Coronavirus Update #91
Updates from MD and National Front, Thank You Message, NHSN COVID-19 Reporting, State Reporting, CMS to Fix PDPM Variable Per Diem Glitch, CMS Calls this Week

Thank you for all you are doing to provide quality care to Marylanders in need and to save lives. And again, thank you for all the COVID-19 testing you are doing.  More and more people are recovering from COVID-19 in your centers.

Interestingly Vice President Pence yesterday told the Governors that they should do universal testing in SNF’s – CLICK HERE for article. It will be interesting, because as you know the state/sector MUST be systematic and phase-in staff testing relative to our workforce needs.

On the Maryland Front:

  • The National Guard is calling and dropping off more test kits to SNF’s; and beginning in AL’s.
  • I do expect more public information on plans/work of Col. Eric Allely – testing, staffing, safety, compliance.
  • I am hearing of hospital back-up’s of non-COVID cases needing to be discharged to post-acute.
  • We are continuing to tell our sector’s story with various stakeholders and audiences.
  • In the coming days and weeks I do believe we will increasingly see federal and state pressure to resume visits to nursing homes and on assisted living campuses.

Also, thank you Fred Stratmann and CommuniCare for this outstanding interview on ABC's "Pandemic: What You Need to Know" – CLICK HERE.

As you know, on May 6, CMS released a memo requiring nursing homes to electronically report COVID-19 information to CDC's NHSN Long-Term Care Facility COVID-19 Module. It is critical that your center gain access to NHSN and submit your first set of data by 11:59 pm on Sunday, May 17. Please be on the lookout for more information on this reporting as the Maryland Department of Health and partners are exploring ways to automatically upload this data. Again, it is critical to register with NHSN and submit your data now.

Additionally, on the national front from AHCA/NCAL:

  • AHCA does expect another Medicaid tranche based on the $10 billion the sector has been asking for from HHS – perhaps an announcement later this week; perhaps based on beds in a SNF.
  • Non-Medicare certified Medicaid only centers (300 of the 15,000 SNF’s in the US) will get their payments, likely this week.
  • Also likely some Tribal, AL and dental (Medicaid payments).

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.
  • 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).
Be well,
Thank you message from Baltimore County Executive Olszewski
In this message Baltimore County Executive Olszewski shows his support and appreciation for staff in long-term care communities. Please share with your teams!
NHSN COVID-19 Reporting: Accurately Reporting Staffing & PPE Shortages
NHSN COVID-19 mandated reporting for nursing homes has begun. AHCA recommends accurately reporting the staffing and PPE situation at nursing homes based on normal standards and guidance for PPE and staffing, not conservation guidance. Federal and state governments will use this data to hold nursing homes accountable for care and services provided and to identify who needs additional resources . It is important that the data reported to NHSN gives an accurate picture of staffing and PPE as well as the other areas collected in NHSN.

Given the instructions on NHSN, reporting that you have what you need, tells CMS that you have enough PPE and staff to follow conventional and normal practices, which will likely be used by surveyors when comparing what they find during their surveys. Please use the below guidelines.


NHSN asks “Does your organization have a shortage of staff and/or personnel?” Answer YES if any of the following are occurring during the time period of reporting:
  • Staffing less than your facility needs or internal policies for staffing ratios prior to COVID or based on increased needs since COVID
  • Employing contingency or crisis strategies for staffing shortage
  • Using more agency staff than you used before the pandemic
  • Using volunteers for staffing needs more than what you may have used prior to the pandemic
  • Using any temporary positions per waiver allowances (such as temporary nurse aide or temporary feeding assistant)

NHSN asks “Do you have enough for one week?” each for N95 masks, surgical masks, eye protection, gowns, gloves, alcohol-based hand sanitizer. Answer NO if any of the following are occurring during the time period of reporting:

  • Employing any conservation strategies for PPE use; if you are not able to use PPE per conventional transmission-based precautions in place before the pandemic you should answer NO
  • Using alternative PPE such as cloth masks or other types of face coverings, clothing or other types of coverings instead of surgical gowns, or glasses for eye protection
  • Reusing any single use supply item such as gown or masks
  • If additional residents in the next week will need to be placed on precautions, it will compromise your PPE supply
  • If additional staff in the next week will need to use PPE when returning to work, it will compromise your PPE supply
  • If visitors or contractors in the next week need to visit, it will compromise your PPE supply 

As a reminder, nursing homes should keep documentation of their efforts to secure more PPE as well as staffing . You should report to your local and state health departments that you are employing contingency and crisis strategies to conserve PPE and staffing. 
Reminder: Daily CRISP Reporting

As we have previously shared, the Maryland Department of Health (MDH) has issued this  nursing home reporting notice.

This is a reminder regarding the  mandatory daily reporting   requirements in CRISP. 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
CMS to Fix PDPM Variable Per Diem Glitch

SNF PPS Part A claims were not being paid day-1 variable per diem rates when a beneficiary switched from Medicare Advantage (MA) to fee-for-service Medicare Part A during a stay. AHCA reported to CMS that this was inconsistent with current policy.

CMS agreed with AHCA and on May 8 published a change request to the Medicare Administrative Contractors (MACs) to update the claims processing systems retroactive to October 1, 2019. A summary of the changes is posted in this MLN Matters article . Although this is retroactive, the systems changes will not occur until October 5, 2020.

Providers should notify billing staff that the MACs will adjust any improperly adjusted SNF PPS claims related to a beneficiary switch from MA to fee-for-service during a stay ONLY IF BROUGHT TO THEIR ATTENTION, so that the prior days count is corrected to exclude the MA days. 
CMS COVID-19 Stakeholder Engagement Calls – Week of 5/11/20

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.

Call details are below. Conference lines are limited so you are encouraged to join via audio webcast, either on your computer or smartphone web browser.

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

Office Hour Calls provide an opportunity 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

This week’s Office Hours:
Tuesday, May 12th at 5:00 – 6:00 PM Eastern
Toll Free Attendee Dial In: 833-614-0820; 
Access Passcode: 8968295
Thursday, May 14th at 5:00 – 6:00 PM Eastern
Toll Free Attendee Dial In: 833-614-0820; 
Access Passcode: 5688374

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

Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.
This week’s Lessons from the Front Lines:
Friday, May 15th at 12:30 – 2:00 PM Eastern
Toll Free Attendee Dial-In: 877-251-0301; 
Access Code: 8983296

Weekly COVID-19 Care Site-Specific Calls

CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

Home Health and Hospice (Tuesdays at 3:00 PM EST)
Tuesday, May 12th at 3:00 – 3:30 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 9503927

Nursing Homes (Wednesdays at 4:30 PM EST)
Wednesday, May 13th at 4:30 – 5:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 2675207
Dialysis Organizations (Wednesdays at 5:30 PM EST)
Wednesday, May 13th at 5:30 – 6:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 6772827
Nurses (Thursdays at 3:00 PM EST)
Thursday, May 14th at 3:00 – 3:30 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 4279137
Reminder: Additional Clarification on Orders

The Maryland Department of Health released additional clarification on Governor Hogan's orders.

As you know, on April 29th, Governor Hogan announced  "new directives to protect residents and staff at nursing homes."   The directives include "universal testing of all residents and staff at all Maryland nursing homes, regardless of whether they are symptomatic" and "t he development of surge staffing plans to ensure continuity of care in the event of an outbreak. To aid in this effort, the state is supplementing strike teams with new bridge teams, which will provide emergency clinical staffing to nursing homes that are experiencing a staffing crisis."
Below, please find the following additional documents related to these topics: 

To comply with the secretary's order to register with the Chesapeake registry, facilities can  email   and request to be registered per the governor’s executive order. The facility will need to provide the name, address and a point of contact. A signed contract is not required to register; it’s necessary only to request staff. This is the same email address to reach out to request agency staffing.  
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.