Coronavirus Update #47
HFAM Survey Reminder, CMS Calls, and Additional Updates

Thank you for all you and your teams are doing to provide quality care to Marylanders in need as we battle the COVID-19 pandemic. Your preparation over recent months will be critical in our success going forward, as will your focus, diligence and team work. 

As of last night, across Maryland, there have been over 4,300 COVID-19 cases in the state across all settings and over 100 deaths. Our region is in the exponential growth phase of COVID-19. In a couple of weeks cases, hospitalizations, people in hospital ICU's, and deaths will increase dramatically. 

To prepare and be proactive as a sector, your completion of this survey is critical.
These reminders are obvious, but so very important:

  • Love, support, and over communicate with your care teams.
  • Over communicate with families.
  • Operate DRIVEN by your infectious disease protocol.
  • Execute your observation and isolation beds.
  • Work closely with your acute-care hospital partners and home health partners.
  • Stay in contact with local health offices and the Office of Health Care Quality (OHCQ).

Skilled nursing and rehabilitation centers and assisted living communities are a valuable asset to the healthcare network in our most urgent fight ahead. The COVID-19 pandemic is and will be the biggest challenge of our lifetimes.

As Secretary Phillips said yesterday, COVID-19 is sneaky, there is no cure, no vaccine, it spreads easily, and you don’t know you have it for several days. As a nation and as a sector, we have gotten through crises before by working together to create innovative solutions. In the early days of the HIV/AIDS crisis, before we understood how it spread and before universal precautions were implemented, nursing homes in Maryland were among the first to compassionately care for terminally ill patients including infants, men, and women.

Thankfully, HIV/AIDS is today well understood, not terminal, and our sector is proud to have played a role in this. While we face many challenges with the current pandemic, we will continue to step up and find solutions to care to for Marylanders in need.

For those like me and my family who are Jewish: Zisen Pesach. As is stated in the Mishnah, the earliest post-biblical record of Jewish law: “If any person saves a life, a single life, Judaism considers that he has saved the whole world” (Mishnah, Sanhedrin 4.5).

Thank you!

Be Well,
Joseph DeMattos
President and CEO, HFAM
CMS Call Today

Please join the Centers for Medicare and Medicaid Services (CMS) for a call on COVID-19 with Nursing Homes today at 4:30 PM EST.

CMS leadership will provide updates on the agency’s latest guidance and we will be joined by leaders in the field interested in sharing best practices with their peers. The call will be recorded if you are unable to join.

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Wednesday, April 8
4:30 – 5:00 PM EST
Attendee Dial-In: 833-614-0820
Conference ID: 6798274
CMS “Office Hours” on COVID-19 

Opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to: 

  • Increase Hospital Capacity – CMS Hospitals Without Walls; 
  • Rapidly Expand the Healthcare Workforce; 
  • Put Patients Over Paperwork; and 
  • Further Promote Telehealth in Medicare 

Submit questions in advance to , including “Office Hours” in the subject line. There will also be live Q&A. Conference lines are limited, so it is highly encouraged you to join via audio webcast, either on your computer or smartphone web browser. 
Thursday, April 9 
5:00 – 6:00 PM EDT
Attendee Dial In: 833-614-0820 
Event Plus Passcode: 1881716 
OSHA Issues Memo on Respiratory Protection  

The Occupational Safety and Health Administration (OSHA) has issued two separate enforcement memoranda related to the use of respirators by healthcare and non-healthcare employers. This includes all long term care providers: skilled nursing, assisted living, and ID/DD providers. The memoranda address issues facing employers regarding the respirator shortage, giving employers limited relief from OSHA’s Respiratory Protection standard as a result from COVID-19.

Payroll Based Journal Update 

CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system. This means that staffing data for the first quarter of 2020 (1/1/20 – 3/31/20) will not need to be submitted for the May 15, 2020 deadline, nor will this data need to be submitted later.

At present, there is no additional information as to how long this waiver will remain in place and providers should continue to collect staffing data , as CMS has only waived submission of data but not the collection of the data. 
FAQs on the Payroll Protection Program 

The Department of the Treasury released a new FAQ  this week that clarifies certain areas of the Paycheck Protection Program created by the Coronavirus Aid, Relief and Economic Security Act (CARES Act). Among other topics, the FAQ specifies that the $100,000 cap on payroll costs used to calculate the PPP loan size applies to salary costs only. This means that a wider range of employees can be factored into the loan size calculation than originally believed, since healthcare benefits, retirement benefits and other compensation do not need to be factored into the cap.

HUD COVID-19 Relief 

AHCA/NCAL has received confirmation from the U.S. Department of Housing and Urban Development (HUD) that in response to recommendations from the industry, HUD review and approval of the below types of transactions for Section 232 insured facilities impacted by COVID-19 is not required. If the Lender has been notified that the project is with the Risk Mitigation Branch, then HUD approval is required. This is effective through July 31, 2020 and applies to the following: 

  1. Suspend monthly deposits to the replacement reserve through July 31, 2020, at which time the deposits will resume unless HUD grants a further extension. At the conclusion of the suspension period, the sum of the suspended payments shall be paid into the Reserves for Replacement in equal monthly increments over the next 12 consecutive months. 
  2. Use operating deficit funds to meet debt service payments, subject to repayment provisions, if any, contained in the subject escrow agreement. 
  3. Use debt service reserves to meet debt service payments; subject to repayment provisions, if any, contained in the subject escrow agreement. 
  4. Use replacement reserve accounts to meet debt service payment requirements so long as the account balance does not fall below $1,000 per unit. 

To exercise this authority, borrowers must demonstrate, to the lender’s satisfaction, that their request results from the impacts of COVID-19. While HUD approval will not be required, the lender is expected to report any utilization of the above to their assigned account executive and discuss any new risks at the facility that have may have emerged. 

On a case-by-case basis, HUD will consider requests from borrowers for other non-conventional uses of escrow funds. Balances in these accounts are typically not significantly larger than the projected amounts needed for those accounts’ intended purposes. Moreover, the balances are not likely substantial enough to significantly offset COVID-19 operating revenue and expense impacts. 

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.