Coronavirus Update #31
Stay-at-Home Order, MDH Waivers, and More
Governor Hogan Issues Stay-at-Home Order

In a press conference today, Governor Hogan issued a stay-at-home order, effective this evening at 8:00 p.m.   Under the order, no Maryland resident should leave home unless for an essential job or essential reason such as obtaining food or medicine.

Healthcare workers are exempt from this order. This is an important and correct action to help mitigate the spread of COVID-19. We will continue to share regular updates and we will get through these uncharted waters together.  Thanks again for all you and your teams are doing.

See the stay-at-home order document here .
MDH Temporarily Waives PASRR Requirements and MDS Validations

To assist nursing facilities in meeting the many challenges they are facing because of the COVID-19 pandemic, the Maryland Department of Health (MDH) is temporarily waiving Requirements for Pre-Admission Screening and Annual Resident Review (PASRR) and Minimum Data Set (MDS) Validations.

These waivers will be in effect immediately and until further notice.

If you have any questions regarding these waivers, please contact Jarrod Terry or Jane Sacco.
Reminder: HFAM & Hospital Partner Call - TODAY 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 third 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, post-acute capacity, models to expand capacity, and other priorities amid the COVID-19 pandemic.

This call will take place  Monday, March 30 from 4:00 - 5:00 PM EST

Dial-in: 1-415-655-0001
Passcode: 316 561 900 #
Medicare Accelerated and Advanced Payments Now Available 

Over the weekend, CMS announced that it is expanding its accelerated and advance payment program for Medicare providers. These payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19. 
To qualify for accelerated or advance payments, the provider or supplier must: 
  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form; 
  • Not be in bankruptcy;
  • Not be under active medical review or program integrity investigation; and 
  • Not have any outstanding delinquent Medicare overpayments. 

Medicare will start accepting and processing the Accelerated and Advance Payment Requests immediately. CMS anticipates that the payments will be issued within 7 days of the provider’s request. See an informational fact sheet on the accelerated/advance payment process and how to submit a request.  

CMS guidance on provider eligibility and submission processes from today’s announcement differ from those found in the Medicare Financial Management Manual , Overpayments, Chapter 8, Section 150. Providers should contact their MACs, directly, to understand how the MAC will be operationalizing CMS’s guidance. CMS is delegating the payment request processing to the MACs. See the MAC regional coverage map .  
Telehealth Toolkit 

CMS recently issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. 

This toolkit contains links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS in response to the National Health Emergency. Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. 

There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.  
Third Stimulus Package Signed into Law 

Late last week, the House passed and the President signed into law the third stimulus bill, H.R. 748, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Of particular note to skilled nursing facilities and assisted living facilities it includes the following provisions: 

  • A temporary suspension of Medicare sequestration cut 
  • $100 billion fund for eligible health care providers 
  • Deferral of 6.2% payroll tax 
  • $200 million in funding to prevent, prepare for, and respond to coronavirus 
  • Childcare support for health care sector employees 
  • New loan program for certain employers 
  • Funding for housing for the elderly and disabled 
  • Temporary relaxation of rules limiting net operating loss deductions 
  • Relaxation of excess business loss rules for passthroughs and sole proprietors. 
  • Refundable employee retention tax credit 

AHCA/NCAL has a more detailed summary of the bill, along with a summary of other COVID-19 related relief packages. AHCA/NCAL will be reaching out to the Administration, specifically on the $100 billion health care fund, to ensure long term care providers quickly receive a portion of these crucial resources. 
VA Referrals to SNF During COVID-19 Emergency 

Per an email to AHCA/NCAL from the Veterans Administration (VA), community care has halted non-urgent, non-emergent VA referrals to the community. Referrals for geriatrics and extended care services (including all nursing home referrals) will continue but they are being clinically reviewed based on guidance to carefully evaluate and prioritize referrals that are urgent/emergent and medically necessary based on clinical triage. NOTE: The VA and TriWest have delayed the deployment of community care network throughout Region 4; Montana and Eastern Colorado will deploy June 8, 2020 and the remainder of Region 4 by August 31, 2020. Referrals in these regions for post-acute care would continue to be via local VA contracts or veterans care agreements. 

The following are useful web links to access updated VA information. 

  • The VA provider latest news webpage is here
  • The VA COVID-19 webpage is here
  • The Optum CCN Network COVID-19 webpage is here 
  • The TriWest Network provider webpage is here.
COVID-19 and Issues with Postal Carriers and Mail Delivery

AHCA/NCAL has been made aware by several of our provider members about issues with mail delivery during the COVID-19 pandemic. Specifically, our national affiliate has been hearing that postal carriers are refusing to comply with screening process as required by CMS and many states for entrance into long term care facilities. When these issues have arisen, rather than simply adhering to the new safety protocol, postal carriers have refused to deliver the mail and/or required providers to retrieve their mail from the local post office. 

Getting mail is one of the primary ways for residents to stay connected to loved ones as well as to continue their important everyday routines. Many also receive crucial packages, such as prescriptions and tax preparation information in the mail. AHCA/NCAL has been advocating on Capitol Hill that postal carriers be subject to the same screening process as all essential personnel to our communities. 

That being said, AHCA/NCAL has recently heard that the United States Postal Service (USPS) will be offering centers and other customers three options for mail delivery if there are issues with their current delivery.

  1. You may opt to redirect to a temporary mail receptacle inside or outside the building where screening would not be necessary. 
  2. Place the mail on hold at the Post Office servicing this delivery. Mail and parcels can be held up to 30 days and will be available for customer pickup. 
  3. Redirect all mail for the business to an alternate location. 

Please note that in addition to the Capitol Hill efforts around this issue, AHCA/NCAL joined forces with other national associations to send a letter to the Postmaster General and Chief Executive Officer of the U.S. Postal Service to express our concerns. AHCA/NCAL will continue to monitor this issue, and keep members apprised of any relevant updates. 
Department of Labor Guidance on New Leave Benefits Excludes Health Facility Employees 

In response to AHCA/NCAL’s advocacy to include nursing home, assisted living, and ID/DD staff in their definition of “health care provider,” the Department of Labor has published guidance to address exemptions and employer requirements to the expanded Family Medical Leave Act and sick leave benefits included in the recently passed Families First Coronavirus Response Act. Of note, the Department’s exemptions FAQ (see #56) states that the “health care provider” exemption to these new leave requirements applies to “anyone employed at any... nursing facility, retirement facility, nursing home, home health care provider... This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.” The exemption also applies to employees of contractors with the above institutions who “provide services or to maintain the operation of the facility." Employers with over 500 employees are also exempted. Please review this FAQ  closely. 
To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA. 
Additionally, the Department of Labor has posted an Employer Fact Sheet and an Employer Notice Requirements FAQ
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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.