Coronavirus Update #19
Thank You and Updates to Stay Prepared
Staying Informed and Prepared

First, thank you for all you and your teams are doing during this unprecedented time.

We wanted to provide an update as we continue working with leaders at UMMS and the Maryland Hospital Association (MHA), as well as other state and federal leaders to communicate concerns, information, and guidance. Please know that we plan to have our second hospital/SNF call early next week -- stay tuned for more details on this upcoming call.

As many of you know, with community spread and the exponential increase of COVID-19 in Maryland and across the nation, we are likely at the dawn of the acute care surge. This predicted surge is anticipated to be real and dramatic. It will be critically important very soon for skilled nursing and rehabilitation centers to take an increasing number of patients from our acute care partners to free up acute care beds.

During this surge, SNFs will likely need to take patients quickly; these patients may be very sick or clinically challenging If this develops, SNFs with vents, dialysis, or who employ physicians will likely be the first needed to help.

Please know that we continue working with our hospital partners to establish clinical protocols that are standard across all hospitals in Maryland. In addition, we continue to work with our State and Federal partners to find solutions to workforce and childcare challenges, lack of PPE supplies, testing shortages, and financial concerns.

This is a difficult time for staff, patients, residents, and families. That said, our partners have prepared a communications document to help guide staff in answering difficult questions that may come up . It is very informative and written in easy language that is honest and simple. Please review and share with your teams in order to learn from and help others.

COVID-19 will require us all to work together, stay vigilant, and adapt to evolving challenges. HFAM will continue working to ensure that you have the tools and resources necessary to navigate this developing pandemic. Below is the most recent additional information from our partners regarding how to stay informed and prepared.
PPE Updates & Reminders

The Centers for Disease Control and Prevention (CDC) issued new guidance today on the use of masks, gowns, and face shields including suggestions on what to do if in crises shortages and when your supplies are exhausted. AHCA/NCAL released an informative alert summarizing this new guidance. Click here to view the full AHCA/NCAL alert.

As a reminder:

  1. Your first step for help is to call the local health department where your SNF is located.
  2. Everyone is short, but still ask your neighbors and partner hospitals.
  3. Finally, this is the email to the state to tell them you have PPE supply issues in advance: sns.mdh@maryland.gov
Telehealth Guidance

Yesterday, CMS expanded telehealth for Medicare . Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries for a wider range of services. CMS Under the new waiver, Medicare can pay for office, hospital, and other telehealth visits. For the duration of the COVID-19 Public health Emergency, Medicare will make payment for professional services to beneficiaries in all areas of the country in all settings.  

Be prepared to utilize telehealth in advance of the incoming surge. We strongly recommend your center prepare equipment and processes for Skype/Facetime/videoconferencing -- especially for your physicians, PAs, and RNs.
Waivers

3-Day Stay Waiver:
On March 14, CMS issued a nationwide waiver of the 3-Day Stay requirement . This waiver means that SNF care will be covered by Medicare without a 3-day inpatient hospital stay required. CMS has told us that this applies to all Medicare beneficiaries during this national emergency, regardless of diagnoses or relationship to the coronavirus, however, CMS has not provided written specifics on this. 

Additional Waivers:
CMS has also authorized certain Medicaid flexibilities; their FAQ on this is available here .  

On March 17, CMS released the first Medicaid Section 1135 to the State of Florida. The waiver focuses exclusively on Medicaid and has no direct impacts on Medicare. AHCA/NCAL has created an overview of this waiver . 
PACE COVID-19 Press Release

Yesterday , the Centers for Medicare & Medicaid Services (CMS) issued guidance to all Programs of All-Inclusive Care for the Elderly (PACE) Organizations (POs) to protect the health and safety of Americans in response to the 2019 Novel Coronavirus (COVID-19) pandemic.

PACE is a Medicare and  Medicaid   program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. CMS is putting out COVID-19 guidance to all types of healthcare providers and facilities. PACE is the latest area of focus because these organizations serve older adults who often have serious chronic medical conditions and therefore are at higher risk of serious illness from the virus.

Upcoming Call and Accessing Prior Calls

Centers for Medicare & Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) will host a call on COVID-19 on Wednesday, March 18 for nursing home organizations. CMS leadership will discuss 1135 waivers and the agency’s latest telehealth guidance. There will be audience Q&A, and the call will be recorded if you are unable to join . The call-in information is as follows: 
 
Wednesday, March 18
4:30 – 5:00 PM EST 
888-455-1397 Access Code: 5854574  

CMS will continue to hold future calls and post those transcripts and audio recordings as they become available. To access Coronavirus COVID-19 Stakeholder calls visit:   https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts   

Centers for Disease Control & Prevention
Yesterday, the CDC held a call that focused on current information about COVID-19 as it relates to long-term care facilities, including nursing homes. Topics discussed include infection prevention and control guidance, steps facilities should take to prepare, and available resources. Click HERE to view a recording of that call.
CMS Virtual Toolkit

CMS has released a Virtual Toolkit to help you stay up-to-date on CMS materials available on COVID-19. Please share these materials with your teams and check back often for the most up-to-date information.
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.
Please email COVID19@ahca.org for additional questions, and visit
www.ahcancal.org/coronavirus for additional information and resources.
As a reminder, we continue to advise:

  • The #1 action you and your teams can do right now is keep all non-essential people out of your centers.

  • Employees simply cannot come to work if they are symptomatic.

  • Be prepared to over-communicate with staff, residents, patients, and families.

  • Inventory supplies and medication - especially infectious control gear.

  • Review your policies and training.

  • Closely monitor the health of your patients, residents, and staff.

  • Establish lines of communication with your hospital partners, local and state health officials.
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.