Coronavirus Update #97
CMS Reopening Recommendations, New AHCA/NCAL IPCO Training,
OSHA Alert, Updated CARES Act FAQ, SSA Update, HEROES Act in House,
Meals for Healthcare Heroes, CMS Calls this Week
Friends:

Below is information on the CMS Guidelines for Reopening Recommendations for Nursing homes, as sent by AHCA/NCAL last night. Yesterday I participated in an online conversation with my state executive colleagues from across the nation on visitation . Here is a summary:

  • 33 states participated in the conversation.
  • None have reopened visitation.
  • Indiana for instance has extended the visitation ban until July 4.
  • Nebraska, Florida, and Ohio are looking into a timeline and criteria to phase-in visitation, early stages, nothing firm yet. I expect FL to go first.
  • Hawai’i and Alaska, where they have had few cases, little community surge, just a handful of cases in nursing homes, and no deaths, would like a phased return to visitation.

Here is some of what I shared with the HFAM Board on Friday:

We have known that there would be pressure to resume family visits to nursing homes, assisted living and in senior living. There are still concerns about opening our sector as there has not been nearly enough testing (few places in the country), and testing will have to exponentially increase in the future to effectively screen workers and visiting family. And truth be told, in Maryland and across the nation, there is not enough PPE for healthcare workers and families. 

We need to think about how we might use high and low tech for increasing virtual family or surrogate visits. We urge you and your teams to start thinking and working with infectious disease physicians, first about more socialization among patients and residents that can be done in a COVID-19 safe way, and also how outdoor visits might be possible.

Thank you again for all you do!

Be well,
Joe DeMattos
President & CEO
CMS Issues Nursing Home Reopening Recommendations for State and Local Officials  

CMS has provided recommendations on a nursing home phased reopening for states. The recommendations cover the following items: 

  • Recommendations for testing residents and staff 
  • Dedicated space for cohorting residents with COVID-19 
  • Criteria for relaxing certain restrictions and mitigating the risk of resurgence 
  • Visitation and service considerations 
  • Restoration of survey activities 

The guidance encourages state leaders to collaborate with the state survey agency and local health departments to decide how these criteria should be implemented. Given the critical importance in limiting COVID-19 exposure in nursing homes, CMS recommends that decisions on relaxing restrictions be made with careful review of the following facility-level, community, and state factors: 

  • Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (e.g., face coverings) 
  • Status of COVID-19 cases in the local community 
  • Status of COVID-19 cases in nursing homes 
  • Adequate staffing 
  • Access to adequate personal protective equipment (PPE) 
  • Local hospital capacity 

Read the press release , guidance and FAQs from CMS. 
Heroism is taking place at nursing homes, too

Click here to read a great op-ed by Howard Guzik, MD, is medical director of Northwell Health’s Stern Family Center for Rehabilitation.

This op-ed highlights what we have always known and continue to share: "Nursing home and adult care workers are among the most-dedicated caregivers and should be recognized as such."

We appreciate all you and your teams are doing. Thank you!
The emergence of COVID-19 has compounded the need for centers to have an effective infection prevention and control program. AHCA/NCAL’s new and expanded version of its popular Infection Preventionist Specialized Training, IPCO Version 2   is now available. The online training is recommended for individuals responsible for infection prevention and control in all long term care settings, including assisted living communities. 

IPCO Version 2 is designed to train the Infection Preventionists to run a comprehensive infection prevention and control program. It is also now available for administrators to take to gain a deeper understanding of the infection prevention and control in the overall operation of a nursing facility. AHCA/NCAL recommends that each skilled nursing facility train at least two Infection Preventionists through AHCA/NCAL’s IPCO training program should one Infection Preventionist leave the facility. The training is also highly recommended for assisted living communities because they care for a similar population and can face similar infection risks. 

As an added feature to all participants registered for the IPCO Version 2 program, bonus content related to COVID-19 is included. The bonus content includes topics such as: Interim COVID-19 Guidance, courses on PPE, and N-95 mask use. 

Members will need to login with their AHCA/NCAL usernames and passwords to register for IPCO Version 2 . For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.
OSHA Alert on Nursing Home and Long Term Care Workers' Safety

The US Department of Labor’s Occupational Safety and Health Administration released guidance aimed at protecting nursing homes and long term care facilities workers from exposure to COVID-19. Many of the recommendations are based on CDC guidance including optimizing PPE, screening workers and sending sick workers home. The guidance includes encouraging staff to report any safety or health concerns and staggering breaks to avoid overcrowding in the break from. 

The U.S. Department of Health and Human Services has posted a reorganized and updated set of Provider Relief Fund FAQs . Structurally, the document now is broken out by Allocation type: Targeted, General, Uninsured, Rural and Indian Health Services. FAQs of interest to AHCA/NCAL members that have received grants, specifically SNFs, include: 

  • Additional detail on Attestation – DHHS provides information on accepting funds, rejecting funds, as well as how to accept one award but reject another. 

  • Publication of Payment Data – Through a CDC data portal, DHHS now is displaying award data by provider name and award amount. Tax Identification Numbers (TIN) and provider type are not included in the database available here. DHHS notes in the FAQs is does not intend to add data elements such as NPIs, TINs, or other provider identification details. 

  • Tranche 2 General Allocation Formula – DHHS show the formula and discusses why a provider that received a Tranche 1 allocation might not have received a Tranche 2 allocation.

  • Payment Portal – DHHS offers guidance on how providers without a TIN, such as county owned providers may attest and/or apply for funding. 

  • Additional Payments – Additional detail is provided on requesting additional funds in the context of the 2% limit.
Economic Impact Payments for Social Security and SSI Beneficiaries with Representative Payees
 
The Social Security Administration recently issued an update that beneficiaries who have their regular monthly payments managed for them by another person, called a representative payee, will begin receiving their economic impact payments (EIPs) from the IRS in late May. 

It is important to note that under Medicaid rules, a stimulus payment is not counted as income. Therefore, receiving a stimulus payment does not change a resident’s monthly payment (often called a ‘patient pay amount’ or ‘share of cost’). The resident pays the same monthly amount to the nursing facility and keeps the stimulus payment for their own use. In addition, the stimulus payment does not count as a Medicaid resource for 12 months. In other words, for the first year, the payment cannot cause you to have ‘too much’ savings.

More details on these payments can be found in this  SSA press release . You may also find information about the eligibility requirements and other information about the Economic Impact Payments   here . In addition, please continue to visit the IRS at www.irs.gov/coronavirus for the latest information. Social Security will continue to update the agency’s  COVID-19 web page   with additional information. 

On Friday, May 15th, the United States House of Representatives passed H.R. 6800, The HEROES Act, another piece of legislation aimed at addressing the effects of the COVID-19 pandemic. This bill was passed largely along party lines with most Democrats voting for it and Republicans voting against the package. Leader McConnell has stated that he will not bring up this legislation in the Senate. The Senate is likely to craft its own bill. Our partners at AHCA/NACL continue to work with both chambers and advocate for our sector's priorities during this challenging time.

Of particular note to our sector, below are the provisions found in the bill: 

  • Ensures an additional $100 billion for the provider fund. 
  • Improves the Accelerated and Advance Payment Program that has been critical to keeping providers afloat including lowering interest rates for repayment. 
  • Allows facilities with the most losses from this pandemic to be compensated fairly. 
  • Increases the Federal Matching Assistance Percentage (FMAP) by 14 percentage points through June 30, 2021. At a time of financial instability, this would ensure State governments have the resources they need to continue providing critical services. 
  • Delays the implementation of the Medicaid Financial Accountability Rule (MFAR) until the end of the emergency period. 
  • Requires Medicare’s Quality Improvement Organizations to provide infection control support to nursing homes struggling with COVID-19 outbreaks. 
  • Ensures skilled nursing facilities have a means for residents to conduct “televisitation” with loved ones while in-person visits are not possible during the COVID-19 emergency. 
  • Requires public reporting of positive cases in nursing facilities. 
  • Provides $150 million to states to create strike teams if three or more residents or staff are diagnosed with COVID-19 in a 72-hour time period. 
  • Provides a 20 percent per diem increase for facilities with COVID-19 only units. 
  • Provides a $13.00 increase in wages for essential workers up to $10,000. 

As the Senate begins to consider this bill, we will keep you updated as to what the final outcome will be. 
Meals for Healthcare Heroes

Capital Funding Group (CFG) and CFG Bank (CFGB) are reinvesting some of the funds earned from facilitating Paycheck Protection Program (PPP) loans to provide meals to frontline healthcare workers at skilled nursing and assisted living facilities in Maryland.

CMS COVID-19 Stakeholder Engagement Calls – Week of 5/18/20

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 highly encouraged to join via audio webcast.

Calls recordings and transcripts are posted on the CMS podcast page.
 
CMS COVID-19 Office Hours Calls (Tuesdays and Thursdays at 5:00 – 6:00 PM Eastern)

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, rapidly expand the healthcare workforce, put patients over paperwork, and further promote telehealth in Medicare.

Tuesday, May 19th at 5:00 – 6:00 PM Eastern
Toll Free Attendee Dial In: 833-614-0820; 
Access Passcode: 1908409
 
Thursday, May 21st at 5:00 – 6:00 PM Eastern
Toll Free Attendee Dial In: 833-614-0820; 
Access Passcode: 9984433
 
Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM Eastern)

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 22nd at 12:30 – 2:00 PM Eastern
Toll Free Attendee Dial-In: 877-251-0301; 
Access Code: 6086125
 
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 Eastern)
Tuesday, May 19th at 3:00 – 3:30 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 6477704
 
Nursing Homes (Wednesdays at 4:30 PM Eastern)
Wednesday, May 20th at 4:30 – 5:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 4879622
 
Dialysis Organizations (Wednesdays at 5:30 PM Eastern)
Wednesday, May 20th at 5:30 – 6:00 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 3287645

Nurses (Thursdays at 3:00 PM Eastern)
Thursday, May 21st at 3:00 – 3:30 PM Eastern
Toll Free Attendee Dial-In: 833-614-0820; 
Access Passcode: 2874976
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   HealthcareHeroes@HFAM.org   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.