May 27, 2020
Stay Connected - LeadingAge Illinois COVID-19 Resources
Stay up to date on state and federal COVID-19 information and updates by accessing the LeadingAge Illinois COVID-19 Resources page. You can also engage with other Illinois members through our listservs, connecting you with your peers by provider type. We have now added a COVID-19 listserv . Contact LeadingAge Illinois if you’d like more information about the listservs or would like to join one.

TOP STORIES
LeadingAge Illinois Continues Meetings with Congressional Offices
This week, LeadingAge Illinois continues a series of meetings with congressional offices to discuss member issues and COVID-19 relief.
 
The meetings this week began yesterday with a follow-up conference call with the office of U.S. Representative Jan Schakowsky (D-9th District) . Along with staff from LeadingAge, LeadingAge Illinois met with Osaremen Okolo, Senior Health Policy Advisor to Rep. Schakowsky. It was a follow-up to a call with the representative last week that involved several members from her district. One of the items of discussion included the need for a charter and funding for a post-COVID Bipartisan Congressional Commission to develop a legislative strategy that establishes an infrastructure of aging services that is adequately financed, promotes quality of care and quality of life, and enables all Americans to grow old with dignity.
 
The meetings continued today in a morning call with the office of U.S. Senator Tammy Duckworth . LeadingAge Illinois affordable housing members encouraged the senator’s support and co-sponsoring of LeadingAge’s $1.2 billion affordable senior housing ask :
 
  • $845 million for COVID-19 costs for services, staffing, disinfecting, PPE, etc. Funds from the March 27 CARES Act will begin to make up for lost tenant rent revenue, but not help pay for other related costs.
 
  • $300 million for Service Coordinators, both to support existing Service Coordinators and to get new ones for the senior housing communities that do not have one.
 
  • $50 million for wireless internet installation and service fees in resident units and in community common spaces. The lack of internet access has slowed efforts to combat social isolation, engage residents with telehealth, and connect residents to needed supports.
 
  • $7 million for a one-year extension of HUD’s Integrated Wellness in Supportive Housing demonstration, whose funding for wellness nurses and service coordinators is set to end on September 30 without congressional action.
 
Special thanks to the following members for taking part in the meeting with the senator’s office:
 
  • Ralph Gaines, CEO, Embrace Living Communities
  • Dave Opitz, Senior Director of Mission Services, Embrace Living Communities
  • Greg Watson, Director of Housing Operations, Embrace Living Communities
  • Lisa Ingalls, Executive Director of Affordable Housing, Lutheran Social Services of Illinois
  • David Guthridge, Director of Affordable Housing CJE SeniorLife
  • Vida Wojewski, Assistant Manager, Catholic Charities of Chicago
 
The meetings continue tomorrow as we meet with the office of U.S. Representative Lauren Underwood (D-14th District) . The purpose of this call is to urge the representative’s support of LeadingAge’s COVID-19 relief asks. Friday, we will meet with the office of U.S. Representative Michael Quigley (D-5th District) to again push for support of the $1.2 billion senior housing ask. 
FY21 Special State Budget Session Update
The Fiscal Year 2021 special budget session adjourned last week after a three-day period in which the Illinois Senate and House came back to Springfield to take up COVID-19 issues and the State Budget.
 
The Senate met in the Illinois State Capitol, while the House met at the local convention center, to ensure social distancing. Listed below are the most recent numbers we currently have with regard to the fiscal year 2021 budget and COVID-19 relief funding:
 
FY 2021 Budget:
This year’s budget has several components to allow flexibility to deal with the current COVID-19 pandemic. Some key parts include:
  • Budget-related (but in a separate bill), the General Assembly would allow the Governor to borrow up to $5 billion from the Federal Reserve as allowed under the federal CARES Act. This authority passed both in the House and Senate on Friday (SB 2099).
  • Not specifically in any language, it was stated in committee debate that HFS will increase the wage adjuster floor in the Medicaid rate formula from .95 to 1. This was supported by LeadingAge Illinois.
 
COVID-19 Relief:
LeadingAge Illinois joined other long term care groups in advocating for direct payments to long term care settings from the federal CARES Act funds allocated to Illinois to handle the extraordinary costs from the pandemic. LeadingAge Illinois was pushing for lump sum payments to skilled nursing centers, assisted living and supportive living. Our request was like the actual federal payments that began May 22.
 
At this time, we know that the state will be making COVID-19 relief payments to providers from the federal CARES Act.  Assisted living communities are not going to receive funds as written because they are not part of the Illinois Department of Healthcare and Family Services (HFS) medical assistance program.
 
The total CARES Act distribution for health care providers will come from HFS and currently total $830 million. LTC settings include SNFs, SLF communities, and ID/DD providers are allocated $435.4 million of the total. The LTC spending pool is divided into these categories:
 
  • $127.2 million to providers in counties which did not get direct federal support
  • $258.2 million for providers statewide
  • $50 million for providers serving, “disproportionately underserved communities”
  • Amounts are not approved and subject to change. 
 
Most counties did not get direct support. Providers in Cook, DuPage, Kane, Lake and Will counties are not eligible for payment from the $127.2 million. 
 
The definition of “disproportionately underserved communities” appears to be incomplete but indicates it will be measured using the school free lunch guidelines, income below 133% of the federal poverty level or SNAP benefits. It does not say how those metrics will be applied.
 
The payment distribution guidelines in the language now are:
  • Only providers who serve HFS medical assistance / Medicaid patients are eligible (does not include Assisted Living)
  • Payments will be separate from existing Medicaid rates.
  • Providers will be required to attest that funds will be used to cover COVID-19 related expenses not part of their annual budgets established before March 1, 2020.
  • HFS will consider individual factors such as number of COVID-19 cases, workforce issues, etc.
  • HFS will likely reduce state payment by amounts received from federal CMS.
 
Medicaid and Health Care Issues:
Unlike recent years, there is not a Medicaid omnibus bill. Instead, various health care and Medicaid issues are in the same bill and it is smaller:
  • Medicaid rate increase for Federally-Qualified Health Centers ($25 million).
  • Allows one pay stub for Medicaid eligibility determination
  • Language to give HFS and the Illinois Department of Insurance (DOI) flexibility to implement changes during COVID-19 Public Health Emergency; both federal and state options
  • Creates a Kidney Disease Prevention and Education Task Force
  • Requires HFS and DOI to do “feasibility study to explore options to make health insurance more affordable for low-income and middle-income residents”
  • Language with Telehealth items for COVID effective until May 1, 2021
  • Adds language to Pharmacy Practice Act to define “Emergency Kits”
  • Adds a COVID coverage group to Illinois Medicaid for duration of the Public Health Emergency.
  • Ambulances can get paid without PCS form if they demonstrate they attempted to get form completed
  • Medicaid coverage of clinical trials - “medical assistance program shall provide coverage for routine care costs that are incurred in the course of an approved clinical trial if the medical assistance program would provide coverage for the same routine care costs not incurred in a clinical trial”
  • Adds some items to “Medicaid Required health benefits”
  • Changes Nursing home provider tax form language
  • Requires the MCO tax paid by County Care to be deposited into the County trust Fund rather than Healthcare Provider Relief Fund.
 
We will continue to analyze the actions of the Illinois General Assembly and keep you abreast of all activities. 
Argentum Statement on the Coronavirus
James Balda, President & CEO of Argentum, has issued a statement in response to the announcement of a $4.9 billion distribution by HHS to nursing facilities impacted by COVID-19:
 
“While Argentum appreciates that the Administration is supporting nursing homes, we remain disappointed that it continues to overlook the senior living industry, which is caring for the same vulnerable population and has equally urgent needs. Senior living communities – assisted living, independent living, memory care, and continuing care – critically need financial relief, as they have rising financial pressures due to added staffing and expanded operations, as well as the costs associated with purchasing PPE and test kits.
 
“All in all, expenses for senior living communities are projected to be in the tens of billions over the next year. This could cause extreme financial strain on this industry, which currently serves as a safe haven to residents and a backstop to the larger healthcare system. These communities also desperately need priority access to COVID-19 testing and PPE, but the government has prioritized nursing homes for these critical resources, as well.
 
“We will continue to ask the Administration and Congress not to neglect the urgent needs of the 2 million seniors and 1 million employees who live and work in senior living communities. Lives and livelihoods are at risk, and we are asking our elected officials to stand up for our seniors and those who care for them.”
Experience the RESIDE Dashboard
The admissions process is messy, complicated, and requires heavy manual oversight due to legacy systems and physical paperwork. Facilities can lose up to 20% of revenue due to missing or inaccurate admissions documentation. But with RESIDE, admissions staff, regionals, and owners can oversee the entire admissions process. Our centralized dashboard ensures accountability at each stage, full transparency into every admission, and the necessary reports to maintain compliance. Experience the RESIDE dashboard with our  demo video .

Holly Kasnetz is the VP of Strategy and Implementation at RESIDE Admissions.
STATE
IDPH Assisted Living Survey
Several Assisted Living establishments may have received a survey in March from the Illinois Department of Public Health (IDPH) that is based off the CDC COVID-19 Tele-ICAR tool. They have asked that establishments complete this survey . Communities with known outbreaks should already be coordinating with local health departments on infection control and prevention and do not need to complete this survey. 
 
After surveys have been received, the team has been doing follow up calls to go over any items that were marked as in progress or not started as well as provide any updated guidance since the survey was released. They share any notes from the call with their local health department as well as the community along with any resources/guidance that may be helpful. If you have any questions, please contact State of Illinois contact Hannah Doeseck , MPH, HAI Epidemiologist at 312.768.6036.
COVID-19 Updates and Q&A Webinars for Long-Term Care and Congregate Residential Settings
The Illinois Department of Public Health (IDPH) is hosting webinars to provide COVID-19 updates and answer questions from long-term care and congregate residential settings.
 
 
 
 
 
 
Webinar attendance is limited. If you cannot register or get in, email Michael Moore .
IDPH will be recording the webinars and sending out the links of the recordings.
 
Items discussed on May 22 included:
  • Quarantine.  IDPH says that all new admissions are to be on 14 days of quarantine. IDPH will update guidance to clarify that once someone has recovered they can return to the regular units and be monitored every eight hours instead of four hours.

  • Testing.  State lab testing turnaround is currently three days.

  • Residents Going Outdoors. Residents may go outside. Necessary safety precautions must be taken, however, such as wearing a mask, proper hand hygiene and practicing social distancing.

  • Salons. Along with the move into phase three of Restore Illinois, beauticians can be onsite starting June 1 if required screening, masking, hand washing occur. A limited number of people can be in the salon. IDPH cautioned about the risks. 
Governor Pritzker’s Daily Press Conference Updates
Governor JB Pritzker is conducting daily press 2:30 p.m. conferences on COVID-19. Click here to listen daily.  LeadingAge Illinois monitors the briefings daily for information coming directly from the Governor and Dr. Ngozi Ezike, Director of the Illinois Department of Public Health (IDPH). 
 
Yesterday’s update included:
 
Cases:
  • 1,178 new cases (113,195 total)
  • 39 new deaths (4,923 total)
  • There were 780 deaths the week ending May 16. It signals the first week that there have been fewer deaths than the previous week. Also signals the hopeful begin of a downward trend. 
 
Hospitalizations:
  • 3,788
  • 1,035 in ICU
  • 590 on ventilators
  • Hospitalizations have dropped to 6 week low with 1,200 fewer beds in use. ICU bed availability is above 30%. 
 
Testing:
  • 786,794
  • 17,230 in last 24 hours
  • The April positivity rate was 23% and is now 9.2% for last 7 days.
 
Remdesivir:
  • Illinois received their third shipment last week
  • 353 cases were distributed to hospitals around the state
  • Each case has enough viles to treat 5 patients depending on course of treatment (5-10 days)
  • Distribution was determined based on COVID data and hospitalizations. 
  • Hospitals that do not need their shipment or all of it can send to other hospitals. 
  • Another shipment coming next week to Illinois. Intent is to make sure every hospital with COVID patients gets a case.
  • Early studies show good results, but they are still being investigated. 
  • Shows decreased hospital days. 
 
Restore Illinois:
All regions will move to phase three at end of May. This means that outdoor seating will be available at many restaurants, outdoor recreation can resume with social distancing and no groups larger than 10, salons and barbers can reopen and more. However, the Governor stated that cities and towns may put stricter guidelines in place if they feel they are needed. The Chicago Mayor has indicated that the city will not move forward in phase three until mid-June.    
 
LeadingAge Illinois continues to meet with representatives from the Governor’s office, the Illinois Department of Public Health (IDPH) and the Illinois Department of Healthcare and Family Services (HFS) twice per week after the Governor’s briefings to receive agency updates and address member concerns. The meetings have been helpful in clarifying statements made by the IDPH Director and the Governor in the briefings and getting ahead of the issues. 
FEDERAL
CARES Act Provider Relief Fund Frequently Asked Questions
HHS has updated its FAQ document (see all notations that say 5/21/2020, most on pages 10 and 11). The new questions dig deeper into scenarios about changes in ownership and receipt of General Distribution funds.
GAO Study on Nursing Home Infection Control 
The Government Accountability Office (GAO) issued a report on infection control deficiencies in nursing homes, titled “ Infection Control Deficiencies were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic. ” The investigators found that nursing homes frequently fell short on preventive measures like hand hygiene or isolating sick residents (this is prior to COVID-19). Of course, they note that all the deficiencies they found were not severe and residents were not harmed by the oversight. Here’s an article from the Washington Post on the report.
CDC Guidance for Travelers
A number of members have been asking how to handle staff vacations and the issue also came up on LeadingAge Illinois’ congressional call yesterday. Should staff be excluded from work for a time period after returning from a vacation or travel? CMS has not weighed in on this. The CDC says that international travelers should be excluded from work and self-quarantine for 14 days upon return. The CDC has not made a call on self-quarantine and domestic travel, but cautions that some states may require it. The CDC also recommends avoiding cruise ship travel at this time. When developing an individual facility policy on how to manage staff vacation and travel, members should be sensitive to any potential for workplace discrimination and/or harassment.
New HUD Guidance for Electronic Signatures and Documents
Yesterday, HUD finalized guidance to allow (but not require) HUD-assisted senior housing communities to use electronic signatures and documents for certain management operations. The Notice effectively expands electronic flexibilities in place due to COVID-19 and will help communities limit virus exposure for both staff and residents. When adopting electronic file policies, housing providers need to comply with federal standards, including reasonable accommodations under the ADA and federal privacy/security requirements outlined in the Notice, as well as state and local requirements for file transmission and storage.
Provider Relief Fund Updates
HHS announced late in the day on May 22 that it was again changing and extending the attestation deadline to give providers 90 days from receiving a Provider Relief Fund payment to attest to the terms and conditions.
Providers who received their first payment on April 10 would now have until July 9. April 24 payments deadline will now be July 23 and May 22 payments (the recent SNF-only targeted distribution) until August 20. What remains unclear from this announcement is whether June 3 is still the last possible day for providers to submit financial data in order to be eligible for a second General Distribution payment, as was announced on May 20. If the June 3 deadline remains for the second payment eligibility, providers who have not yet received the second payment would need to attest by this earlier deadline as providers must complete the attestation step prior to submitting financial data through the General Distribution Portal. It is also unclear if this extends the time for providers to return funds received currently set at 45 days from receipt of payment for ACH payments and 60 days for providers who received paper checks.
 
The SNF-only targeted distribution payment went out May 22 as well. Medicare certified SNFs and 333 Medicaid only nursing homes are the recipients of these payments according to staff in the office of the HHS Secretary. The payments will be sent to the SNF’s central billing office as an Automated Clearing House (ACH) payment from Optum Bank with the description, “ CARES Act SNF-Pmt*HHS.GOV.”
 
According to the letter, payments will be based off of the following formula: $50,000 per SNF plus a per bed amount ranging from $1,800 per bed for those with more than 200 beds up to $2,000 for SNFs with 5-25 beds. For example, a 300-bed SNF would be estimated to receive $590,000 while a 20-bed organization would receive $100,000. 
Source: LeadingAge
Paycheck Protection Loan Forgiveness Guidance
Last Friday, the U.S. Small Business Administration (SBA) issued an interim rule on the Paycheck Protection Program (PPP) loans regarding forgiveness. Some key items in the rule include:
  • New flexibility on the eight week loan period,
  • Information on allowable utilities,
  • Forgiveness of pay for furloughed workers and for bonuses/hazard pay and how forgiveness reduction is handled for borrowers who reduce their full-time employees.
Updated OSHA Guidance Documents
The Occupational Health and Safety Administration (OSHA) recently issued an updated interim enforcement response plan for dealing with workplace investigations during the COVID-19 pandemic. In addition, OSHA released revised enforcement guidance for recording case of COVIS-19. These two requirements go into effect on May 26 and replace the previous interim enforcement response plan and recordkeeping guidance, respectively, on that date. Finally, OSHA also released a one-page alert titled " COVID-19 Guidance for Nursing Home and Long-Term Care Workers ." Here is a  summary of the new guidance   with links to the documents.
OTHER NEWS
CAST COVID-19 Telehealth Pulse Survey
LeadingAge CAST would like to know about your use of telehealth during the pandemic. Please take their one-question COVID-19 Telehealth Pulse Survey so that they can design resources to support you.
Telligen Presents-COVID-19 in LTC Office Hours
Dr. Nimalie Stone from the CDC will be presenting for Telligen’s interactive LTC Office Hours tomorrow. She is the Team Lead for Long-term Care for the Prevention and Response Branch within CDC’s Division of Healthcare Quality Promotion. Please click here to register .
LeadingAge Illinois Monthly HUD Member Call Set for June 16
Please join us for the next monthly LeadingAge Illinois HUD Member Update on June 16 at Noon. These calls feature Linda Couch, Vice President of Housing Policy and Juliana Bilowich, Director, Housing Operations and Policy at LeadingAge, Washington, D.C.  You will receive important updates on HUD and COVID-19 issues. There is also time for sharing best practices, asking questions and discussion. RSVP to Jason Speaks
Value First – Opportunities for Prevention and Detection of Covid-19
Value First has partnered with American Knits, a US based company, to provide reusable gowns and masks for our communities. Value First now has a contract with Strategic Lab Partners to order COVID-19 testing kits, and with Meridian for a personnel management system to help with temperature monitoring. See below for addition information.
 
As part of a consortium with Hanes, America Knits manufactures Level 1 Isolation Gowns and Personal Safety Masks in Swainsboro, Georgia. America Knits is identified as a trusted supplier but Value First does not have a GPO agreement with this supplier; LeadingAge members are receiving the manufacturer cost with no fees being paid to Value First or any other entity outside of America Knits.
 
Strategic Lab Partners is now procuring COVID 19 testing materials that includes Universal Transport Media and swabs. SLP has relationships with multiple transport media manufacturers and has the ability to create kits quickly for COVID 19 testing.
 
Meridian’s Personnel Management Solution is designed to help protect the health and safety of both employees and guests by preventing anyone with a temperature from entering a facility. Alarms can be added to sound when those above the temperature threshold and those without access attempt to enter.
 
Remember to check the Value First website and resource page for up-to-date information for your community. For questions or needs, contact Terry Romin at 224.230.7365.
LeadingAge Live Online Coronavirus Daily Member Update
LeadingAge is hosting daily live online updates each weekday afternoon. Subscribe to "LeadingAge Need to Know" via communications preferences in your MyLeadingAge account to receive email updates. Register for live online updates 5 days/week at 2:30 p.m. through May. You can find an archive of all member updates here

Also, if you’re a member of both LeadingAge Illinois and LeadingAge National, stay connected with other LeadingAge National Members and share information and resources through the MyLeadingAge Member Community: COVID-19 . This is a place to connect with your peers to share and discuss everyday practices related to the coronavirus. Take a moment now to log into your my.leadingage.org account and join the group to stay connected. LeadingAge also has a COVID-19 webpage with the latest updates, information and resources for members.
EDUCATION
LeadingAge Illinois Requests Your Feedback
As your provider association, LeadingAge Illinois wants to offer the most relevant and up-to-date education offerings in the best format possible all while being respectful of provider time constraints and staffing considerations. We’d like your feedback regarding your education needs and readiness to participate in virtual events. 
 
Please complete this short survey Friday, June 5.  It should take less than 2 minutes to complete.
 
LeadingAge Illinois staff will use your responses to plan education for the remainder of the year. Thank you in advance for responding to this request and for your dedication to serving your residents.
Save the Date:
 
Leadership and the LGBTQ Senior in the Age of COVID-19 (Webinar)
June 23
1:30-2:30 p.m.

Presenters:
  • Donna Sue Johnson, Licensed Social Worker, St. Mary's Center, Inc. / Adult Day Health Center
  • Dan Churchill, Chief Financial Officer, The Admiral at the Lake; Board Member, Project Q, Boston, Massachusetts
  • David Alfini, Esq., Partner, Hinshaw & Culbertson, LLP; Board Member, One Roof Chicago

Sponsored by:
New QuickCast Available on LeadingAge Learning Hub
In this 30-minute QuickCast , Diane Meier describes the leading sources of suffering - symptom distress, loneliness, and lack of information - and how best to address them to support older adults and their loved ones. This is currently available for free to members and non-members.
Source: LeadingAge