First, something that is not work-related yet is important. Tuesday, September 11, 2001 was a bright and sunny day on the US east coast. Millions of people woke up, loved, gave best wishes to those they care about, and headed off to work. Then, because of the hatred and evil acts of a handful of people, the day turned dark— 3,000 people died and 6,000 people were immediately injured. September 11, 2001 was one of the world events that forever changed our lives and the world. Many of us know people who were tragically lost, including my wife’s cousin in tower two. As we approached this solemn twentieth anniversary of 9/11, let us not forget the victims of that day, or since, or their families. Let our words of that day and time guide us as we go forward: “United We Stand.”
Now at work, you and your teams are rock stars – don’t you forget it! On August 31, roughly 90 skilled nursing and rehabilitation centers and 51 assisted living campuses had a COVID-19 outbreak of at least one case. Most of those outbreaks were a single case or a handful of cases. A few were a bit larger, perhaps nine or ten cases. Today, roughly 79 skilled nursing and rehabilitation centers and 53 assisted living campuses have single case outbreaks. Over the last 18 months in our battle against COVID-19, your teams have been fighting hard to hold the line against his virus. The reality is that we will be fighting this battle for the long haul with the Delta, Lambda, and Mu variants, as well as other variants to come. Let us remember we are fighting the virus and not another.
Last night President Biden issued broad orders on COVID-19 vaccination, within healthcare and for employers with more than 100 employees. Earlier this week, Governor Hogan cleared the way for COVID-19 vaccine boosters in our sector and people over 65 in Maryland.
It is important to remember that not all people age 65+ living or working in a skilled nursing and rehabilitation center or the community-at-large have the same clinical need for a third dose just because of their age or where they live. Therefore, the timing for that third dose should be guided by a physician based on the patient. Marylanders age 65+ or immune-compromised should consult their physician on their clinical need for an immediate COVID-19 third dose booster. Families, residents, and patients in our setting should also consult with medical professionals.
Additionally, with the help of the federal government, the Maryland National Guard, and the state government, it took several weeks to get most residents, patients, and staff in Maryland nursing homes vaccinated. Just as the initial rollout took several weeks, expect that the booster rollout will take time.
Finally, Maryland policy on the boosters is not currently in alignment with federal policy, but that said, we’ve been alerting our sector for months on the necessity to sign-up for ImmuNet, work with their pharmacy partners, and be prepared to administer both COVID-19 boosters and even perhaps the seasonal flu vaccine.
CLICK HERE for the Baltimore Sun article on the Hogan Booster announcement.
It is an important and quick read.
CLICK HERE for a Washington Post article, also an essential read.
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IMPORTANT, Monoclonal Antibody new EUA:
- Regeneron can be used for post-exposure prophylaxis for unvaccinated persons at high risk and for those who have been vaccinated but not expected to have mounted an adequate immune response, even with the vaccine.
- Regeneron may be administered subcutaneously when IV infusion is not available in a timely manner.
- Regeneron can be ordered directly through the supplier - AmerisourceBergen
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Here is a link to administration information https://www.regencov.com/hcp/dosing/dosing-administration
As Always:
- Focus on what is in your control and not what is out of your control.
- Overcommunicate – with residents, patients, families, staff, and government partners.
- Adapt and innovate.
- Rely on your partnerships.
- Speak up when you need help.
- Double efforts on infectious disease protocols, training, and operations.
- Take and document your action; keep a timeline.
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CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing.
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Joe DeMattos
President and CEO
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Federal Provider Relief Fund Update
Today, the Biden-Harris Administration announced that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new provider relief funding available for healthcare providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan Act (ARPA) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients and $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.
Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based in part on providers’ lost revenues and coronavirus-related expenditures between July 1, 2020 and March 31, 2021. As part of the Biden-Harris Administration’s ongoing commitment to equity, Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers. Phase 4 will also include bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patients, who tend to be lower income and have greater and more complex medical needs. HRSA will price these bonus payments at the generally higher Medicare rates for Medicaid/CHIP patients to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.
Similarly, HRSA will make ARPA rural payments to providers based on the amount of Medicaid/CHIP and Medicare services they provide to patients who live in rural areas as defined by the HHS Federal Office of Rural Health Policy. As rural providers serve a disproportionate number of Medicaid/CHIP patients, rural patients have disproportionately greater and more complex medical needs, and rural communities have been hit particularly hard by the pandemic, the ARPA rural payments will also generally be based on Medicare reimbursement rates.
In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. The application portal will open on September 29, 2021.
Additionally, in light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is announcing today a 60-day grace period to help providers come into compliance with their PRF reporting obligations if they fail to meet the September 30, 2021 deadline for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate recoupment or similar enforcement actions for noncompliant providers during this grace period.
For more information about eligibility requirements, the documents and information providers will need to complete their applications, and the application process for Phase 4 and ARPA Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.
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Biden-Harris Administration to Expand Vaccination Requirements for Health Care Settings
New action will protect patients of the 50,000 providers and over 17 million health care workers in Medicare and Medicaid certified facilities
The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant. Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect.
The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the Medicare and Medicaid programs. The decision was based on the continued and growing spread of the virus in health care settings, especially in parts of the U.S. with higher incidence of COVID-19.
“There is no higher priority for us than patient health and safety. As the Delta variant strengthens, the Biden-Harris Administration is committed to doing everything we can to keep patients, and those who care for them, safe,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. “There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health. Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.”
Nursing homes with an overall staff vaccination rate of 75% or lower experience higher rates of preventable COVID infection. In CMS’s review of available data, the agency is seeing lower staff vaccination rates among hospital and End Stage Renal Disease (ESRD) facilities. To combat this issue, CMS is using its authority to establish vaccine requirements for all providers and suppliers that participate in the Medicare and Medicaid programs. Vaccinations have proven to reduce the risk of severe illness and death from COVID-19 and are effective against the Delta variant. CMS will continue to work closely with all Medicare and Medicaid certified facilities to ensure these new requirements are met.
“We know that those working in health care want to do what is best for their patients in order to keep them safe,” said CMS Administrator Chiquita Brooks-LaSure. “As the Delta variant continues to spread, we know the best defense against it lies with the COVID-19 vaccine. Data show that the higher the level of vaccination rates among providers and staff, the lower the infection rate is among patients who are dependent upon them for care. Now is the time to act. I’m urging everyone, but especially those fighting this virus on the front lines, to get vaccinated and protect themselves, their families, and their patients from COVID-19.”
CMS is developing an Interim Final Rule with Comment Period that will be issued in October. CMS expects certified Medicare and Medicaid facilities to act in the best interest of patients and staff by complying with new COVID-19 vaccination requirements. Health care workers employed in these facilities who are not currently vaccinated are urged to begin the process immediately. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.
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CMS Updates COVID-19 Billing Guidance
On September 8, 2021, the Centers for Medicare and Medicaid Services (CMS) Updated MLN Matters Article SE20011 titled Medicare FFS Response to the PHE on COVID-19. In the billing guidance CMS DID NOT change the longstanding blanket 3-day qualifying stay or spell-of-illness waivers for beneficiary eligibility for SNF Part A coverage.
In the CMS SE20011 guidance update, CMS added emphasis that all other coverage requirements including need for skilled level of care remain (page 13). This is consistent with prior CMS and AHCA guidance. Additionally, CMS now notes that contractors will be monitoring and auditing as needed to verify that the need and delivery of a skilled level of care was present.
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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:
- COVID-19 Epi Summary
- TB Testing Update
- Updated Outbreak Line List
- FAQs
- Q&A
Please note that the slides and recordings are for congregate living settings use only. The next webinar is Thursday, September 23rd for assisted living facilities. Nursing homes should receive information about the MD/DC/VA/CDC call about C. auris and CPOs by close of business today.
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We are thrilled to announce that you can now attend the 2021 HFAM conference in person OR virtually. The 2021 HFAM Conference “Together We Re-Imagine” will be held in person AND online from 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.
No matter how you attend, you will gain valuable knowledge and insight through exclusive, dynamic presentations and an innovative Solutions Lounge.
CEs awarded for in person and virtual attendance.
for more information and to register.
HFAM's safety protocol requires proof of vaccination
or a negative PCR test within 72 hours of attendance.
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Thank you to our current sponsors! |
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Plus, Visit our Sponsors and Supporters in the
Brand New "Solutions Lounge"
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Did you miss an update?
Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
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