Coronavirus Update #85
Updated MDH Order, Reminder on State Reporting Requirements, Federal Reporting Requirements, Medline PPE Survey, VA Update, Avoiding PPE Scams
Updated MDH Directive and Order

Today the Maryland Department of Health released an AMENDED DIRECTIVE AND ORDER REGARDING VARIOUS HEALTHCARE MATTERS. Please note that this Directive and Order replaces and supersedes the Directives and Orders Regarding Various Healthcare Matters, dated April 5, and March 23, 2020 and the Directive and Order regarding Availability of Testing dated March 20, 2020.
Reminder: State Reporting Requirements

As you know, the Maryland Department of Health (MDH) recently issued this nursing home reporting notice.

All Maryland nursing homes are required to submit daily reporting information through CRISP as required by COMAR and Governor and Health Secretary orders and directives, issued during a declared State emergency and healthcare pandemic. Under Maryland Health General Article Sections 19-359 and 19-1401 et. seq., and COMAR through .74, the Maryland Department of Health has the authority to impose a  civil money penalty   (CMP) based upon the existence of a deficiency at a nursing home.    The failure to comply with this directive constitutes a deficient practice.  

OHCQ will be monitoring compliance with this requirement on a daily basis and will issue daily CMPs for not reporting. Please ensure immediate and continued compliance.

Please note that the link in the MDH order does not link to the actual CRISP portal.    Form responses are only accepted between 12AM and 11AM eastern time.

This is the link to the reporting portal:

Should you have any questions, please contact: William (Bill) Hokemeyer, Jr. at 410.596.8205 or at
Update on Federal Reporting Requirements
In Maryland, HFAM and our partners at LeadingAge, LifeSpan, CRISP, and MHA are working to coordinate efforts. Expect a future webinar on reporting requirements. In the meantime, please review and adhere to the following federal guidelines in addition to the required daily state reporting through CRISP.

Is your nursing center still waiting access to the National Healthcare Safety Network (NHSN) COVID-19 reporting module? There is a lag time between initiating registration to NHSN and completion of the registration process due to the number of long term care facilities that are trying to gain access. NHSN is reporting a 24-48 hour, and in some instances longer, lag time between initial registration to actual completion of registration and the ability to use the COVID-19 reporting module. 

While waiting for the registration process to complete, you should download now the four data collection pathway forms and accompanying instructions to start collecting the data that you will be uploading to NHSN  once registration process is complete. It is extremely important to download, and refer to, the instructions page for each of the four data collection pathways. Refer to the definitions of each term prior to completing the data collection form. 

The four data collection pathway forms are: 

NHSN COVID-19 Retrospective Reporting to January 1st Optional  

There has been some confusion as to whether retrospective reporting in NHSN COVID-19 module is required or not. Our partners at AHCA have confirmed with CDC that it is optional to submit data back to January 1, 2020. CDC also stated that retrospective reporting was optional at the end of its pre-recorded NHSN training webinar yesterday (Tuesday, May 5). CDC is working on revisions to the NHSN guide and instructions to make this clearer. We are also expecting CMS to issue a memo this week that will answer several questions that have been raised about this requirement as well as the new resident, representative, family notification requirement. 

As a reminder, the new rule requires reporting starting last Friday, May 1, which must be done at least weekly . This makes Friday, May 8 the end of the first reporting period. 

AHCA continues to advocate for CMS to allow a grace period from enforcement due to the length of time necessary for nursing homes to gain access to NHSN as well as time needed to establish systems for reporting.

NHSN COVID-19 reporting is not required but optional for assisted living communities. Assisted living communities should follow specific state reporting requirements and can consult AHCA/NCAL’s guidance on notifications .
AHCA has been in touch with CMS directly on behalf of ICF/IID providers and whether this is optional for them. On the NHSN site, there is a category for LTC/DD, but the CMS rule itself does not list ICF/IID as a provider type. ID/DD providers will be updated once there is more information to share.

Also, CDC is offering several live Q&A sessions for nursing homes between May 6-14. Details can be found on the CDC NHSN website . Scroll down to the training section. 
Medline PPE Survey

Given the unprecedented demand due to COVID-19, Medline is working on forecasting future production and inventory. With so much change, please help Medline understand what you believe you need for the remainder of this year and 2021. Please take this survey. The more insight that Medline can gather the better.
VA Suspends Transitions to New Systems Due to COVID-19  

The VA recently announced that their transition to HealthShare Referral Manager (HSRM) and Electronic Claims Administration Management System (eCAMS) for the Community Nursing Home (CNH) program has been suspended until further notice due to COVID-19. As a result of this suspension, the following actions are required: 

  1. Non-CCN CNH authorizations should continue to be issued through VistA. Any authorizations for non-CCN CNH made through HSRM need to be reissued through VistA, according to the guidance provided by the Office of Geriatrics and Extended Care dated April 2, 2020. 
  2. CNH providers need to be notified to continue to send CNH claims via paper directly to VA medical centers (VAMC) under previously established processes. CNH claims should not be sent via electronic data interchange (EDI) to VA at this time. 

Additional training and guidance are being developed for VA staff and CNH providers, and will be announced once the transition to HSRM and eCAMS restarts. 

Shortages of PPE such as N95 respirators persist. However, there is no shortage of non-medical suppliers and distributors that claim to have N95 and KN95 masks and other PPE for sale. Many of the sales calls come from third party representatives claiming to have ready access to PPE. Be cautious and ask yourself, “Why does this non-medical distributor have access to PPE when the major medical distributors and suppliers that I have used in the past do not?” 

Be on the lookout for these BIG red flags when contacted by these salespersons: 
  • Emails that come from personal email accounts such as Gmail or Yahoo accounts. 
  • No last name from the sender or company contact information in the email, including a website that you independently can verify through a web search engine. 
  • Pressure tactics such as “you must place your order and pay today/now if you want to get your order in the next shipment.” 
  • A requirement that you must pay up front to place your order usually through wire transfers, direct transfers from your bank accounts, PayPal or Venmo. 

When working with a new supplier, ask for references of other long term care providers who have ordered from the company and had the PPE delivered. Then, independently check those references. Read more complete guidance on avoiding scams
CMS COVID-19 Stakeholder Engagement Calls – Week of 5/04/20

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

  • CMS COVID-19 Office Hours Calls (Tuesdays and Thursdays at 5:00 – 6:00 PM Eastern

  • Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM Eastern)

  • Weekly COVID-19 Care Site-Specific Calls:

  • Home Health and Hospice (Tuesdays at 3:00 PM Eastern)
  • Nursing Homes (Wednesdays at 4:30 PM Eastern)
  • Dialysis Organizations (Wednesdays at 5:30 PM Eastern)
  • Nurses (Thursdays at 3:00 PM Eastern)
May is Older Americans Month and Mental Health Awareness Month

Below are upcoming opportunities and resources:

  • The National Coalition on Mental Health and Aging is co-sponsoring a virtual event with the Substance Abuse and Mental Health Services Administration, the Administration for Community Living and the Veterans Health Administration as part of NATIONAL OLDER ADULT MENTAL HEALTH AWARENESS DAY 2020 on May 7th at 1pm. The title is “Combating Social Isolation for Seniors during the COVID-19 Pandemic” and attached is the announcement. For those who cannot attend for the live broadcast the webinar will be recorded and posted to the NCMHA, when available. Recordings of all past NCMHA webinars can be found here:

  • As part of the Older Americans Month observation in May, the Coalition to End Social Isolation and Loneliness and the National Coalition on Mental Health and Aging are co-sponsoring a special webinar “Social Isolation and Loneliness Among Older Americans During COVID-19: Evidence, Policy, and Advocacy”. This 90-minute event will provide an in-depth examination of the: scope of the problem, biological impacts of social isolation and loneliness, interventions and promising practices, and policy considerations. Register here:

  • The Administration for Community Living developed a COVID 19 resource titled “What Do Older Adults and People with Disabilities Need to Know?” which is regularly updated and very helpful for older adults and their care partners. Visit

  • The Older Adult Behavioral Health Specialists (OABHS) in Maryland are able to be flexible and helpful with local COVID 19 behavioral health concerns / efforts. Attached is an updated OABHPS brochure for your information. If you are thinking about establishing a local response to older adult behavioral health needs, call on your local OABHS for collaboration.

  • Two weekly virtual 12 step meetings of Alcoholics Anonymous, “Better with Age”, have been established to support older Marylanders during this pandemic and beyond. More information on these meetings and others can be found through the Baltimore Intergroup Council of Alcoholics Anonymous website
Healthcare Heroes
Elkton Nursing & Rehabilitation Center's healthcare heroes are working hard to keep residents safe and the local community is coming together - the local fire department came by to fix the flag. Click here for a Heroes Article in the Cecil Whig .
Who are your healthcare heroes?

There are so many amazing stories of dedication, sacrifice, and compassion by long term care professionals who are going above and beyond to ensure the safety, health, and happiness of residents during this unprecedented time. These individuals are saving lives; they are heroes.

We want to hear your stories! Please email     to share a current story and picture of members of your team who are going above beyond to provide quality care during this unprecedented time. 
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.