Coronavirus Update #115
HFAM Update, COVID & LTC Webinar Recording, MDH Webinar, On-Site Focused Infection Control Surveys, AHCA Updates: CMS Citations, Relief Fund Porta l
HFAM Update


On March 17 New York Columnist Thomas L. Friedman wrote about BC and AC – Before COVID (BC) and After COVID (AC). From all we’ve learned about this killer virus since March 17, we know that we won’t be experiencing AC for quite some time. The phrase "New Normal" is overused, but most certainly in terms of healthcare in general, our sector of care, public health, and yes inclusion, diversity, and equity, we ARE in a new normal.

And, to be clear, operating the same way we did on December 1, 2019 is simply not possible. There is good and bad with that, but that is irrelevant. What is relevant is recognizing the new normal, identifying the changes and challenges, and revisioning and reinventing to bring value in the new landscape. In the end, you are a people-helping-people enterprise engaging patients, residents and staff to take action and become their best selves. As you know, I’ve always loved this quote from Peter Drucker: “The best way to predict the future is to invent it.” We have a tremendous once in a lifetime positive opportunity to redesign and rebuild our sector.

Thank you for all you and your teams are doing to provide quality care to Marylanders in need during the healthcare pandemic and economic crisis that is COVID-19. Every single death is sad, we are all working tirelessly, and we are all praying.

That said, it is important to remember that today in Maryland skilled nursing and rehabilitation centers, more people are surviving than dying from this virus. Last night I was happy to receive emails and texts from centers that previously had cases and are now in the clear with no cases.

Many centers in Maryland have done broad resident and patient testing. The State completed, with lab submissions in early June, a round of universal testing of all residents, staff, and patients in Maryland skilled and rehabilitation centers – that’s approximately 27,000 licensed beds and 33,000 employees. As those numbers come in, we will see an increase of COVID-19 positive cases. Yet, because since late March we have seen a correlation between the COVID-19 “hotness” of a community and healthcare settings in that community, and because today communities are less “hot” than they were, I suspect that percentages of infections will be generally down compared to mid-April.

Maryland’s stay-a-home orders worked to massively flatten the curve, which is outstanding, especially given that COVID-19 is often asymptomatic. According to one study by the Centers for Disease Control and Prevention (CDC), 57 percent of older adults who tested positive did not have any symptoms but were likely infectious to others. This had a tragic impact on many skilled nursing and rehabilitation centers across the country. Given the often-asymptomatic nature of the virus and without adequate testing and PPE support from the federal government, skilled nursing and rehabilitation centers have been fighting an uphill battle. And, until there is a broadly available vaccine, we will likely face future waves of COVID-19 and continue this fight together.

On March 18, the federal government enacted legislation to provide emergency increases in Medicaid during the COVID-19 pandemic, but state governments were not required to pass those funds directly along to healthcare providers. Also, in most cases, state governments have not provided CARES Act funding relief directly to nursing homes, group homes, and assisted living campuses. Fortunately, thanks to the advocacy and leadership of our colleagues at the American Health Care Association (AHCA), the U.S. Department of Health and Human Services (HHS) has provided direct payments to Medicaid/Medicare organizations to help underwrite the work of healthcare heroes who provide quality care to those in need and to support inflated prices for much-needed PPE.

Some of the ironic tensions of the COVID-19 pandemic and economic crisis:

  • The long-term care sector and our hospital partners are working closer than ever. Across both settings, lives are being saved. However, more often than not hospitals and their teams are being heralded as heroes and nursing homes are being vilified. That’s why Bob Atlas, President and CEO of the Maryland Hospital Association (MHA), and I wrote a letter to the Baltimore Sun highlighting the heroic work that employees in both settings have done during this crisis. I have personally doubled down positive messaging about hospitals and nursing homes because it is true that together you all are saving lives.

  • Nursing homes are saving more lives than not. During this crisis much was rightfully spent on wages and bonuses to frontline healthcare heroes and on often inflated prices for much-needed PPE -- all the while rates and revenue did not increase.

  • Because elective surgeries stopped in hospitals, rehabilitation care supported by Medicare also stopped in nursing homes. Costs massively increased while revenue massively decreased and, for the first time in decades, occupancy in Maryland nursing homes is down by 20 percent on average.

Going forward:

  • Make no mistake we will be fighting COVID-19 until there is a broadly available vaccine.

  • We can expect State of Maryland resuming visitation guidance any day now (see our recommendations to the State); and we have been advising our sector to prepare for this since May 11, 2020.

  • Ongoing testing and infectious disease surveillance will be necessary, must be clinically driven, and we have to learn from other states’ mistakes. Maryland’s approach must make common sense and it will be expensive – tens of millions of dollars a year in an environment where Medicaid is already underfunded.

  • Increased staff costs and decreased census will continue at least through this year and maybe next; increased PPE costs and shortages will also continue.

  • Staff training, staff PTSD, and burnout will be real. There will be increasing need for support and to build our bench and adapt career ladders in new ways.

  • This is a new normal. Healthcare in general and long-term and post-acute care specifically could and will be reformed. Together we have vital expertise in that effort, and we must band with others in this important work—we have a tremendous once in a lifetime positive opportunity to redesign and rebuild our sector.

  • The time for meaningful and real work on diversity, inclusion, and equity is now and our sector has so much to offer on that front.
Joe DeMattos
President & CEO
Recorded Webinar Available

COVID-19 and Long-Term Care Facilities: How Maryland's Long-Term Care Industry is Responding

We, along with our partners at the Alzheimer's Association, LifeSpan, and LeadingAge MD, held a virtual public conversation on the impact of COVID-19 on Maryland's long-term care industry and those we serve. Understand how we have approached this unprecedented pandemic, our response in areas such as: testing, reporting, surge capacity, and what additional actions are needed to support staff, individuals at their facilities, and family caregivers.
On-Site Focused Infection Control Surveys: Implications and Strategies
June 17, 2020 - Live Webinar - 10:30 AM - 11:30 AM

On June 1, 2020, CMS mandated that states conduct boots-on-the-ground infection control surveys at every nursing home in the country by July 31, 2020 and COVID-19 focused surveys at centers that have experienced “COVID-19 outbreaks” by July 1, 2020. States that miss these deadlines risk losing a percentage of their CARES Act stimulus funding. This webinar will explore the implications of this new directive and strategies for responding to the surveys.

Attendees will:

  • Learn what CMS is requiring of state survey agencies, including what events might trigger an on-site survey.

  • Review the new and enhanced enforcement remedies related to Infection Control deficiencies (including Directed Plans of Correction, Discretionary Denials of Payment for New Admissions; prescribed and short time periods for demonstrating compliance, and Civil Money Penalties).

  • Develop and discuss facility-specific and industry-wide mitigation strategies.

Presenter:   Paula Sanders, Principal, Post & Shell, Co- chair Health Practice Group and Chair COVID-19 Task Force; Member of AHCA/NCALs Legal Committee

Target Audience:   Administrators, Directors of Nursing, Infection Preventionists, All Department Directors and Care Teams, Regional Directors.

Cost:  HFAM Members – FREE   - Non-Members - $25.00

CEUs are NOT offered for this program
MDH Webinar

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:

  • Review current situation of COVID-19
  • State and Federal Updates
  • Updates on Relaxing Restrictions
  • Admitting residents to observation
  • Legionella and Reopening
  • Tele-ICAR for NH & ALFs
  • Town Hall

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

If you have any questions, please email
CMS Issuing F884 Citation and CMPs for Failure to Report NHSN COVID-19 Data 

This week, CMS began issuing 2567s with F level citations for F884 with a $1,000 per instance civil monetary penalty (CMP). These are being issued to all SNFs identified by CMS from data transmitted by CDC as not having submitted data or submitting incomplete or otherwise erroneous data for the week of June 1 to June 7.

The notifications of deficiency and CMP are being sent via the CASPER/QIES system (not the traditional method for notifying a facility with a deficiency). Thus, facilities must log in to CASPER to see if they have a citation or not.
Relief Fund Portal for Medicaid Providers Launches  

As we previously shared , on June 10, the U.S. Department of Health and Human Services (HHS) launched a web application portal for Medicaid providers other than SNF Medicaid providers. SNF Medicaid-only providers already should have received a Medicaid Allocation or will receive payments over the course of the week. The new Provider Relief Fund Payment Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund including assisted living communities, ICFs/ID-DD, and home and community-based providers.  

Other COVID-19 Updates

Provider Relief Fund FAQs: On June 10, the U.S. Department of Health and Human Services (HHS) updated its Provider Relief Fund FAQs . The update provides information on the new web application portal for Medicaid providers other than SNF Medicaid providers. Read More   

How to Make COVID-19 Notifications Meaningful:  While nursing homes must continue reporting confirmed and clusters of suspected cases in a cumulative manner in order to meet the current CMS requirements, AHCA/NCAL suggests nursing homes consider including additional information in these notifications, so they are more meaningful and useful to residents, their representatives and families. We have added optional items in this updated template letter to residents and families as suggestions for you to consider including. Read More

New FAQs for ICFs/IID : On June 10, CMS released new FAQs (pages 13-15) for intermediate care facilities for individuals with intellectual or developmental disabilities related to COVID-19. Read More  

Coalition Submits Request to Extend Therapy Telehealth Waivers : On June 10, AHCA/NCAL and 13 other therapy advocacy organizations submitted a  letter  to HHS Secretary Azar, CMS Administrator Verma, and other key CMS officials requesting extension of COVID-19 therapy telehealth waivers as well as efforts to make these policies permanent in law.  Read More  

COCA Webinar for Tuesday, June 16 : the CDC Clinical Outreach and Communication Activity (COCA) will be hosting a  webinar  on applying COVID-19 infection prevention and control strategies in nursing homes.  Read More  
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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.