June 9, 2020
Quick Links:
UPCOMING EVENTS CALENDAR:
Thursday June 11 at 9:30 AM:
WHCA/WiCAL Survey and Regulatory Committee Meeting

Held via teleconference

Thursday June 11 at 11 AM:
Long-Term Care Webinar - Nursing Home Response to COVID-19

To Join:
Join Zoom Meeting (click this link to go straight to the room without needing to enter the meeting ID and password)
Meeting ID: 948 1795 1711
Password: covid19

Or by Phone: (312) 626-6799
Enter 94817951711# when asked for the meeting ID
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COVID-19 Updates: June 9, 2020
This update includes:
  • WHCA/WiCAL Promotes PPE Partnership with NBA Legend NBA Legend Kareem Abdul-Jabbar Gives Assist to Wisconsin Long-Term Care Providers
  • HHS Releases $15 Billion for Medicaid Provider Relief
  • CMS Posts SNF COVID-19 Data, Inspection Results on Nursing Home Compare
  • DHS Releases Guidance on Adult Day Services and Programs
  • Assisted Living Communities Ask HHS for COVID-19 Help, Support
  • Revised DQA Memo 20-004 RE: Nursing Home Waivers
  • Economic Impact Payment Guidance
  • OPRI Health Care Facility Survey Team Supervisor Announcement
  • 2020 Candidate Profiles Released
  • ICYMI: CARES Act Provider Payment Application Open
As of today, there are 21,308 confirmed cases of COVID-19 in the state of Wisconsin and 661 deaths caused by the virus. Yesterday marked the first day since mid-May in the state with no COVID-19 deaths. 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.
WHCA/WiCAL Promotes PPE Partnership with NBA Legend
NBA Legend Kareem Abdul-Jabbar Gives Assist to Wisconsin Long-Term Care Providers
WHCA/WiCAL is pleased to  announce  that with the assistance of NBA legend and former Milwaukee Bucks player Kareem Abdul-Jabbar, WHCA/WiCAL is working with  Magid Glove & Safety Manufacturing Company , on a PPE order of PPE including gowns and N-95 masks.

The goal of this partnership is to reduce the cost of PPE by helping facilitate a bulk purchasing order on to key PPE supplies including gowns, 3-ply and N-95 masks. All of the state's skilled nursing and assisted living facilities are asked to fill out this survey if they are interested in participating in this bulk purchasing order.

“Getting PPE to our heroes working on the front lines of the COVID-19 pandemic is a top priority,” said John Vander Meer, President & CEO of WHCA/WiCAL. “On behalf of Wisconsin’s long-term care providers, I would like to thank Kareem for his support of Wisconsin’s long-term heroes on the frontlines, and to the Magid team for helping provide critically needed PPE to caregivers who are serving Wisconsin’s frail older adults and citizens with an intellectual or development disabilities.”


"I am equally in awe of the great effort and sacrifices that you are making in Wisconsin to keep your communities safe," said Abdul-Jabbar in the below video to Wisconsin's long-term care providers. "Some people claim that a crisis brings out the best in people. But I think that it only brings out the best in the best people. Those that believe they are part of something greater. You are the heart of our humanity and you inspire us to be our best selves."
HHS Releases $15 Billion for Medicaid Provider Relief
AHCA/NCAL has advocated for the last several weeks for HHS to make provider relief payments to Medicaid providers. Today, June 9, HHS announced the distribution of $15 billion from the Provider Relief Fund to Medicaid providers. We have provided details below on this distribution of funds. These additional resources are critical for providers. We also know that more is still required to ensure the safety of our residents and staff. We’ll continue to advocate on your behalf for the funds and other resources you need.  

Eligible providers include Medicaid and Children’s Health Insurance (CHIP) providers that participate in state Medicaid and CHIP programs and have not previously received a payment from the Provider Relief Fund General Allocation.  

How to Access Relief Funds 

On Wednesday, June 10, HHS is launching a Medicaid and CHIP Targeted Distribution Provider Relief Fund Payment Portal. Eligible providers must report their annual patient revenue, which will be used as a factor in determining their payment. The payment to each provider will be at least two percent of reported gross revenue. The final amount each provider receives can only be determined after the data is submitted through the portal. 

In May, HHS made an initial general distribution provider payment to approximately 62% of all providers participating in state Medicaid and CHIP programs, who are also Medicare Providers. This week’s Medicaid and CHIP Targeted distribution will provide relief funds to the remaining 38%.  

This funding will supply relief to Medicaid providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers that may be eligible for this funding include opioid treatment and behavioral health providers, ICFs/IID, Medicaid-only nursing homes, assisted living communities and other home and community-based service providers. 

Eligibility for Medicaid Allocation 

To be eligible for this funding, health care providers must have not received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid programs, or Medicaid managed care plans for “healthcare-related services” between January 2018 and May 31, 2020.  

If you have any questions, please contact WHCA/WiCAL Director of Reimbursement Policy Kate Dickson.
CMS Posts SNF COVID-19 Data, Inspection Results on Nursing Home Compare
The Centers for Medicare & Medicaid Services (CMS) has posted the first set of underlying coronavirus disease 2019 (COVID-19) nursing facility data, a move the skilled nursing profession said earlier in the week should be used to help direct resources to the elderly with chronic diseases and the dedicated staff who care for them.

On April 19, CMS announced the requirement that skilled nursing facilities (SNFs) inform residents, their families, and their representatives of COVID-19 cases in their facilities. And, SNFs must also report COVID-19 cases and deaths directly to the Centers for Disease Control and Prevention (CDC), and now CMS said it is making this data publicly available.

“As part of today’s announcement, CMS is also posting the results from the targeted inspections announced on March 4, 2020, to allow inspectors to focus on the most serious health and safety threats like infectious diseases and abuse during the pandemic,” the agency said.

What the data show is that as of May 31, about 13,600 nursing facilities—approximately 88 percent of the 15,400 Medicare and Medicaid nursing facilities—had reported the required data to CDC. These facilities reported more than 95,000 confirmed COVID-19 cases and almost 32,000 deaths. The next set of data will be updated in two weeks. Going forward after that date, CMS said it plans to update the data weekly.

Earlier in the week, Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living, said, “We hope this public reporting system will help identify areas that are most in need of resources to fight the battle against COVID-19. We hope state and federal public health officials can use the data to help nursing homes by sending urgently needed resources.”

In addition, CMS said since March 4, the agency and its network of state-based inspectors have conducted more than 8,300 surveys with the results of a total of 5,700 available now. The results of the completed surveys and the reports are available on Nursing Home Compare. CMS plans to post the results of the inspections monthly on an ongoing basis as they are completed.

On the issue of inspections and possibility of increased penalties on SNFs, Parkinson said, “What would really be helpful to improve the situation is for CMS and its survey teams to work together with the nursing home industry to fight this COVID-19 battle.”

He added that the situation will get worse if surveyors are only looking for reasons to find deficiencies and issue fines instead of identifying ways for nursing facilities to make real changes and help them improve their infection control programs. “It’s time to recognize that when nursing homes receive citations, it’s a failure not just of the provider, but of CMS and the survey process as well. Citations and fines without assistance will not help us keep residents and staff safe from this virus,” Parkinson said.

“The reality is that long term care providers are facing an unprecedented situation that has left them begging for testing, personal protective equipment, and staffing resources. Just like hospitals, we have called for help. In our case, it has been difficult to get anyone to listen,” he said.

"Whether it’s federal, state, or local health agencies, long term care needs to be a priority for supplies and help. It’s time that America rally around our long term care residents just as they did with hospitals.”

For a quick overview of the nursing facility COVID-19 data, visit here:  www.cms.gov/files/document/covid-nursing-home-reporting-numbers-5-31-20.pdf.

To view the inspections results, visit:  www.medicare.gov/nursinghomecompare/search.html?

DHS Releases Guidance on Adult Day Services and Programs
Guidance on adult day services, care centers, programs, and adult pre-vocational programs has been posted to the DHS COVID-19 Long-Term Care Facilities page. These programs are at increased risk for COVID-19 transmission because there is increased risk when multiple people gather and interact. The guidance provides considerations related to capacity, spatial separation, physical distancing, infection control practices, and staffing.

Facilities/programs should also follow all appropriate provisions in the COVID-19: Long-Term Care Facilities and Services sections for:

  • Visitors to facilities
  • Guidance for all facilities
  • Resources

Please contact the Bureau of Assisted Living (BAL) Regional Director for the county in which you are located if you have questions.
Assisted Living Communities Ask HHS for COVID-19 Help, Support
Earlier today, AHCA/NCAL sent a letter to HHS and FEMA to request $5 billion in emergency funding and support for assisted living communities in response to the COVID-19 outbreak.

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) wrote to Alex Azar, HHS secretary, and Peter Gaynor, FEMA administrator, to praise their support for the skilled nursing industry, but at the same time “urgently request” aid for assisted living communities fighting COVID-19.

“With initial funding provided for nursing homes, we would like to direct your immediate attention to assisted living communities and urgently request your help and financial support to protect our residents from COVID-19 outbreaks,” said Mark Parkinson, president and chief executive officer of AHCA/NCAL, and Scott Tittle, executive director of NCAL.

They said the more than 42,000 assisted living communities in the United States, serving more than 1 million people, need help and “to date, assisted living communities have not received any direct federal funding, PPE [personal protective equipment], or prioritization for testing (outside of some minimal state support).”

“While much warranted attention has been focused on nursing homes, there has been an alarming number of confirmed COVID-19 cases in assisted living communities reported,” AHCA/NCAL said. “Sadly, many assisted living residents have suffered the same fate as older adults in nursing homes who have contracted the virus. Like nursing homes, our residents are among those most vulnerable to COVID-19, as more than half are above the age of 85, and many are living with underlying health conditions.”

Parkinson and Tittle said the assisted living staff are, like those employed in skilled nursing centers and other health care and congregate settings, are on the frontlines when it comes to preventing the virus from entering facilities and containing it if there is infection.

In that vein, the letter said assisted living operators are dedicating significant resources right now related to COVID-19 measures, including those imposed by the states that regulate them. These enhanced expenses are due to:
  • Hiring additional staff to address workforce shortages;
  • Providing overtime and other incentive pay;
  • Restricting communal dining, requiring additional dietary staff to administer meals in residents’ rooms;
  • Securing critically needed and premium-priced PPE supplies;
  • Testing and diagnosing COVID-19 cases;
  • Quarantining COVID-19 positive or suspected positive residents;
  • Offering enhanced, one-on-one activities and telehealth capabilities during visitor and group activities restrictions;
  • Enhanced and more frequent cleaning and disinfecting of the entire facility; and
  • Accepting COVID-19-positive residents discharged from hospitals per state requests.

The three critical areas where assisted living communities need support starts with funding, and the request for $5 billion from HHS to pay for staffing, testing, and PPE equipment.

Parkinson and Tittle said disbursements from the COVID-19 Provider Relief Fund should be dedicated to all assisted living communities across the country: to those facilities that have confirmed COVID-19 cases in an effort to help contain the outbreak, as well as funds to prevent an outbreak in nonimpacted facilities.

In facilities that do not have confirmed COVID-19 cases, additional staffing and supplies can help ensure that residents and staff are able to keep the virus out of their buildings. Such funds will be critical to also help prepare providers for any subsequent outbreaks of COVID-19 in long term care facilities, AHCA/NCAL said.

On PPE, the letter asked FEMA to expedite shipments of quality PPE and work with state governments to identify additional supplies for assisted living communities. 

“The lack of available PPE has also put long term care providers at a serious disadvantage in protecting residents and staff, especially given the vulnerable population in assisted living communities,” the letter said.
Since the beginning of the pandemic, these providers have faced similar challenges as other health care and congregate settings in acquiring this equipment, due to its high demand and world supply chain issues.

“As many states reinstitute public gatherings as well as plan guidance on ‘opening up’ long term care facilities to visitation, this is a critical time period to ensure our assisted living communities are equipped to keep COVID-19 out of their buildings,” AHCA/NCAL said.

 Click HERE to view the letter.
Revised DQA Memo 20-004 RE: Nursing Home Waivers
DQA Memo 20-004 for Nursing Homes has been revised.

Effective May 11, 2020, the state public health emergency ended and Emergency Order #21 is no longer in effect. As a result the rule suspensions and companion orders contained in Emergency Order #21 are no longer valid.

Note: the contents of this memo are not new information. This memo appears to simply formally announce these changes, but WHCA/WiCAL reported on these changes in mid-May. WHCA/WiCAL has worked with DHS officials to create a simplified waiver request process for the creation or continuation of temporary and/or emergency nurse aide programs. You can find the detailed information HERE (navigate to the top story, “Temporary/Emergency Nurse Aide Training Program Update: Facilities Must Submit Waiver Requests to Continue/Create Programs; Waiver Request Form Templates Now Available.”
 
WHCA/WiCAL has reached out to DQA for further clarification. Please direct any questions you may have to jstoa@whcawical.org


Please see the DQA Memo webpage at https://www.dhs.wisconsin.gov/dqa/memos/index.htm for more information.
Economic Impact Payment Guidance
Skilled nursing facility (SNF) and assisted living (AL) residents were eligible for Economic Impact Payments (EIPs). EIPs are one-time payments of $1,200.

The Internal Revenue Service (IRS) began issuing electronic EIPs on or about April 15 to people who received a tax refund electronically, and to the same account as the tax refund. If people did not get an electronic refund or no refund, the IRS sent the payment by mail.

Important questions have been raised about SNF and AL resident checks and management of these dollars. Below are FAQs and guidance: 

Does the EIP payment impact Medicaid eligibility immediately?
No. 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. After 12 months, EIP could push a resident over asset limits and result in the need to spend down to Medicaid asset limits. Medicaid asset limits are state specific.

Can Social Security benefit representative payees manage the EIP dollars? 
No. Under the Social Security Act, a representative payee is only responsible for managing Social Security or SSI benefits. An EIP is not such a benefit. A representative payee should discuss the EIP with the beneficiary . If the beneficiary wants to use the EIP independently, the representative payee should provide the EIP to the beneficiary. If the beneficiary asks the representative payee for assistance in using the EIP in a specific manner or saving it, the representative payee can provide that assistance outside the role of a representative payee.

What if a beneficiary alleges a representative payee misused the economic impact payment (EIP)?
Because an EIP is not a Social Security or SSI benefit, SSA does not have authority to investigate or determine whether the EIP has been misused. However, if SSA receives an allegation that the EIP was not used on behalf of the beneficiary, SSA may decide to investigate for possible misuse of the beneficiary’s Social Security or SSI benefit payments. SSA may also determine the representative payee is no longer suitable and appoint a new representative payee.

Are SNFs and ALs allowed to use EIPs dollars to pay resident bills?
The EIP dollars belong to the recipient and are at his/her discretion for use. Providers may not access these funds without the permission of a resident who is legally competent or, in the case of someone with a cognitive impairment, the permission of a court appointed guardian or other individual with power of attorney.

Are there other considerations for EIP and SNF and AL residents?
Yes. If the resident or legal representative uses the funds to cover any sort of resident expenses, evidence must document there was no coercion on the part of a family member, provider or other. 

What should a resident do if she/he feels their EIP dollars have been misused?
A resident, family member or legal guardian can contact the Elder Care Locator network at 1-800-677-1116 for more information about local legal aid offices and your state’s Protection and Advocacy System and State and Local Long-Term Care Ombudsman Offices
OPRI Health Care Facility Survey Team Supervisor Announcement
The Division of Quality Assurance, Office of Plan Review and Inspection (OPRI), announced last week that Fokruddin Khondaker has accepted the position of supervisor. Mr. Khondaker is supervising the OPRI health care facility survey team and assisting with oversight of the health care construction team while that position is under recruitment. Mr. Khondaker is licensed in the states of Wisconsin, Maryland, and Texas as an Architect. He brings a wealth of knowledge and experience having received his undergraduate degree in architecture from the Bangladesh University of Engineering and Technology, Dhaka, Bangladesh, as well as his master’s degree in architecture from the University of Oklahoma Norman, Oklahoma. Prior to joining the team at DHS, Mr. Khondaker began his career in public service with the State of Wisconsin Department of Commerce in the Division of Safety and Buildings.

For more information regarding the OPRI team, please see the contacts and plan review information. If you have questions, please email DHSDQAPlanReview@dhs.wisconsin.gov.
2020 Candidate Profiles Released
Last week, the profiles of candidates running for office in 2020 were released by the Wisconsin State Senate Democratic Committee (SSDC), Republican Assembly Campaign Committee (RACC), and the Wisconsin Legislative Almanac which provides election data and predictions for all 132 Wisconsin legislative districts.

As campaign season continues to ramp up, donations to the WHCA/WiCAL Political Action Committee (PAC) are more important than ever.

TWO WAYS TO DONATE:

Please write your personal check to WHCA/WiCAL PAC and send it to:
131 W. Wilson St. #1001
Madison, WI 53703
-OR-

GO HERE  to donate using your personal credit card!
You can make a single payment or set up recurring contributions.

THANK YOU to all who have already given to the PAC. Your contribution directly helps to advance the best interests of the long-term care provider community!
ICYMI: CARES Act Provider Payment Application Open
Last week, 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 in 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 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

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.

CONTACT:
Basic American Medical Products
Jacqueline Greenfield
920-904-0989



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