Coronavirus Update #87
“Stay focused on the objective, not the obstacle.”

Thank you for all you are doing to provide quality care to Marylanders in need and to save lives.  You are not alone and you are not forgotten.  I am reminded today of a quote from one of my colleague leaders at AARP, “Stay focused on the objective, not the obstacle.”

Until there is a vaccine, we are in a long defensive battle against COVID-19. As social distancing orders are loosened, our heroic workforce will face increased risk in their comings and goings -- that’s the obstacle.  

Our objective is to do all we can to keep patients, residents, and staff well while acknowledging it’s harder with our staff teams as they come to and from work every day.

There has been a great deal of talk about testing. We all of course are for testing; knowledge is power as long as there is context and a plan forward.  And the below context is critical:
  • COVID-19 silently and viciously attacks people with pre-existing conditions. One hundred percent of the people in your care and many of your staff suffer from and mange such pre-existing conditions. Just as there has not been universal testing in our sector, there has not been universal testing in hospitals or in the community at large.

  • People in our sector sometimes die with COVID-19 and not because of it.

  • Testing of patients and staff became critically important in this battle relatively recently as we learned from our physician partners and nursing homes that got ahead in testing that COVID-19 can be largely asymptomatic.

  • As a sector we have known all along that staffing would increasingly be a challenge, and with the asymptomatic nature of COVID-19, testing must be staged and can only be done when we have a workable plan to augment staff or reduce staffing ratios as staff are found to be positive are rightfully sent home.

  • Staffing can be augmented by the State Bridge Teams, the National Guard, and with local hospital partners; but again, in extreme emergency there must be relief from staffing ratios. The State Bridge Teams themselves are such a measure with a single RN and five to seven CNAs per 100 patients.

Again, under the heading, stay focused on the objective, not the obstacle. I am really impressed with the testing capacity of HFAM’s newest Associate Member, AMS Onsite Testing. Click here for more information.  Testing is key in order to fight COVID-19 in terms of residents, patients, staff and maintain operations— no small task, I know. I strongly urge you to contact AMS Onsite Testing: Patrick Britton-Harr via email at

The general themes we’ve been discussing together, communicating and advocating since February remain more critically important than ever before:

  • File your daily CRISP Report, seven days a week, before 11 a.m.!
  • Focus on providing quality care—continue to train employees on proper PPE use and deployment.
  • Don’t let what you can’t do prevent you from what you can do in providing quality care.
  • Appreciate your team.
  • Be transparent in your communication with residents, patients, families and staff.
  • 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).
  • Develop a timeline of your actions to fight COVID-19 from February 1 to present.

Be well,
Joe DeMattos
President & CEO
MDH Webinar Recap

Yesterday, the Maryland Department of Health held a webinar call to update the long-term care sector on COVID-19 developments and best practices. The call was recorded, in case you were unable to join or would like to review the topics discussed.

You can also view the webinar's   PowerPoint presentation here.

If you have any questions, please email
Summary of CMS Reporting Requirements 

Our natioal partners at AHCA have developed a detailed summary of the QSO memo issued by CMS on May 6, 2020, including further information on: 

  • requirements for notifying residents, representatives, and families of COVID cases, 
  • NHSN reporting requirements, and 
  • survey and enforcement of these new requirements. 

Although CMS has provided clarification on some aspects of these new requirements in the memo, we continue to communicate with CMS and CDC on several outstanding issues and to advocate for needed flexibility including an extended grace period for NHSN reporting enforcement due to the current delays and backlogs in NHSN enrollment.
FEMA Press Release About PPE Shipments

As we have previously shared, FEMA will coordinate two shipments totaling a 14-day supply of personal protective equipment (PPE) to nursing homes across the nation. Click here to see the press release about PPE shipments and their content.
Members with questions may direct them to
Attestation Period Extended for CARES Act Provider Relief Funds 

Yesterday, the U.S Department of Health and Human Services (DHHS) announced that the attestation window and related acceptance of Terms and Conditions has been extended to 45 days, formerly 30 days, from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds. Members will need to identify the date of their initial funding relief payment and identify their new attestation and Terms and Conditions acceptance date based on the extension. In the press release , DHHS offers an example of how the extension of the window will be operationalized.

Shortly after announcing the extension of the provider-specific attestation period, DHHS released an updated set of FAQs . Members should review the FAQs in detail and compare these with the Terms and Conditions . Below are preliminary highlights. Additional AHCA/NCAL assessment will be provided tomorrow. 

  • Additional Funding is Available to Targeted and General Allocations. This point has been a notable point of confusion. DHHS now states, “Any provider who has already received a payment from the Provider Relief Fund … should apply for additional funding.”

  • General Fund Allocation Updates. Skilled Nursing Facilities (SNFs) are eligible for general fund awards. Below is a list of new or updated: 

  • Higher Payment Than Expected. DHHS describes what a provider should do if they believe payment is greater than expected or received in error; 

  • Description of Recoupment. DHHS notes that in general the Department “does not intend to recoup funds as long as a provider’s lost revenue and increased expenses exceed the amount of Provider Relief funding a provider has received. Additionally, in the General Allocation portion of the website, DHHS has added text bolstering this point and noting “there will be significant anti-fraud and auditing work done by HHS, including the work of the Office of the Inspector General.”

  • Expenditure of Funds on Individuals with Possible, Presumptive, and Actual Cases of COVID-19. DHHS notes that Provider Relief Funds may be used for possible, presumptive, and actual COVID-positive patients and discusses each term. 

  • Terms and Conditions Updates. DHHS offers additional details on how it will monitor adherence to the Terms and Conditions and offers detail on certain provisions. The majority of the updates focus on the Targeted Allocations such as High Impact and Rural Allocations. 

  • Rejecting Funds. DHHS notes that “providers may return their General Distribution payment by going into the attestation portal indicate they are rejecting the funds. The CARES Act Provider Relief Fund Payment Attestation Portal will guide providers through the attestation process to reject the funds.” AHCA/NCAL assumes DHHS’ intent is within 45 days but will seek clarification. 

  • Reporting Requirements. The Department notes it will be posting specific reporting requirements in the coming weeks. 

Our partners at AHCA/NCAL will continue to submit questions and examples of challenging fund scenarios to DHHS including Change in Ownership (CHOW), Tax Identification Number (TIN) aggregation, disaggregation, or lack of TIN arrangements, additional questions about financial terminology and use of tax filing data for validation. 
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. 
Karen Hall-Thickman and the team and CommuniCare. Thanks for all you are doing!
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
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.
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.