June 5, 2020
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UPCOMING EVENTS CALENDAR:
Tuesday June 9 at 10 AM:
Bureau of Assisted Living Meeting

To Join:
Meeting ID: 723 961 504

Or by Phone: +1 312 626 6799
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COVID-19 Updates: June 5, 2020
This update includes:
  • CARES Act Provider Payment Application Open
  • WHCA/WiCAL Sends Follow-up Letter to Gov. Evers on Tuesday Meeting with Members, Staff
  • Congress Sends PPP Flexibility Bill to President
  • Correcting NHSN Data Errors
  • NHSN Efforts and Supportive Documentation
  • HHS Releases Additional Provider Relief Fund FAQs
  • CMS Creates Flexibilities for Certain CMMI Models to Mitigate COVID-19 Impact
  • WHCA/WiCAL Staff Attend Virtual Candidate Rollouts
  • Reminder: CMP Funds for Virtual Socialization
As of today, there are 20,249 confirmed cases of COVID-19 in the state of Wisconsin and 633 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.
CARES Act Provider Payment Application Open
Today the Wisconsin Department of Health Services opened its CARES Act Provider Payment Application for long-term care providers. The application will be open for providers to apply for funding from now until June 30. This $100 million i n funds for these payments were provided to the State under the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.

All long-term care providers all eligible for this funding – including home and community-based service providers, assisted living facilities and skilled nursing facilities. Remember that all licensed providers of the above types are eligible to receive funding – they do not have to be participating in the Medicaid or Family Care programs to be eligible. Amounts available during the first round, by bed size, can be found at the link above.

The DHS webpage provides details on what costs and losses are eligible to receive this money and answers other FAQs. Providers will set up a username and password and can then go in and out of the application, saving as needed and check on their status after submitting their applications. It is important to note this is NOT a first come first served situation – the $50 million available in the first round has been calculated based on the number of providers and so whenever you complete the application in June, you will be eligible for the same amount of money. They do intend to process and issue checks quickly once applications are submitted however – so the sooner you complete your application, the sooner you will receive a payment.

Please note: when registering, please check your junk email folder for your confirmation email.

There is a lot of important information on the CARES Act Provider Payment page but of particular note:
 
  • Funding will be based on provider tax-ids (TINs) so each individual TIN qualifies for this funding.
  • Providers can submit an application for lost revenue and new COVID-19 related expenses directly attributable to providing services to Wisconsin residents during March, April, and May 2020, including:
  • Lost revenue due to lower service utilization related to the COVID-19 pandemic
  • Additional costs for the purchase of equipment and supplies (for example, PPE, cleaning supplies, etc.) necessary for service provision during the COVID-19 pandemic
  • Additional staffing costs (for example, costs associated with hazard pay, retainer payments to staff, overtime payments, etc.) necessary for service provision during the COVID pandemic
  • You will need to upload:
  • Your W-9
  • Your 2019 tax return
  • If you have not filed your 2019 return you may upload the final draft version that will be marked “DRAFT” at the top of the first page.
  • If your organization did not exist in 2019, or if you have any questions about the process send an email to DHSDMSDCPP@dhs.wisconsin.gov indicating the circumstances.
  • Sole proprietors must provide Schedule C from the tax return.
  • Your 2020 first quarter payroll IRS Form 941
  • This does not apply if you have no paid employees.

As WHCA/WiCAL reported last week, the money will be paid out in two rounds. Methodology for the second round has not been determined yet but it is also important to note that whatever information you enter into the application will be valid for the second round of payments as well so it is important for providers to accurately enter excess costs and revenue losses they’ve experienced.
 
DHS has also provided a help email that will be monitored and answered by personnel appropriate to the provider type.

Click HERE to view the press release submitted by the Department.
 
If you have other questions, please contact Director of Reimbursement Policy Kate Dickson
WHCA/WiCAL Sends Follow-up Letter to Gov. Evers on Tuesday Meeting with Members, Staff
WHCA/WiCAL sent a letter following up on the meeting members and staff had with Gov. Evers earlier this week, which addressed funding concerns.

Click HERE to read the letter that WHCA/WiCAL submitted.

Please stay tuned to WHCA/WiCAL's communications for further advocacy efforts and information on our on-going funding advocacy concerns.
Congress Sends PPP Flexibility Bill to President
The Senate unanimously passed the Paycheck Protection Program Flexibility Act of 2020 (H.R. 7010) which addresses some of the concerns borrowers have regarding the program. The U.S. House of Representatives passed the bipartisan in a 417-1 vote on May 28, and is on its way to the president to be signed. 
The bill includes provisions to: 
  • Extend the amount of time borrowers have to spend PPP funds from eight to 24 weeks. 
  • Lowering the amount of PPP funds that must be spent on payroll from 75% to 60%. Under the language in the House bill, the payroll expenditure requirement drops to 60% from 75% but is now a cliff, meaning that borrowers must spend at least 60% on payroll or none of the loan will be forgiven. Currently, a borrower is required to reduce the amount eligible for forgiveness if less than 75% of eligible funds are used for payroll costs, but forgiveness isn’t eliminated if the 75% threshold isn’t met. 
  • Waiving any reduction in loan forgiveness if a company can show that some employees declined to return to their jobs or the pre-pandemic headcount is no longer required.
  • Extend the June 30 rehiring deadline.
  • Extend the period for when a business can apply for loan forgiveness, from within six months to within 10 months of the last day of the covered period, before it must start making interest and principal payments. 
  • Extend the loan terms for any unforgiven portions that need to be repaid from two years to five years, at 1% interest. 
  • Regarding the term extension, it is WBA’s understanding that for PPP loans which have already been documented and closed, in order for the loan term to be extended from the current two years to the new 5-year term, both borrower and lender must agree to the new term. The change of term is not automatic for those PPP loans already closed. 
  • Authorizing a delay of employer payroll tax payments through the end of 2020. This was prohibited under the Cares Act.  
Correcting NHSN Data Errors
On June 4, the Centers for Medicare and Medicaid Services (CMS) publicly released  individual facility data  related to COVID-19 on Nursing Home Compare. Some centers who reviewed their data, have found errors in the data as it appears on Nursing Home Compare. Centers are encouraged to check Nursing Home Compare for data accuracy. 

Nursing homes are required to report data to the National Healthcare Safety Network (NHSN). The data is then submitted from NHSN to CMS for upload into Nursing Home Compare.

Centers who review Nursing Home Compare and identify issues to their data may make corrections to data entered into the NHSN system by:
  • Logging into the NHSN COVID-19 LTCF module 
  • Choose the relevant date on the calendar feature
  • Edit the inaccurate data
  • Click “SAVE” before exiting


NHSN submits data to CMS every Monday morning. When CMS receives the data, the center’s revisions will be reflected with the next update of the CMS Nursing Home Compare webpage. The change will not be immediate due to the delayed upload to Nursing Home Compare.
NHSN Efforts and Supportive Documentation
The grace period for National Healthcare Safety Network (NHSN) reporting has officially ended and CMS will automatically issue civil monetary penalties (CMPs) if facilities fail to report by the June 7, 2020 deadline. Nursing homes are required to report COVID-19 related information to NHSN at least weekly. Centers who fail to report to NHSN will be issued per day (PD) CMPs by CMS and amounts will increase if nursing homes fail to report in subsequent weeks. 

If your center has tried to submit data, but you are receiving error reports, or if you have been experiencing technical issues that have not been resolved, you should keep copies of the information, responses, and attempts to show proof of your efforts to be in compliance. This may help you appeal any CMP you receive.

Below are examples of documentation to help show proof of your efforts to be compliant with the NHSN reporting requirements. It may be helpful to organize all this information in chronological order and in one location.
  • Any documentation on the dates you reached out to NHSN for help with technical issues/registration issues 
  • Any documentation that provides a response to your question to the NHSN help desk 
  • SAM registration information and dates 
  • All email confirmations from NHSN or CDC about your communications and registration  
  • Copies and screen shots of any error messages you received  
  • Documentation of data you collected on NHSN forms if/when you were unable to input it into the online system while awaiting response to technical or registration issues 

All supporting documentation should be compiled in a manner that is easy to access should you need to provide this information to the health department, surveyors and/or CMS Regional Offices.

Review this list to see if your facility is listed by NHSN as having submitted partial or no data.

Please email  COVID19@ahca.org  for additional questions, or visit  ahcancal.org/coronavirus  for more information.
HHS Releases Additional CARES Act Provider Fund Facts
On June 4, the U.S. Department of Health and Human Services (HHS) released three additional  FAQs . The new FAQs address the ability to retract attestation and implications of the June 3 deadline. The new FAQs are below and in the  HHS document  the FAQs are date-stamped June 3.

AHCA/NCAL resources on the CARES Act Provider Relief Fund are available on  www.ahcancal.org/coronavirus under the Finance and Reimbursement Issues tab.

New HHS FAQs

What if I attested and accepted a Provider Relief Fund payment, but would now like to reject the funds and retract my attestation?  If you affirmatively attested to a Provider Relief Fund payment already received and later wish to reject those funds and retract your attestation, you may do so by calling the provider support to reject those funds and retract your attestation, you may do so by calling the provider support line at (866) 569-3522; for TTY dial 711. Note, HHS is posting a public list of providers and their payments once they attest to receiving the payment and agree to the Terms and Conditions.

I wasn’t able to attest to the $20 billion General Distribution funding by June 3, 2020. What should I do?  The June 3, 2020 deadline was for providers to submit revenue information to be considered for a portion of the $20 billion General Distribution. Providers have 90 days from receipt of their payment from the $20 billion General Distribution to attest and agree to the Terms and Conditions.

I was not able to submit my revenue information to the General Distribution Portal by June 3, 2020 to be considered for a portion of the $20 billion General Distribution. Can I still be considered for these funds?  The June 3, 2020 deadline was for providers to submit revenue information to be considered for a portion of the $20 billion General Distribution. Providers have 90 days from receipt of their payment from the $20 billion General Distribution to attest and agree to the Terms and Conditions.

Next Steps

AHCA/NCAL continues to advocate on critical issues such as Change in Ownership, the 10-Day Reporting window, and reporting and reconciliation policies and procedures. To-date no new information on these topics has been released. The membership will be alerted immediately when new Provider Relief Fund information becomes available.

Please email  COVID19@ahca.org  for additional questions, or visit  ahcancal.org/coronavirus  for more information.
CMS Creates Flexibilities for Certain CMMI Models to Mitigate COVID-19 Impact
On June 3, CMS released a  table  outlining the new flexibilities and adjustments to current and future Center for Medicare and Medicaid Innovation (CMMI) models. The model adjustments are categorized according to financial, quality and model timeline modifications. CMS used specific principles such as flexibilities currently offered in model design, minimizing reporting burden, maintaining financial incentives to promote quality outcomes and entice continued participation in value-based arrangements, leveraging COVID-19 flexibilities outlined in regulation and waivers, etc. to identify apposite flexibilities. Some of the notable flexibilities include:

  • The opportunity for BPCI-A participants to opt out of upside and downside risk by excluding Clinical Episodes from Reconciliation for Model Year 3 (2020), and for those that choose to continue in two-sided risk to remove episodes with a COVID-19 diagnosis from reconciliation. 
  • Model extension of CJR Year 5 until March 2021 along with removal of downside risk by capping actual episode payments at the target price for anchor hospitalizations with an admission date between January 31, 2020 through the termination of the PHE. 
  • Postponement of the start of the first performance period of Professional and Global Direct Contracting Model to April 1, 2021 and creation of a second cohort application cycle during 2021 for launch January 1, 2022. 

 The chart also includes previously adopted flexibilities to the MSSP and Next Gen ACO models.

Please email  COVID19@ahca.org  for additional questions, or visit  ahcancal.org/coronavirus  for more information.
WHCA/WiCAL Staff Attend Virtual Candidate Rollouts
On Monday, June 1, WHCA/WiCAL staff attended three virtual events for new candidates running for State Senate and State Assembly.

The events were hosted by legislative caucus committees, including:

  • The State Senate Democratic Committee
  • The Assembly Democratic Campaign Committee
  • The Republican Assembly Campaign Committee

Note: the Committee to Elect a Republican Senate will host its candidate rollout event later this summer.
Reminder: CMP Funds for Virtual Socialization and Telehealth Visits
The Centers for Medicaid & Medicare Services (CMS) has announced that federally certified nursing homes are eligible to receive up to $3,000 in Civil Money Penalty (CMP) funds to purchase electronic devices to enable residents to visit with family and friends in a virtual setting and participate in telehealth visits. This program was initiated in response to the restrictions placed on visitors in nursing homes to prevent the spread of COVID-19.

CMP funds may be used by nursing homes to purchase tablets, iPads, and similar devices, as well as accessories including headphones and protective covers to help with cleaning between uses. Additional information about the grant is available in the Frequently Asked Questions document prepared by CMS.

Federally certified nursing homes interested in participating in this grant program who have not already submitted an application are asked to submit a completed Civil Money Penalty (CMP) Reinvestment Application to DHSDQAFiscal@dhs.wisconsin.gov . Applications will be reviewed to verify that requests for equipment are within the parameters established by CMS. Facilities will receive an approval letter from DQA with instructions on how to submit invoices for payment.

Please note that nursing homes who have already applied should not reapply. Previously submitted applications are being reviewed and processed.
Please direct questions regarding this information to DHSDQAFiscal@dhs.wisconsin.gov .

For more information about the Nursing Home Grant Program, please see the DHS webpage and the CMS webpage .
WHCA/WiCAL Staff
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

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