April 14, 2020
KHCA/KCAL is committed to providing our members with important updates. Below is a list of the most recent COVID-19 updates. Please visit our website for a list of complete updates.  www.khca.org

The KHCA/KCAL staff is here working for you! Due to the volume of calls you may need to leave a message. We will return your call as soon as we possibly can.
Recommendations for When a Resident Wants to Leave the Building  
AHCA/NCAL has developed  recommendations  to help you address when a resident wants to leave the building to go into the surround community and then return. This could introduce COVID-19 into the building and endanger others. Our recommendations include communicating with the resident and family, requiring isolation, and contacting the ombudsman and the local health department. 

Find this  resource  on our  COVID-19 website  under AHCA/NCAL Guidance and Resources > Screening Essential & Restricting Non-Essential Visitors
Medicaid FAQs  
Yesterday evening, CMS released  guidance to states  on Medicaid-related COVID-19 issues.  

Although the guidance covers a range of topics, including implementation of coverage for COVID-related services for the uninsured and benefits and cost sharing for COVID-19-related testing and diagnostic services, below we have highlighted items important to long term care providers:  

Treatment of Relief Payments in CARES Act
CMS clarifies that the relief payments eligible people receive from the CARES Act may not be counted as income when making Medicaid and CHIP eligibility determinations. In addition, these payments may not be counted as resources for 12 months (Question 54). 

Eligibility Considerations for States to Receive Enhanced Federal Matching Rates
To continue to receive the temporary FMAP increase, the state must not cut eligibility for benefits during the public health emergency, even if that person no longer meets the existing eligibility criteria. Several questions in the FAQ document address targeted questions states have raised related to people using long term services and supports, or who become eligible for Medicare as well as Medicaid. These include: 
  • When a Person no Longer Meets Level of Care (LOC) or Other Requirements of a 1915(c) Waivers: If a person is participating in a 1915(c) home and community-based services (HCBS) waiver and they are determined to no longer meet the LOC requirements (or other requirements) for the waiver, the state should maintain an individual’s participation in a 1915(c) waiver for which the individual is enrolled during the emergency period, even if the individual is determined to no longer meet the LOC or other requirements for waiver participation (Question 25). 
  • When a Person’s Medicaid Eligibility Is Connected to Need for 1915(c) Waiver Services and They No Longer Meet LOC Requirements: If a person’s Medicaid eligibility is connected to their need for and receipt of 1915(c) waiver services, and they are determined to no longer meet the LOC requirements, to continue to receive the enhanced federal matching rate, the state must maintain the individual in this eligibility group and continue to provide coverage for 1915(c) services, unless they are now eligible for a different eligibility group that provides the same amount, duration, and scope of benefits (Question 26). 
  • Medicaid beneficiaries who become eligible for Medicare: If a person enrolled in Medicaid turns 65 and becomes eligible for Medicare during this time, CMS clarifies steps the state would have to take to ensure that their services are not reduced so that the state can continue to receive the 6.2% federal matching bump (Question27). 
  • Changes in SSI eligibility when this is the basis for Medicaid eligibility: If a person who is eligible for Medicaid based on their receipt of SSI benefits were to become ineligible for SSI during the public health emergency, they may not be terminated from Medicaid before the end of the month when the public health emergency ends. If the person is eligible for a different Medicaid eligible group that offers at least the same benefits available to SSI beneficiaries, the state is able to move them to that new group (Question 33). 
  • Moving between Medicare Savings Program (MSP) groups: During the public health emergency, states must maintain a person’s eligibility for at least the same amount, duration, and scope of benefits as are covered for the group in which the individual is enrolled. This includes paying for Medicare Part A and Part B premiums through MSPs and other Medicaid categories. This means that a person could not be moved to a different MSP group that offers less assistance with Medicare premiums and cost sharing during the emergency (Question 34). 
1915(k) Clarification and EFMAP 
CMS addressed an incorrect statement in a previous FAQ document, clarifying that Community First Choice 1915(k) service expenditures are in fact eligible for the enhanced federal matching rate of 6.2 percent under this public health emergency (Question 36). 
A Couple Messages from the CMS Office of Communications
Join us for a CMS COVID-19 Call with Nursing Homes on April 15th

Please join the Centers for Medicare and Medicaid Services (CMS) for a call on COVID-19 with Nursing Homes, Wednesday, April 15th at 4:30 PM EST. CMS leadership will provide updates on the agency’s latest guidance and we will be joined by leaders in the field interested in sharing best practices with their peers. The call will be recorded if you are unable to join us.
Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.
Wednesday, April 15th from 3:30 – 4:00 PM CST
Attendee Dial-In: 833-614-0820
Conference ID: 3770227

We greatly appreciate the incredible work of nursing homes and assisted living facilities around the country to keep our senior citizens healthy during these difficult times. We look forward to continuing our work together on this important issue.

2019 Novel Coronavirus (COVID-19) Long-Term Care Facility (LTC) Transfer Scenarios

CMS is providing supplemental information for transferring or discharging residents between skilled nursing facilities (SNFs) and/or nursing facilities based on COVID-19 status (i.e., positive, negative, unknown/under observation). In general, if two or more certified LTC facilities want to transfer or discharge residents between themselves for the purposes of cohorting, they do not need any additional approval to do so. However, if a certified LTC facility would like to transfer or discharge residents to a non-certified location for the purposes of cohorting, they need approval from the State Survey Agency.
A copy of the guidance and a graphic explaining the various scenarios can be found here:   https://www.cms.gov/files/document/qso-20-25-nh.pdf
To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here:  www.coronavirus.gov . For information specific to CMS, please visit the  Current Emergencies Website .

Notification Guidelines for Confirmed COVID-19 Cases
Saturday, AHCA/NCAL released new   guidance   and a   press statement    on notifying public health officials and stakeholders about confirmed cases of COVID-19 in long term care facilities. This guidance reinforces much of what long term care providers are already doing and are currently required to do in their states. Our guidance today suggests that long term care providers should also report to the state survey agency, if you are not already, so that CMS and other federal agencies have another way to gather national information.
When a COVID-19 case is confirmed (whether resident or personnel) in a long term care facility, several notifications need to occur.

For the initial case of confirmed COVID-19 in the facility:

For each resident in the facility who has a COVID-19 positive test (including each additional case after initial cases):
  • Notify the resident and/or their representative when they have a positive COVID-19 test. 
  • Notify state survey agency that you have a case. (Contact your KDADS Regional Manager)
  • Notify the local and state health departments with information per state reporting requirements. 
  • CDC guidelines state the health department should be notified about residents with severe respiratory infection or a cluster of respiratory infections (e.g., 3 or more residents or Health Care Professional (HCP) with new-onset respiratory symptoms over 72 hours) of residents or HCP with symptoms of respiratory infections.
  • AHCA/NCAL NOTE: COVID-19 would constitute a severe respiratory infection and should be reported; required information may vary by state.
  • Notify the primary physician for the resident who has a confirmed case. 
  • Notify all employees working in the facility.

For each staff member of the facility with a COVID-19 positive test (including each additional case after initial cases):
  • Notify state survey agency that you have a case. (Contact your KDADS Regional Manager)
  • Notify the local and state health departments with information per state reporting requirements. 
  • CDC guidelines state the health department should be notified about Health Care Professional (HCP) with symptoms of respiratory infection. Required information may vary by state.

For all communications above, keep records of notifications that have been made.
Kansas Health Care Association and the Kansas Center for Assisted Living
1100 SW Gage Blvd Topeka, KS 66604
PH: 785-267-6003 FAX: 785-267-0833