Coronavirus Update #102
Thank You & General Update, Special Guest Column Opportunity, CARES Update,
NHSN Reporting, Senate Hearing, CMS Training and Webinars

Thank you Marquis Health Care Services, Lean on Me!   CLICK HERE

On so many fronts, HFAM and I personally appreciate you and your teams. And it’s not just words – Maryland skilled nursing and rehabilitation centers provide critical fabric to the public health safety net in our state. You and your teams are truly saving the lives of Marylanders in need. Thank you.

In terms of our association, the true power of association comes when we recognize diverse views and then align in agreement toward the priority shared goal and when we pull in the same direction to take action toward the achievement of that goal. We are our most powerful working together when we are accountable for the good of the order, when we realize that focus is power and that an association cannot be all things to everyone, and when we know that we are only as strong as our weakest link.

NOTE:  On the COVID-19 front broad testing in our sector is occurring and we are seeing reduced positive numbers with some hot spots. We are working, hoping, and praying this trend continues.

As we navigate COVID-19 together, we have been driven by the power of association, here at HFAM and at AHCA/NCAL.  Our common purpose, the life threatening challenge of COVID-19, and the power of association have been and continue to be the driver of these universal messages we have sent time and time again:

  • Focus on providing quality care
  • Value your team
  • Over communicate with residents, patients, families and staff
  • Operate DRIVEN your infectious disease protocol
  • Take and document your action
  • Keep a timeline
  • Work with your hospital partners, and coordinate with local and state regulatory partners
  • Training - now is the time to be continuously training on PPE, Donning, Doffing and all things infectious disease protocol, workforce/workflow

Thank you for all you do! Potential power is realized with unity, focus, and consistent right action.

Be well,
Joe DeMattos
President and CEO
Special Guest Column Opportunity - National Writer Seeking Stories from COVID Frontline

Our national partners at AHCA/NCAL have shared that there is a special opportunity to participate in a guest column and highlight the amazing work of the long term care profession on a national stage.

Peter King, a national NFL reporter and writer of "Football Morning in America" is seeking stories from individuals working on the frontline of the coronavirus response. He is specifically looking for stories about how participation in sports or athletics plays a role in how these individuals respond to high-stakes situations:

  • "I am interested in your stories, and I am interested in what role your background in sports might have played in your work and in your diligence in putting your lives on the line for the rest of us. Maybe your discipline or work ethic as molded by a high school team, or a college team, or some experience in athletics." 

If you or someone on your team would like to participate, please email  and include: your name, where you live, your job and a description of 200 words or less about how something in your athletic past influenced what you’re doing now.
CARES Attestation Window Extended, Updated Guidance & Financial Resources
On Friday May 22, U.S. Department of Health and Human Services (HHS) extended the CARES Act Provider Relief Fund attestation window. This allows time to address additional questions and to offer providers time to collect necessary payment portal information. In the press statement , HHS announces that the attestation window and related acceptance of Terms and Conditions has been extended from 45 to 90 days from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds . Providers should have received emailed letters from HHS on Friday.

Members will need to identify the dates of each relief payment and identify their new attestation and Terms and Conditions acceptance date based on the extension. HHS updated the Fund FAQs twice this past week. 
Our partners at AHCA/NCAL have updated the COVID-Related Cost and Loss Calculator   and prepared a guidance document on the CARES Act Provider Relief Fund (member login required for both resources). The guidance includes: 

  • Updated AHCA/NCAL CARES Act Provider Relief Fund FAQs; 
  • A merged version of Tranches 1 and 2 Terms and Conditions with easily identifiable changes as well as a redline version of the SNF Allocation Terms and Conditions showing differences relative to the Tranches 1 & 2 Terms and Conditions. SNF Allocation has its own Terms & Conditions. Each of the three versions of the T&C must be attested to using TINs and award dollar amounts; and 
  • A table containing key FAQs and AHCA/NCAL interpretations of HHS guidance. 

Questions about Award Amounts

If you have questions or concerns about Tranches 1, 2, 3 awards, contact the HHS Hotline at (866) 569-3522. HHS reported on Friday that the call center now has access to additional data and new HHS guidance to better answer questions. When calling have the following information ready: 

  • TIN(s)
  • CCN(s)
  • Dollar Amount in question by tranche and by building

Also, if questions about Tranche 3, the SNF Allocation, also have the number of SNF certified beds (Medicare, Medicaid or both) as well as the amount you received and the amount you believe you should have received. 
For Tranches 1 and 2, in its May 14 FAQ update, HHS provided an explanation of why a building might not have received a Tranche 2 allocation. The FAQ provides a formula and explanation of how a Tranche 1 award may have impacted eligibility for Tranche 2. See FAQs on page 7 of the updated FAQ document . HHS added Change in Ownership (CHOW) FAQs as well as TIN FAQs. The latter FAQs are called out in the AHCA/NCAL Guidance document in addition to inclusion in the HHS FAQs.  

Next Steps – Additional CHOW, TIN, and Other Questions

AHCA/NCAL will continue to submit questions and examples of challenging fund scenarios to HHS including CHOW, TIN aggregation, disaggregation, and additional questions about financial terminology and use of tax filing data for validation. However, HHS has verbally indicated the Department’s goal is “maximum flexibility.” While we will continue work with them during the additional assentation window time, it is possible they will defer to reconciliation and reporting documentation to address all scenarios. 
NHSN Reminder, Update, and FAQs 

Nursing facilities were required to submit their first set of data to NHSN by 11:59 pm on May 17, 2020 to be compliant with the new requirements . As a reminder, the Maryland Department of Health and CRISP have uploaded this data as long as your center has granted access to the MDH group and you are submitting your daily CRISP reports.

Access your NHSN account and make sure your center is added to the MDH group using this information: Group Number: 44030; Password: DHMH. There are detailed instructions about how to join a group on the  CDC NHSN COVID website. If you would like to make sure your center in enrolled in the MDH group correctly, please email Rebecca Perlmutter at  

General Reminders & Background

Facilities may choose to report more frequently, but at minimum must report at least once every seven days. The initial two-week grace period ends at 11:59 pm on May 24, 2020. Facilities that fail to begin reporting after the third week, ending at 11:59 pm on May 31, will receive a warning letter reminding them to begin reporting the required information to CDC/NHSN. Facilities who have not started reporting in the NHSN system by 11:59 pm on June 7th, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for one day for the failure to report that week. Each subsequent week that the facility fails to report will result in an additional one day PD CMP imposed at an amount increased by $500. 

NHSN updated the instructions for the pathway forms on May 12. When completing the data collection and upload, be sure that you are using the most current instructions . You can find the new instructions on the NHSN website. During one of the NHSN data reporting webinars, the NHSN team identified that each item question must have an answer entered or it will be counted as missing data and it will be counted as not being reported. When you enter count data, even if the answer is nothing or zero, you must enter 0 in the data field. If you leave it empty, it will be flagged as “no answer”. 

According to the CDC, “to maintain consistency in reporting, if a facility is using crisis level strategies” the facility is experiencing a shortage. “In other words, PPE strategies that do not commensurate with U.S. standards of care are considered as a shortage. For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), we encourage facilities to refer to Optimize PPE Supply website

A center can easily identify if they are missing data in the NSHN module by reviewing the calendar view page. Any pathway that is incomplete will be highlighted as a tan color. Pathways highlighted as green indicated all questions were answered. Missing pathway means the pathway has not been started. As of right now, NHSN does not send notices for incomplete data. Centers are encouraged to review the calendar view to ensure all four pathways are highlighted in green to ensure compliance with reporting to NHSN. 

Centers nationally are continuing to report a delay in being able to register and upload data to NHSN. There are also centers who are reporting significant delays in having their questions answered via NHSN help desk. Centers who are experiencing delays are encouraged to keep documentation of all attempts of contacting NHSN and any communications you have with them. 

Some centers are reporting that they are not receiving the Agreement to Participate and Consent email. If this is happening to your center and you do not receive the Agreement to Participate and Consent in your inbox for whatever reason, you should follow these instructions: 

  1. Log-in to SAMS. 
  2. Select Long-term Care Facility Component and your facility/group name. 
  3. Click “Submit” to review the “Agreement to Participate and Consent”. 
  4. Click ‘Accept’ next to the appropriate contact name. 
  5. Click “Submit”. A pop-up notification will appear confirming this action. 
  6. Click “ok” to acknowledge the notification. 

If you log in to SAMS and see the “Annual Survey” alert on your facility homepage, you should follow these steps to remove the alert: 

  1. On the facility homepage, click "Survey Required 2020" alert on the facility homepage to be directed to the online survey 
  2. Complete the "Facility Characteristics" section and scroll to the bottom to click "save" to submit your survey. 

CDC Posts NHSN Training Recording and Offers Webinar for Groups

The COVID-19 Module Overview for Long-term Care Facilities recorded video presentation and slideset are now available on the COVID-19 LTCF Module webpage , as well as COVID-19 Module Enrollment Guidance for LTCF under Training
Senate Hearing on Caring for Seniors Amid the Coivd-19 Crisis 

On Thursday, May 21, U.S. Senate Special Committee on Aging Committee held a hearing entitled, “ Caring for Seniors Amid the COVID-19 Crisis .” The hearing featured three non-governmental witnesses that discussed how COVID-19 is affecting seniors, especially seniors receiving care in skilled nursing facilities, as well as other topics including personal protective equipment, infection control, data collection, regular testing of residents and staff, pandemic health care provider funding, and vaccines and treatments. 

Our national affiliate, AHCA/NCAL submitted a statement for the record . You can watch a video recording of the hearing, and read the majority and minority press statements of the U.S. Senate Aging Chairman and Ranking Member. 
CMS Training Series for Nursing Homes

Please join CMS for a new National Nursing Home Training Series! This will be a weekly series focused on infection prevention in the nursing home setting. Invitations will be distributed weekly for each training in the series. Details for this weeks webinar are as follows:  

Title: Establishing an Infection Prevention Program, and conducting ongoing Infection Surveillance in the Nursing Home

Date: Thursday, May 28, 2020

Time: 4:00 – 5:00 PM ET

Advance Registration Required: Register here. 

(Note: Once you register, you will receive an email with your individual web link to join the webinar. The web link you receive will work for only one user. Please forward this email to other team members if you would like them to attend.)

Topic: Establishing an Infection Prevention Program, and conducting ongoing Infection Surveillance in the Nursing Home. Participants of this webinar will learn to identify the basic components of an infection prevention program in the nursing home setting; describe the best-practice strategies needed to establish a program; and understand the key elements necessary for ongoing infection prevention surveillance.

Meet the Speaker:
Eli DeLille, MSN, RN, CIC, FAPIC
Quality Improvement Specialist and Infection Preventionist,
Health Services Advisory Group  
CMS COVID-19 Stakeholder Engagement Calls

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so you are highly encouraged to join via audio webcast, either on your computer or smartphone web browser.

Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM Eastern)

Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.

This week’s Lessons from the Front Lines:
Friday, May 29th at 12:30 – 2:00 PM Eastern
Toll Free Attendee Dial-In: 877-251-0301; 
Access Code: 6350189
Weekly COVID-19 Care Site-Specific Calls

CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.
Nursing Homes (Wednesdays at 4:30 PM Eastern)
Wednesday, May 27th at 4:30 – 5:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 1243649

Dialysis Organizations (Wednesdays at 5:30 PM Eastern)
Wednesday, May 27th at 5:30 – 6:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 6152699
Nurses (Thursdays at 3:00 PM Eastern)
Thursday, May 28th at 3:00 – 3:30 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 2988422
Who are your healthcare heroes?

There are so many amazing stories of dedication, sacrifice, and compassion by long term care professionals who are going above and beyond to ensure the safety, health, and happiness of residents during this unprecedented time. These individuals are saving lives; they are heroes.

We want to hear your stories!

Please email   to share a current story and picture of members of your team who are going above beyond to provide quality care during this unprecedented time. 
Did you miss HFAM's previous alerts?

Visit our website to view all previous HFAM alerts, as well as guidance
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.