Coronavirus Update #21
Interim Guidance on Accepting Patients from Hospitals
Interim Guidance on SNFs Accepting Patients from Hospitals 

Our national affiliate, the American Health Care Association (AHCA) has issued interim guidance to help skilled nursing facilities (SNFs) make decisions about accepting hospital discharges to SNFs during COVID-19 pandemic. The decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community. This guidance is designed to help reduce the risk of admitting someone with COVID-19 into your building, along with the steps you should take to prevent any spread. 

What our centers can do now is take other hard to place non-COVID-19 patients in order to free up acute beds and look for CMS relief with AHCA/NCAL.

During a COVID-19 epidemic, the elderly will still have other medical problems that require hospitalization and post-acute care (e.g., strokes, CHF exacerbations, surgeries, etc.). The volume of some traditional post-acute admission is decreasing as hospitals are discontinuing most elective surgeries and elective admissions. However, hospitals expect to see a surge in admissions related to COVID-19, who will need post-acute care, especially as COVID-19 becomes more wide-spread in the surrounding community. 

CMS has waived the 3-day stay requirement for all discharges, regardless of COVID-19 status, to allow hospitals to more easily create new beds for the surge in COVID-19 admissions. As such, SNFs will face the challenge as to which hospital discharges they can accept. The decision-making process will vary depending on if the SNF has COVID-19 positive residents already, the prevalence of COVID-19 in the surrounding community, and the hospital’s capacity, as well as the ability of the SNF to manage residents who are COVID-19 positive or suspected to have COVID-19. 

We strongly urge SNFs to begin now creating separate wings, units or floors by moving current residents to handle admissions from the hospital and keep current resident separate, if possible . It is likely state public health officials may issue state or regional specific guidance that supersedes this guidance. 

Transfers from SNFs to the Hospital

A positive test for COVID-19 or a person with fever or respiratory symptoms does NOT need to be hospitalized. They should be put in contact precautions and follow CDC guidance for COVID-19 positive or presumptive cases in long term care. If a resident requires IV fluids, oxygen and other treatments due to their respiratory symptoms, Medicare will allow you to switch the person over to Medicare Part A without a 3-day SNF stay . Discussion with families and residents should occur about the risks of hospitalization with COVID-19 during this pandemic period. 
Medicaid Eligibility Re-determination Extension

The Maryland Department of Health just today released this memorandum which states that the Department will be permitting extensions of deadlines for Medicaid re-determinations until April 30, 2020. This applies to all Medicaid cases in Maryland, including long-term care (LTC).

The purpose of this extension is to acknowledge the many challenges families, facilities, and their government partners are facing because of the COVID-19 pandemic. Decisions about extensions for future months' re-determinations will be made as needed. 

Please note: The extension does not provide additional time for applications awaiting documentation or reaching the end of the six-month consideration period, Medicaid participants who have reported a change in circumstances, and/or those who arc no longer eligible (e.g., income overscale, moved out of state, increase in resources, etc.). If this changes, we will let you know as soon as possible.

Please review the memo and share with your eligibility teams.
Reminder: HFAM & Hospital Partner Call - Monday, March 23 at 4:00 PM

Along with the Maryland Hospital Association (MHA), the University of Maryland Medical System (UMMS), Johns Hopkins Medicine, LifeBridge, and other hospital partners, HFAM will be hosting our second call to connect our sectors. HFAM will invite broadly and work with partners and other associations to make all post-acute providers aware of this call.

The purpose of that call will be to discuss topics of mutual interest such as transfers between hospitals and post-acute facilities, telehealth, and any other priorities amid the COVID-19 pandemic.

This call will take place Monday, March 23 at 4:00 PM EST
Dial-in: +1-415-655-0001
Passcode: 316 561 900 #
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.
PPE Updates & Reminders

The Centers for Disease Control and Prevention (CDC)  issued guidance 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:
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.
Reminder: Videos & FAQs

The Maryland Department of Health and Maryland Department of Aging have developed a series of audio and video messages directed at seniors on a variety of topics related to the current COVID-19 pandemic. Please use these materials to help communicate with residents.

Topics include:
  • Use of the dining hall
  • Home sanitation
  • Senior Call Check-in
  • Senior center closings
  • How to keep informed

Possible uses for these materials include:
  • Closed circuit television
  • Lobby screens
  • Social media platforms
  • E-newsletters
If you have questions about how to use the materials, please contact .
CMS Stakeholder Calls

CMS will continue to hold future calls and post those transcripts and audio recordings as they become available. To access recorded COVID-19 Stakeholder calls click HERE    
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 for additional questions, and visit for additional information and resources.
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.