COVID Update #240

HFAM Update, MDH LTC Webinar Recap, MHECN, and Reminders
About a year ago, the first COVID-19 patient was admitted into a Maryland hospital. While we would not identify a known case in a Maryland skilled nursing and rehabilitation center until later in March, and we were mostly unaware of the virus's often asymptomatic transmission, we were actively fighting the virus in our setting. Today, I offer genuine thanks to each of you and your teams. Nationally COVID-19 rates are down by 82 percent, and deaths are down by 63 percent in our sector since December. While in recent weeks there was at least one active COVID-19 case in nearly 200 SNF's, now about 90 centers have at least one active case.

Vaccine Update

A quick update on vaccines in our sector and vaccine distribution more broadly in Maryland following the conclusion of the CVS/Walgreens SNF clinics and the mid-point of the AL clinics. We continue to work with the state and others on next steps for vaccine distribution. The state is outlining a concrete plan and operational progress for ongoing vaccination. I suspect there will be two or three stages to any plan:

  • Getting second dose vaccines to people in SNFs who received their first dose in the third and final federal CVS/Walgreens clinic.

  • Replacing the federal CVS/Walgreens clinics with a state/federal vaccination program utilizing institutional pharmacies in our setting.

  • Some form of public/private/community/county partnership for continued vaccine support of assisted living campuses following the CVS/Walgreens program.
As we wrote earlier on vaccines: We are partnering, serving as a resource, and advocating in every way possible with our Maryland Department of Health colleagues on operationalizing vaccination in our sector as the Walgreens/CVS Federal program concludes. It is interesting to note that just on the skilled nursing and rehabilitation side, CVS/Walgreens has gotten over 90,000 doses into the arms of Marylanders in need since December 23, 2020. In our calls with CVS/Walgreens, I estimate that the number of doses in Maryland assisted living centers is over 65,000 at this point. Looking on with Governor Hogan as those first vaccines were administered last December will remain among my dominant memories. On vaccination, among other points, we are advocating:
  • It would be ideal for the large institutional pharmacies (Remedi and Omnicare) in the long-term and post-acute care space to be allocated Moderna or Pfizer, ideally via federal allocation, but perhaps via the State of Maryland allocation.
  • We would still need contingencies for about 25 percent of the sector not served by Remedi and Omnicare.
  • There are also a fair number of very small assisted living operators in Maryland, typically serving underserved/disadvantaged communities; perhaps we can all partner with the hospitals or physician practices on that front. This 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 co-located assisted living on the same campus (similar to the federal clinics' cycles).
  • The institutional pharmacies would enter the vaccine data of the skilled nursing and rehabilitation center into the federal database.
  • Upon receiving the vaccines onsite at the skilled nursing and rehabilitation center, staff from the center would administer the vaccine to new residents, patients, and employees (like the traditional flu vaccine).

Legislative Update

We are now just over the halfway point of the 2021 session of the Maryland General Assembly and have submitted testimony on more than 30 separate pieces of legislation. We continue to be engaged with legislators, colleagues, partners, and other stakeholders to advocate on issues relative to our residents/patients, workforce, public health, the budget, visitation, testing, and ongoing COVID-related challenges. We are continuing to tell the quality care story of the sector and highlight the heroic work that you and your teams continue to do. We appreciate the guidance and input from the Legislative Steering Committee and others as we navigate this unprecedented virtual session. 

Please see our HFAM State Budget Testimony. Also see the AHCA estimates of financial benefits to individual states in the current stimulus package, an estimated $4 billion for the Maryland State Government. It is important to note these are estimates. Also, both Governor Hogan and the General Assembly are trying to determine how to spend it – likely very different prespecifies and amounts.
Click HERE and HERE for additional examples of recent HFAM testimony.
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
MDH Webinar Recap

Yesterday, 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
  • Ebola Updates
  • FAQs

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

If you have any questions, please email
Patient Care Advisory Committees (PCAC) – Maryland Healthcare Ethics Committee Network (MHECN)

With new ethical challenges imposed by the COVID-19 pandemic and increasing regulatory oversight, it is important to ensure your PCACs are active, accessible, and providing needed support, and that your center follows CMS – Phase 3 Conditions of Participation. Having a PCAC, or access to an ethics committee is an important resource for care decision making and informing residents and their representatives of appropriate medical care.

HFAM is pleased to inform you of a partnership with the Maryland Healthcare Ethics Committee Network (MHECN), established by the Law and Health Care Program at the UM Carey School of Law. The MHECN is available to supplement your center’s PCAC or become your PCAC with participation from your center. In addition, to MHECN, helping you comply with state and federal requirements, they offer many additional benefits to their network members.

HFAM encourages you to review the this letter describing the MHECN’s role and available benefits, you may also visit MHECN, and become a MHECN, network member.
What They Are Saying: Declining COVID Cases In Long Term Care Facilities Indicate Vaccines Are Working

For the past year, long term care residents and staff have been at the epicenter of the COVID-19 pandemic. Thankfully, vaccine distribution has marked a turning point in our fight against the virus. Residents and staff across the country are feeling a sense of hope as they credit the vaccines for a drastic decline in COVID cases in long term care facilities.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) held a video press conference this week to highlight a new report which shows that new COVID cases among nursing home residents have declined by 82 percent since mid-December when cases were at their peak. New resident cases are also at their lowest levels since the Centers for Medicare & Medicaid Services (CMS) began tracking data in May 2020, suggesting that the vaccines are working.

The data underscores the importance of residents and staff getting vaccinated. AHCA and LeadingAge recently announced a nationwide goal of getting 75 percent of the approximately 1.5 million nursing home staff vaccinated by June 30, 2021. AHCA/NCAL continues to educate residents and staff on the importance of vaccination through their #GetVaccinated campaign.

Although cases are declining, we cannot lose the progress we have made. Public health officials must continue to make long term care residents and staff a priority for the vaccines, as well as funding and essential resources. 

WATCH an AHCA/NCAL video celebrating vaccine distribution across long term care facilities.
2021 HFAM Conference
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.
Reminder: Diamond Labs Testing and Reporting

Diamond Labs is happy to announce that, with the release of the new codes from CMS, they are able to compliantly test and bill staff members’ insurance for the testing. If centers are using the screening code z11.52 as intended, Diamond Labs is able to test staff and bill their insurance.

In addition, Diamond Labs will also inherit the burden of reporting all results, rather than committing staff time to report and send results.

Diamond Labs’ method yields a 99.97% accuracy rate via the PCR method, averages a 24-hour turnaround time, and sends reports via three separate methods. 

With vaccine administration, there has also been an increase in antibody testing to see if vaccines are working to build antibodies. Diamond Labs is working the State to identify patients that still test positive after getting both doses of the vaccine -- some theories are exploring the idea that those patients are not building antibodies and/or they came in to contact with new strains of the virus. 

If any HFAM members are looking for prompt, accurate results with a timely turnaround, please contact Casey Young via email or phone at 443-742-4051.
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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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.