budget assistance to states, NASBO reports that half the states have budget FY22 surpluses. These are mostly states with progressive income tax systems; California, for example (Maryland’s tax system is less progressive). I think small and large tourism states, Hawai’i and Florida, are state budget losers much in need of the federal stimulus in mid-March. When I checked in with the state of Maryland budget leaders in December, they predicted a Maryland FY22 budget shortfall of $2.6-$3.8 billion. We are checking again, now.
Finally, on the AHCA/NCAL front, we had a very productive call with AHCA/NCAL last night. We can expect some guidance on the Federal LTC Pharmacy Vaccination Program going forward.
Maryland General Assembly
We are fully engaged in the Maryland General Assembly's regular session, advocating for access to quality care for Marylanders in need, supporting our sector, and serving as experts on important issues of public policy. I've got to tip my hat to the members of the Maryland General Assembly here. It is no small task to convene this session and conduct the people's business in a virtual and socially distanced way. It is different. We all long for a "normal' regular session next year. In the meantime, we have taken every opportunity in our public testimony to not just share the facts, but to tell our sector’s story. We will continue to do so. Here are a few examples of recent HFAM testimony: HB 836, HB 983, SB 13, and SB 565.
As Always
  • People first, quality counts.
  • Be prepared to deploy people and PPE around your organization.
  • Our sector MUST double our efforts on infectious disease protocol, staffing, PPE, observation, and testing.
  • Train, train, and train teams again on infectious disease protocol.
  • Recognize that COVID-19 fatigue is an issue across the county, not just in our sector.
  • Overcommunicate with residents, patients, families, staff, and government partners.
  • Sound alarms early.
  • Know that WE WILL get through this and that you are saving lives!
  • Work with your hospital partners, and coordinate with local and state regulatory partners.
  • Take and document your action; keep a timeline.
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing. 
Be well,
Joe DeMattos
President and CEO
The 2021 HFAM Conference “Together We Re-Imagine” will be held in person October 4 – 7, 2021 at the Maryland Live Hotel and Casino in Hanover, Maryland. Hundreds of long-term care leaders will connect, share best practices and discuss actionable insights on how we can reflect, reform, rebuild, and revolutionize quality care. You and your teams will not want to miss this opportunity as we come together again.

Visit the conference website to learn more and register.
Webinar on COVID-19 Revenue Supplemental Schedule

The Maryland Department of Health and its contractor, Myers and Stauffer LC, are holding a webinar to review the COVID-19 Revenue Supplemental Schedule. This schedule and the accompanying memorandum from MDH are available on the Maryland section of the Myers and Stauffer website at
The webinar will be on Wednesday, March 3, 2021 from 11:00 a.m. to 12:00 p.m. To register for the webinar, CLICK HERE.
Once at the website, select the Register link in the Event Status line. Once on the registration page, complete the first name, last name, email address, and confirm email address fields. All four fields are required. Then select the Submit button. After selecting the Submit button, you will receive a calendar invitation with a link to join the webinar.
The webinar will review the schedule and instructions and the timeline for submitting the schedules. There will be a question and answer period at the end of the webinar. If you have any questions that you would like to submit prior to the webinar, please send them to The webinar will be recorded and posted to for any providers that are not able to attend the live session.
MDH Webinar Recap

Last week, the Maryland Department of Health held a webinar call to update the long-term care sector on COVID-19 developments and best practices. The call was recorded, in case you were unable to join or would like to review the topics discussed, which included:

  • Maryland Epi Updates
  • CDC Updates
  • MDH Updates
  • Safer Vaccine Clinics
  • FAQs

You can also view the webinar's PowerPoint presentation here and the chat box here.

If you have any questions, please email
Reminder: Medicare Accelerated and Advance Payment (AAP) Repayment – Two Months and Counting

AAP repayments for all Medicare providers who received AAP payments begin one year from date of the AAP receipt. Repayment start dates are specific to SNF providers associated with their date of AAP receipt. For many SNFs, repayment dates begin in April 2021. Providers do not need to take any action to repay. 

Rather, Medicare Administrative Contractors (MACs) automatically will begin to recover payment amounts reducing paid claims until the AAP is repaid. AHCA was successful with ensuring SNFs were including in the Continuing Appropriations Act, 2021 and Other Extensions Act. This law extended and modified the repayment schedule. Additionally, the law fixed the interest rate at 4%. Normally, AAP payment extensions are subject to the Treasury Department’s given interest rate. Access to these provisions offer more time to repay and more predictability through a fix interest rate. 

Based on the statutorily defined schedule, SNFs should assess their cash flow for quarter two of 2021. For an AHCA overview of the repayment schedule, additional AAP information (including options to request payment extensions), and MAC webpages, click here. To review the CMS FAQs, click here.
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from our federal and state partners.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.