May 8, 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
State Rewarding Contracts to Facilities with COVID-19 Units
The State of Illinois is currently rewarding contracts to facilities for COVID-19 units. LeadingAge Illinois is continuing to work to make this a statewide process for all facilities. If you have developed a COVID-19 unit or have the capability to do so, please email Ben Winnick and Kelly Cunningham at the Illinois Department of Healthcare and Family Services (HFS). If you have questions, please contact Kirk Riva .
LeadingAge Holds Press Conference on Five Essential Actions
LeadingAge held a virtual press conference yesterday on their Five Essential Actions . LeadingAge is demanding urgently needed protections for older adults and the people who care for them. A total of 16 members of the press attended, including reporters from ABC News, NBC News, Boston Globe, Pew Charitable Trusts, Washington Post, ProPublica, TIME Magazine, Wall Street Journal, Bloomberg , Skilled Nursing News , Home Healthcare News and the relevant trades. Katie Smith Sloan, President and CEO of LeadingAge, addressed the media , walking them through the Five Essential Actions. 
CMS Releases Guidance Ahead of Nursing Home Reporting
The Centers for Medicare & Medicaid Services (CMS) released guidance on nursing home reporting of COVID-19 data ahead of implementation of the interim final rule that goes into effect today, May 8. This rule requires nursing homes to report data directly to the Centers for Disease Control & Prevention (CDC) and to notify residents, resident representatives, and families of COVID-19 status and related operations within the facility. Nursing homes will need to start reporting directly to CDC through the National Healthcare Safety Network( NHSN) system by May 17, 11:59 p.m. CMS anticipates publicly reporting data on a weekly basis beginning at the end of May.
 
Reporting Requirements: Reporting to CDC
Nursing homes will be required to report the following information:
  • Suspected and confirmed COVID-19 infections among residents and staff.
  • Total deaths and deaths related to COVID-19 infection, including both resident and staff deaths.
  • Personal Protective Equipment (PPE) and hand hygiene supplies.
  • Ventilator capacity and supplies.
  • Resident beds and census.
  • Resident access to testing.
  • Staffing shortages.
  • Any additional information as required (none identified at this time).
 
In order to report data into the NHSN system , nursing homes will need to enroll. An expedited enrollment process has been developed and information on enrollment is available on the NHSN system site, including training slides and information on live Q&A sessions. Nursing homes will need their CMS Certification Number (CCN) to enroll and it is imperative that the CCN is entered accurately into the NHSN system, as this will be the way by which CMS can confirm compliance with reporting requirements.
 
Nursing homes will need to submit data on a weekly basis (at least once every 7 days) thereafter to remain compliant with requirements).
 
Nursing homes that fail to report data by 11:59pm on May 31 will receive a warning letter from CMS. Failure to report by 11:59pm on June 7 will result in enforcement actions, outlined below (“Survey and Enforcement”).
 
Reporting Requirements: Notifying Residents, Resident Representatives, and Families
Effective May 8, nursing homes will be required to notify residents, resident representatives, and families of COVID-19 status within the nursing home. By 5pm of the next calendar day following the occurrence of either:
  • A single, confirmed COVID-19 infection among residents or staff or,
  • Three or more residents or staff with new-onset of respiratory symptoms consistent with COVID-19 infection in a 72-hour period.
 
Nursing homes will also be required to provide weekly cumulative updates to residents, resident representatives, and families. If new cases or symptom clusters are identified more frequently than weekly, nursing homes will not be required to make additional notification, as each notification must include cumulative updates, as outlined below. If a week has passed since identification of the last new case or symptom cluster, nursing homes must provide a weekly update to residents, resident representatives, and families.
 
When notifying residents, resident representatives, and families, nursing homes must follow these guidelines:
  • Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered,
  • Include cumulative updates on COVID-19 cases and clusters of respiratory symptoms,
  • Not include any personally identifiable information.
 
When surveying for compliance with this requirement, surveyors will interview residents and resident representatives to determine timely notifications.
 
Nursing homes are not required to distinguish in these notifications between numbers of new cases vs. numbers of total cases, or numbers of cases among staff vs. numbers of cases among residents. For information on what respiratory symptoms should be monitored and reported, CMS refers to CDC guidance Symptoms of Coronavirus and Preparing for COVID-19: Long-Term Care Facilities and Nursing Homes.
 
Survey and Enforcement:
As noted above, nursing homes will receive enforcement actions for failure to comply with requirements for reporting to CDC through the NHSN system and notifications to residents, resident representatives, and families. CMS has created 2 new F-tags to address these requirements:
  • F884 COVID-19 Reporting to CDC: This F-tag will be reviewed off-site and cited at the federal level. It will be cited at scope and severity level F and will be subject to enforcement remedy as outlined below.
  • F885 COVID-19 Reporting to Residents, their Representatives, and Families: This F-tag will be reviewed on-site and may be cited by either state or federal surveyors. Enforcement actions for this F-tag will follow the guidelines outlined in CMS memo QSO-20-20-ALL.
 
If a nursing home fails to comply with requirements for reporting to CDC after the end of the grace period, the nursing home will receive a warning letter). If a nursing home continues to be noncompliant with reporting requirements, the nursing home will receive a per day Civil Money Penalty (CMP) for one day assessed at $1,000. For each additional week the nursing home fails to comply with this requirement, the rate of the per day CMP will increase by an additional $500.
 
For example, if a facility fails to report by the end of Week 4 (June 7), they will receive a CMP of $1,000. If the facility still has not reported by the end of Week 5 (June 14), they will receive an additional CMP of $1,500 for a total of $2,500 in CMPs. If the facility reports by the end of Week 6 (June 21), then fails to subsequently report by the end of Week 7 (June 28), they will receive a CMP of $2,000 for a total of $4,500 in CMPs.
 
CMS has also updated several survey resources for surveyors. These resources can be accessed through the link in CMS memo QSO-20-29-NH or by accessing the Survey Resources folder in the Downloads section on the CMS Nursing Homes site . The following documents have been updated:
  • COVID-19 Focused Survey for Nursing Homes
  • Entrance Conference Worksheet
  • COVID-19 Focused Survey Protocol
  • Summary of the COVID-19 Focused Survey for Nursing Homes
 
CMS notes that nursing homes should use the updated COVID-19 Focused Survey for Nursing Homes tool to complete self-assessments.
 
What This Means for Providers:
Nursing homes should take immediate steps to enroll in the NHSN system if not already enrolled in order to begin reporting to CDC by May 17. Develop a process for reporting, including designating a specific individual or individuals who will ensure compliance.
 
Nursing homes must begin notifying residents, resident representatives, and families of new confirmed cases or symptom clusters on May 8. Develop a process for this notification, including required weekly cumulative updates, and ensure that reasonable accommodations have been made so that residents, resident representatives, and families can access information.
 
Nursing homes will face enforcement remedies for failure to comply with either requirement, including steep CMPs for failure to comply with requirements for reporting to CDC. Nursing homes should also review their infection control self-assessments using the newly updated survey tool.
Source: LeadingAge
LeadingAge Illinois Celebrates Those Who Serve Others
LeadingAge Illinois celebrates the efforts of those who serve others. We celebrate:
  • Those who tend with compassion.
  • Those who tend with commitment.
  • Those who tend with care.
 
We stand in awe and appreciation for the work of our members in caring for and serving residents.
CMP Application for Communicative Technology
The Illinois Department of Public Health (IDPH) has provided an update on how providers can request CMP funds for communicative technology. See the Application FAQs and applications can be sent to Aimee Isham , the IDPH Long Term Care Bureau Chief. 
N95 Mask Decontamination Service
Governor Pritzker announced last week and reported again yesterday, that the State has acquired a new decontamination system for N95 masks. The Battelle Critical Care Decontamination System was acquired to stretch Personal Protective Equipment (PPE) further. The service is based in Waukegan and is free with a 24-hour turn around.  Up to 20 times, an N95 masks can be cleaned and sanitized.

The Illinois Emergency Management Agency (IEMA) has submitted instructions to local health departments and long term care facilities who can take advantage of this fast and free service.  Fed Ex and Cardinal Health are transporting masks from facilities to the Waukegan site and back. Contact David Giles at 614.424.5612 to enroll a nd receive an account number. Masks are dropped off with this account number and identified for pick up with the same. 
STATE
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.
 
To register, click on dates below:
 
 
 
 
 
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.

Answers to IDPH May 1 Webinar:
Below, you will find the answers to the May 1 IDPH Webinar:
 
What long-term care facility types will be required to report?
Per the CMS interim final rule , the requirement for NHSN reporting will apply to “SNFs for Medicare and NFs for Medicaid”. However, the NHSN COVID-19 module is open to intermediate/chronic care facilities for the developmentally disabled and assisted/supportive living. CDC encourages these facility types to also enroll and report.
 
What is the deadline start date for NHSN reporting?
My understanding is once the interim final rule is published on 5/8/20, it will go into effect. Further direction will have to come from CMS.
 
If the facility needs to find out if they were previously enrolled with NHSN, is there a way to find out?
Yes. Contact the NHSN Help Desk . If you use a specific subject line like ‘LTCF COVID-19 – verify previous NHSN enrollment’, it might help get your question triaged more quickly. In the email, include facility name, address, and CCN/CMS certification number, at a minimum. Due to the volume of inquiries, NHSN is experiencing longer wait times for a response.
 
If you have an AL and SNF at same campus, do you register each separately?
Yes. For the AL or any facility without a CCN/CMS certification number, contact NHSN to receive a temporary enrollment number.
 
For NHSN and SAMS, in completing the facility enrollment under SAMS the LTC-SKILLNUR COV19 in the drop-down box is not there. Only LTC SKILLED NURSING. I did email both but still waiting for a solution. Has this been a common problem you are aware of?
Per CDC, you can change facility type once your facility is enrolled.
 
Do facilities need to report a COVID+ patient who was just admitted from hospital? 
Yes, under “ADMISSIONS: Residents admitted or readmitted who were previously hospitalized and treated for COVID-19”.
 
If a resident goes out to the hospital, gets admitted with COVID19, and expires...does the facility or hospital report the COVID expiration?
LTCFs would need to report them under “COVID-19 DEATHS: Residents with suspected or laboratory positive COVID-19 who died in the facility or another location.”
Changes to Isolation Period for COVID-19 Cases
The Illinois Department of Public Health (IDPH) issued guidance on their Changes to Isolation Period for COVID-19 Cases.  A minimum of 10-Day Isolation Period for all COVID-19 confirmed or probable cases includes both health care workers and non-health care workers.  See the guidance here .
Governor Pritzker Daily Press Conferences
Governor JB Pritzker is conducting daily press 2:30 p.m. conferences on COVID-19. Click here to listen daily.

Yesterday’s update included:

Cases:
  • 2,641 new cases (70,873 total)
  • 138 new deaths (3,111 total)
  • Curve has remained flat
  • Data coming out from IDPH is reported in real time, which accounts for any inaccuracies. Data reported to IDPH through Syndromic Surveillance directly from hospitals. 
 
Testing:
  • 379,043 completed
  • 17,783 completed in last 24 hours (15% positive rate)
 
Hospitalizations:
  • 4,862
  • 1,253 in ICU
  • 766 on ventilators
SIREN Notifications
To get the most up-to-date guidance from the State of Illinois, you can register to receive SIREN - State of Illinois Rapid Electronic Notifications .  SIREN provides regional, State and Federal partners with a comprehensive information sharing, collaboration, alerting and notification solution. If you have difficulties registering please contact SIREN .
Source: SIREN
FEDERAL
Provider Relief Fund Update
HHS has announced that it is extending the time providers have to attest to the terms and conditions for payments received from the Provider Relief Funds. Providers will now have 45 days (previously 30 days) to make a decision about whether to keep the payments received and agree to the terms and conditions. No additional FAQs were provided as part of this announcement so questions remain. Leading Age continues to seek additional information to ensure that providers have the answers they need to make a good decision on attestation by the May 24 deadline.
Source: LeadingAge
Paycheck Protection Program Repayment Update
A reminder that the Department of Treasury and Small Business Administration (SBA) issued a new question in its FAQs , extending the deadline for borrowers’ safe harbor repayment one week, from May 7 to May 14. This gives SBA time to provide additional guidance on how it will review certification. LeadingAge is sending a follow up email to the SBA reminding them of their letter seeking a resolution of the problems that have arisen related to SBA loans to affordable housing providers. 
OTHER NEWS
Preparing for COVID-19 Positive Residents
SFCS Architects have prepared a white paper that provides innovative suggestions in best design practices and some adjustments from facility guidelines that can help to mitigate the spread of COVID-19 and future contagions in skilled nursing.
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.
Happy Nurses Week to all the nurses out there! 
Your hard work, skill and compassion make the world a better place.
EDUCATION
Upcoming:
 
May 12
10:45 -11:45 a.m.
Free to LeadingAge Illinois Members
 
May 19
10:15 a.m.
Free to LeadingAge Illinois Members