June 12, 2020
Quick Links:
Tuesday, June 16 at 10:00 AM:
Bureau of Assisted Living Regulatory Response to COVID-19

To Join:
Meeting ID: 723 961 504

Or by Phone: +1 312 626 6799

Tuesday June 16 at 1:00 PM
CDC COCA Call: Applying COVID-19 Infection Prevention and Control in Nursing Homes

Phone: 1-669-254-5252 or 1-646-828-7666

Webinar ID: 161 554 3668
COVID-19 Updates: June 12, 2020
This update includes:
  • Provider Associations, DQA Discuss Wide Variety of Issues on New Bi-Weekly LTC Call
  • Clarification Regarding 14-Day Observation for Residents of Long-Term Care Facilities
  • Changes to CARES Provider Payment Application Requirements
  • Update on NHSN Reporting and Related Citations & Fines
  • Return to Work Guidance for Asymptomatic Health Care Workers
  • Superior Health Quality Alliance Hosts Webinar on Changes to Nursing Home QIO Work
  • AHCA/NCAL Tells House Panel LTC Remains in Need of Resources to Fight COVID
  • Therapy Coalition Submits Request to Extend Therapy Telehealth Waivers
  • CMS Releases New ICFs/IID FAQs
  • Attend a FREE Training Series for Direct Care Workers Working with Persons with Dementia or Intellectual/Developmental Disabilities
  • Webinar: Providers Share Their Experiences with COVID-19 Telehealth Waivers
As of today, there are 22,246 confirmed cases of COVID-19 in the state of Wisconsin and 689 deaths caused by the virus. Click HERE to view the latest outbreak information from the Wisconsin Department of Health Services. Click HERE to view COVID-19 projections for Wisconsin and the United States.
Provider Associations, DQA Discuss Wide Variety of Issues on New Bi-Weekly LTC Call
WHCA/WiCAL today participated in the first of a new regularly-scheduled call with DQA officials about pressing issues facing long-term care.

Present on the call from DHS were Otis Woods, DQA Administrator; Shari Klessig, DQA Deputy Administrator; Ann Angell, BNHRC Director; Alfred Johnson, BAL Director; and Nikki Andrews, Bureau of Education Services and Technology Director.

Present on the call from WHCA/WiCAL were John Vander Meer, President/CEO, Jim Stoa, Director of Government Relations and Regulatory Affairs; and Brian Purtell, Legal and Regulatory Advisor.

Items discussed included:

CMS Memo QSO-20-31-All
Providers again raised concern and frustration over the new survey and enforcement structure found in this new memo. WHCA/WiCAL reiterated that this is a 180-degree turn from the previous collaborative approach to COVID involving providers and regulators.

Providers asked for clarification on several issues found in the memo, and DQA officials plan to report back after review.

Vander Meer asked if the DHS Secretary or DQA officials would publicly raise concerns about these new penalties. We are waiting on feedback on this matter.

WHCA/WiCAL continues to raise serious concerns about this memo and the new survey/enforcement environment it creates. We have already had several conversations with DQA and have elevated concerns to AHCA. We are also working with AHCA to communicate a need to significantly alter this new approach with Wisconsin’s Congressional delegation, urging them to contact CMS and HHS to make needed changes.

WHCA/WiCAL requested that the NHSN grace period should be extended, because we have heard from members facilities who have submitted completed data, but they are still getting CMPs.

WHCA/WiCAL also asked for any more information on the IIDR system in place for these CMPs. The IIDR reviewer is Health Care Management Solutions, based out of West Virginia. WHCA/WiCAL emphasized that providers are relieved that Maximus is not the IIDR review firm for these CMPs due to Maximus’s 91% upholding rate of IDRs/IIDRs in 2019.

Additional questions were: Where do facilities go to make complaints about the accuracy of the data? What happens when NHSN indicates that facilities have positives when they don’t?

WHCA/WiCAL has been in contact with AHCA about the need to address the significant failures of the NHSN reporting system, and AHCA has been in regular contact with federal officials about these concerns.

How to get off the state’s public list of nursing homes with COVID investigations
Vander Meer raised this question, but there is still no clear answer at this time. Ann Angell indicated she would look into it.

DQA officials indicated that guidance is nearing completion, and that we should see new guidance within a week. DQA plans to share a draft with stakeholders for a final review before publication.

WHCA/WiCAL noted that DQA should make clear to surveyors that they can’t be second-guessing decisions related to compassionate care visits – that if facilities are allowing them in certain compassionate care situations in good faith, they should be give the benefit of the doubt.

Angell said that we will also see guidance on beauticians in the near future. The guidance will address proper protocol for allowing a beautician on-site if strict precautions are taken, including PPE use, sanitizing practices, and use of physical space.

Angell also said she would look into the possibility of CNAs or other essential workers being able to fulfill some basic beautician-like services during their shift, as time allows.

Date of July 11 – Liability Protections
WHCA/WiCAL asked if there have been any discussions about extending the liability protections, which will expire on July 11. 2019 Act 185 includes statutory language which says the provision expires 60 days after the expiration of the state’s public health emergency, and the public health emergency expired May 11.

Woods said he would speak to the Secretary’s office and the Governor’s office about any potential for extending those protections.

Status of Emergency Rules
Stoa asked about the current timing for several emergency rules which will reinstate many of the waivers and flexibilities included in Emergency Order 21, which expired in Mid-May. Klessig indicated that the rules could be published and in effect as early as next week.

Federal Emergency Declaration/1135 Waivers
Woods noted that the federal health emergency is set to expire on July 26, and there are some conversations at the federal level whether to extend the declaration by an additional 90 days. Woods questioned whether the expiration of the federal emergency would impact (and potentially end) the CMS 1135 waivers. He said he will provide more information on the implications of the federal health emergency expiring.

Weekly SNF Calls – Thursdays
Woods indicated that next week’s call will be 1.5 hours, instead of 1 hour. They plan to evaluate the usefulness of the additional 30 minutes, and potentially make this a permanent change.
Clarification Regarding 14-Day Observation for Residents of Long-Term Care Facilities
The Wisconsin Division of Public Health (DPH) and Division of Quality Assurance (DQA) are providing this update regarding the Centers for Disease Control and Prevention (CDC) guidance for Responding to COVID-19 in Long-Term Care Facilities (LTCFs). CDC guidance states that facilities should create a plan for managing new admissions and readmissions whose COVID-19 status is unknown. Options include placement in a single room or in a separate observation area so the resident can be monitored for evidence of COVID-19. 

Additionally CDC guidance recommends the following:

  • All recommended COVID-19 PPE should be worn during care of residents under observation, which includes use of an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face), gloves, and gown.
  • DHS BCD 2020-06 Updated Guidance on Infection Control during Specimen Collection for COVID-19 in Outpatient Settings states that N95 respirators do not need to be worn for specimen collection or resident care other than during aerosol generating procedures.
  • Testing residents upon admission could identify those who are infected but otherwise without symptoms and might help direct placement of asymptomatic SARS-CoV-2-infected residents into the COVID-19 care unit. However, a single negative test upon admission does not mean that the resident was not exposed or will not become infected in the future. Newly admitted or readmitted residents should still be monitored for evidence of COVID-19 for 14 days after admission and cared for using all recommended COVID-19 PPE.

The above recommendations are reflected in the Tele-ICAR document found on the COVID-19: Long-Term Care Facilities and Services page under the Guidance for all Facilities tab. See the ICAR Assessment Tool. This information can also be found on the COV ID-19: Health Care Providers page under the Infection Preventionist tab.

Wisconsin DPH and DQA use CDC guidance and recommendations to inform prevention and response activities in LTCFs. The Centers for Medicare and Medicaid Services (CMS) follow guidance provided by CDC.
Changes to CARES Provider Payment Application Requirements
The Department of Health Services has announced they will change the requirements for the application which currently asks for a 2019 tax return. New language will be added to the FAQs stating that 2019 returns are preferred and if possible providers should try to have them by the June 30 deadline but if they can’t, providers may instead submit a 2019 profit and loss statement along with a 2018 tax return. For facilities that were not operating in 2018 they may submit only the 2019 P&L.

There may also be a requirement to notify the application email inbox if you did not upload a draft tax return and significant changes are made to your 2019 P&L after your application date.

This new language is still being drafted and WHCA will update providers once it is finalized. For more information about the program, click here.

As reported in yesterday’s WHCA/WiCAL COVID-19 Update, WHCA/WiCAL continues to advocate for changes to the requirements within the CARES application. WHCA/WiCAL is pushing for a more flexible, fair and accurate measurement of the real life losses and costs providers are facing so that they are able to benefit from this important funding.
Update on NHSN Reporting and Related Citations & Fines
AHCA received communication from the Centers for Medicare and Medicaid Services (CMS) late last night (June 11) regarding NHSN reporting. CMS is researching the issues resulting in providers being marked as noncompliant. 

Click HERE to learn more.
Return to Work Guidance for Asymptomatic Health Care Workers
The Department of Health Services today posted guidance for when health care workers may return to work if they tested positive for COVID-19 and are asymptomatic. You can find the information on the long-term care page , scroll about halfway down, and click on the corresponding tab to expand.
Superior Health Quality Alliance Hosts Webinar on Changes to Nursing Home QIO Work
Earlier today, the Superior Health Quality Alliance held a webinar on its work with facilities and new changes due to CMS memo QSO-20-30-All.

The memo states:
  • Quality Improvement Organizations have been strategically refocused to assist nursing homes in combating COVID 19 through such efforts as education and training, creating action plans based on infection control problem areas and recommending steps to establish a strong infection control and surveillance program.
  • QIOs are being deployed to provide technical assistance to nursing homes, which includes a targeted focus on approximately 3,000 low performing nursing homes who have a history of infection control challenges.
  • States may request QIO technical assistance specifically targeted to nursing homes that have experienced an outbreak.

The QIOs help nursing homes identify what their greatest areas of infection control problems are, then create an action plan, and implement specific steps to establish a strong infection control and surveillance program in the nursing home.

Please review this presentation from Superior Health Quality Alliance for more information on the specifics of new Quality Improvement Initiatives (QII).

Staff from SHQA emphasized that this new orientation was as much of a surprise to them as it was to providers. Staff also noted that while participation by providers is voluntary, they are required to report to CMS any facilities on their list that decline to participate, and CMS will “encourage the facility to participate”.

Please direct any questions to:

Emily Nelson
Nursing Home Program Director

Tesia Looper
QII Program Director
AHCA/NCAL Tells House Panel LTC Remains in Need of Resources to Fight COVID
After a hearing on June 11 of the House Select Subcommittee on the Coronavirus (COVID-19) Crisis, the skilled nursing and assisted living profession told lawmakers that long term care operators remain in need of vital resources like virus testing capabilities and personal protective equipment (PPE).

Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said nursing facilities and assisted living communities have been on the frontlines of the fight against COVID-19 and appreciate today’s “robust” discussion about the pandemic and all they are doing to safeguard those in their care.

“Our heroic caregivers are working around the clock in the face of extraordinary circumstances to protect our residents. Thanks to their tremendous sacrifice, the majority of those who are infected—despite being extremely vulnerable to the virus due to ongoing health conditions—make a full recovery,” he said.

However, to ensure more recoveries and prevent future spread, long term care providers must have the resourcesa they need, Parkinson said.

“Our greatest challenge remains lack of widespread testing, adequate PPE, and staffing support. We appreciate the renewed focus in prioritizing testing and PPE for nursing homes and assisted living communities, but more must be done,” he said.

“Lack of proper funding for these critical supplies puts our caregivers and the residents they care for at a severe disadvantage.”

Still, Parkinson told lawmakers it is not too late to make improvements. “The health and well-being of our residents and caregivers will always be our highest priority, and we look forward to continuing to work with lawmakers to help meet these critical needs.”
Therapy Coalition Submits Request to Extend Therapy Telehealth Waivers
On June 10, AHCA/NCAL and 13 other therapy advocacy organizations submitted a letter to HHS Secretary Azar, CMS Administrator Verma, and other key CMS officials requesting extension of COVID-19 therapy telehealth waivers as well as efforts to make these policies permanent in law. AHCA/NCAL worked closely with this coalition in the development of this letter, which also aligns with previously submitted AHCA/NCAL  comments regarding the COVID-19 Interim Final Rule as well as in the FY 2021 SNF PPS Notice of Proposed Rule Making.
CMS Releases New ICFs/IID FAQs
On June 10, CMS released new FAQs for intermediate care facilities for individuals with intellectual or developmental disabilities (ICFs/IID) related to COVID-19.

Questions and answers covered include:

  • How should an ICF handle the discharge summary when a client is admitted on a temporary emergency basis from the community or another ICF? 
  • How should an ICF handle the development of a Comprehensive Functional Assessment and an Individual Program Plan when a client is admitted on a temporary emergency basis from the community or another ICF? 
  • During the public health emergency are ICFs still required to have and use a specially constituted committee or committees? 
  • When a client has tested positive for COVID-19 and the ICF/IID implements quarantine procedures, client rights are immediately abridged and severe behaviors are likely to occur. What is the guidance from CMS on balancing the CDC expectations with the rights of the individual? 
  • Are ICFs required to participate in the COVID-19 CDC National Healthcare Safety Network reporting requirements? 

The ICFs/IID FAQs are listed on pages 13-15 here.
Attend a FREE Training Series for Direct Care Workers Working with Persons with Dementia or Intellectual/Developmental Disabilities
The Collaborative Stabilization Coalition (CSC) of Dane County, through funding from the WI Department of Health Services, is offering a FREE training series for direct care workers working with persons with dementia or intellectual/developmental disabilities (I/DD) with focus on crisis prevention and person centered planning for persons with dementia or I/DD.

Intellectual/developmental disability focus topics include:

  1. Trauma's Influence on the Brain, Body, and Behavior: Promoting Healing & Well-Being/Health Issues Causing Crises? What to Look For, What to Do (4 hours)
  2. Power and Control/Client Rights and Limitations and Resources (4 hours)
  3. Managing Threatening Confrontations/Sensory Regulation and Self-Care (6 hours)

Each training will offered 5 times between February and December of 2020 at several locations: Community Living Alliance on the East Side of Madison, The Atrium on Park Street, and Catholic Charities on the West Side of Madison. People can sign up for one or all of the topics.

A Few Upcoming Dates:

July 8th
July 22nd

For a full event listing, including descriptions, dates, and locations, please visit their website at: cow.waisman.wisc.edu/training/crisis-prevention-and-person-centered-planning-direct-care-worker-training/

Click HERE to register.

Registration is capped at 30 people for each training, so register early to ensure a spot!

For information on trainings for caregivers working with people living with dementia, please visit:  https://dementia-training.dcdhs.com/

Questions? Contact Rachel at  weingarten@waisman.wisc.edu
Webinar: Providers Share Their Experiences with COVID-19 Telehealth Waivers
AHCA/NCAL has posted a 45-minute webinar on ahcancalED in which four members, from independent owners to large multistate for-profit and nonprofit organizations, share their experiences in implementing the COVID-19 telehealth waivers, and how the waivers have helped improve care during the public health emergency (PHE). The webinar is free to AHCA/NCAL members and is viewable on-demand.

Since March 1, 2020, the Centers of Medicare and Medicaid Services (CMS) has removed geographic telehealth limits, limits on the type of services and frequencies of physician telehealth visits, limits on telehealth services that non-physician practitioners such as nurse practitioners can furnish, and removed the prohibition on furnishing physician and occupational therapy and speech-language pathology services via telehealth. Additionally, relaxation of certain privacy regulations by the Department of Health and Human Services (HHS) has permitted an explosion in the use of lower-cost, audio/visual technology including smartphones, tablets, and software such as facetime and skype in the delivery of telehealth services.

The presenters share their thoughts on which waiver details they would like for AHCA/NCAL to advocate to CMS, HHS, and Congress to make permanent.
John Vander Meer, MPA | President & CEO | john@whcawical.org

Jim Stoa, J.D. | Director of Regulatory Affairs and Government Relations | jstoa@whcawical.org

Pat Boyer, MSM, RN, NHA | Director of Quality Advancement and Education | pat@whcawical.org

Kate Dickson, MPA | Director of Reimbursement Policy | kate@whcawical.org

Kate Battiato, MPA | Director of Workforce Development | kbattiato@whcawical.org

Allison Cramer | Communications and Government Relations Specialist | allison@whcawical.org

Jena Jackson | Director of Development | jena@whcawical.org

Jammie Moore | Director of Administrative Services | jammie@whcawical.org

Business Partner Spotlight
GF Health Products, Inc. ("Graham-Field") is one of the world's leading manufacturers of medical products in the health care industry. Graham-Field offers a wide array of over 50,000 items used in hospitals, extended care facilities, clinics and for people being cared for at home.

Graham-Field’s well known brand names include Everest & Jennings® Wheelchairs; Lumex® Patient Aids and Healthcare Seating; Basic American Medical Products® Beds and Furnishings; Hausted® Surgical Stretchers and Chairs; John Bunn® Respiratory Products; Labtron® Diagnostic Equipment; Grafco® Medical-Surgical Products; Intensa™ Medical and Laboratory Furniture; and Lumiscope® Consumer Diagnostics.

Graham-Field’s products and services have been designed to enhance the quality of life of the people that use our products and those that care for them. Our Made in USA Strategy continues to increase the number of products manufactured in the United States to provide customers with more choices and faster delivery times.

Basic American Medical Products
Jacqueline Greenfield

For the complete listing of WHCA/WiCAL Gold Business Partners, click  HERE !
WHCA/WiCAL | 608.257.0125 | info@whcawical.org | www.whcawical.org