April 10, 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
HHS Announces First Release of Funds from $100 Billion COVID-19 Provider Fund
Early this morning the U.S. Department of Health and Human Services (HHS) announced that they have distributed the first part of funds from the $100 billion provider fund. It is an immediate infusion of $30 billion into healthcare system.
 
Here’s a closer look:
  • Skilled nursing facilities are included.
  • Payments to Medicare providers will be based on 2019 Part A and Part B billings.
  • Funds are expected in accounts as early as today and at the latest next week. Providers are reporting nationwide, receiving payments today from United Healthcare. 
  • Funds are grants and not loans. 
  • This is different than the CMS Accelerated and Advance Payment Program. Both can be participated in. 
  • The Administration is working rapidly on targeted distributions that will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. 
IDPH Holds Question and Answer Session for Long Term Care and Congregate Residential Settings
This afternoon, the Illinois Department of Public Health (IDPH), held a Question and Answer Session for Long Term Care and Congregate Residential Settings. The webinar offered an opportunity to receive the latest CDC and IDPH updates as well as obtain answers to burning questions.  Click here for slides from the webinar. A recording will be made available soon and we will share the link. 
 
IDPH has announced two more upcoming webinars:
 
Personal Protective Equipment and Transmission-Based Precautions, Resident Placement, and Crisis Capacity Strategies
April 15
1-2 p.m.
 
COVID-19 Updates and Q&A for long-term care and congregate residential settings
April 24 and May 1
1-2 p.m.
LeadingAge Advocacy Success! More Blanket 1135 Waivers Approved by HHS
CMS announced in a press release at 7 p.m. last night that they are suspending additional rules to maximize frontline workforces in hospitals, clinics and other healthcare facilities. Two of the 1135 blanket waivers LeadingAge requested were in the mix:
  • Allowing hospices to use pseudopatients (mannequins or role players) in aide competency training; and
  • Waiver of the annual 12-hour in-service training requirement for hospice aides. The hospice chart is updated here. Additional analyses, as needed, for other settings will be provided soon.
Nursing Homes, Assisted Living and Senior Living Communities Added to Amazon Preferred List for Personal Protective Equipment (PPE)
Amazon has added nursing homes, assisted living and senior living to the priority list to buy Personal Protective Equipment (PPE). You just need to fill out and submit this form .
Protect your residents and staff with RESIDE
As the COVID-19 pandemic has rapidly intensified the daily lives of workers in healthcare facilities, doctors and nurses have urged other people to stay at home and use personal protective equipment (PPE) to limit the spread of the coronavirus. Many tasks unrelated to clinical care, such as the admissions department, can be completed, measured, and monitored REMOTELY, using the RESIDE Admissions platform. RESIDE is the tool that keeps your residents and staff safe. R ead more.

Author: Holly Kasnetz, VP of Strategy and Implementation at RESIDE Admissions
STATE
Continuances for Supportive Living Appeal Hearings
The Illinois Department of Healthcare and Family Services (HFS) Fair Hearings staff informed their Bureau of Long Term Care that a Supportive Living Program provider, resident or their designated representative may submit a request for a continuance of an appeal hearing due to the COVID 19 emergency.  Fair Hearings will review and respond quickly. Contact information for Fair Hearings: E-Mail and Phone at 855.418.4421. Be sure to include the appeal hearing number with your request. 
Source: HFS
Temporary Transportation Prior Approval Requirement Changes due to COVID-19
The Illinois Department of Healthcare and Family Services (HFS) issued a notice informing providers of temporary changes in transportation documentation and policy requirements during the COVID-19 national emergency. The Department’s goal in implementing these changes is to reduce barriers to participant access to medical appointments and ease the burden on transportation providers. The information applies to prior approval requests and claims for participants covered under fee-for-service and does not apply to HealthChoice Illinois managed care plans and the Medicare/Medicaid Alignment Initiative (MMAI) plans.  See the notice here
Applying for Medicaid and Other Medical Programs During the COVID-19 Emergency
The Illinois Department of Healthcare and Family Services (HFS) issued a notice addressing current avenues available to patients who want to contact the State to apply for or manage coverage through Medicaid and other medical programs. Click here for the notice.  
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.
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
Targeted Infection Control Survey
On March 23, CMS announced further suspension and re-prioritization of survey activity in response to the COVID-19 pandemic.  Memo QSO-20-20-ALL   highlights this re-prioritization, as well as new guidance for non-nursing home settings on visitors and screening, and access to all settings for health care providers. LeadingAge provided suggestions during a recent webcast on how to prepare for the targeted infection control survey. Below are suggestions and guides to prepare for this type of survey based on members who have recently been surveyed. (Suggestions are not all-inclusive). Please refer to COVID-19 Focused Survey for Nursing Homes for all- inclusive information.

Complete the CMS Self- Assessment Tool:
  • Surveyors will ask for the completed self-assessment infection control tool that was issued by CMS. LeadingAge has created an Infection Control COVID-19 tool and checklist and should be used in conjunction with the CMS self- assessment tool. Using the LeadingAge tool helps to fill in gaps.
  • Helps to identify gaps in COVID-19 preparedness
  • Gives you a guide to basics in what you should be doing in your building
  • It helps you with your preparedness efforts for COVID-19

What member are saying who had a targeted infection control survey :
  • Have a thoughtful, meaningful plan
  • Think through scenarios, so you have a plan when you have your first COVID-19+ case in your building, or half of your staff is unable to work
  • Completing the self- assessment tool is not a one and done, but constantly evolving; revisit often to figure out how to operate on a day to day basis

CMS Survey Tool Covers

  Standard and transmission based precautions:
  • How are you mitigating PPE shortages? Follow CDC guidelines for optimizing supplies, optimizing current supply or identify next best options for residents including prioritizing use of PPE
  •  Is your organization notifying proper authorities to get more PPE or informing them that your supply is running low? Provide documentation to support efforts

General Standard Precautions:
  • Respiratory /Cough Etiquette- include teaching residents but surveyors will also be observing staff to ensure they are adhering to proper etiquette
  • Cleaning and disinfecting equipment- how are you reprocessing reusable equipment such as B/P cuffs, glucometers, etc.
 
Hand Hygiene:
  • Are staff performing when indicated and while assisting residents with hand hygiene?
  • What do staff do when there are no hygiene supplies such as hand sanitizer?
  • Are staff donning PPE on and off correctly?

Transmission Based Precautions:
  • Are staff able to identify droplet, airborne and contact precautions? Do they know which precautions to use with identified residents?
  • Are staff aware of which precaution to use for unidentified respiratory infections?
  • Are staff aware of Aerosol Generating Procedures (APGs)? Do they know what precautions to use for APGs? What PPE to wear?
  • Masks- are staff aware of which one to wear and what PPE to wear when entering a resident’s room?
  • How are staff monitored for wearing the appropriate PPE?

Resident Care:
  • If there is a positive Covid-19 case or presumed positive case, how are staff taking care of resident in their room? How do you handle the positive person that needs to leave the room ( i.e. go to dialysis or hospital -how is this communicated?)
  • Are residents being co-horted?
  • How is isolation being handled?
  • How are you managing and monitoring symptoms?

Visitor Entry:
  • Are all access points of your building consolidated? Do not allow any entry into building that is closed off- even for surveyors
  • Are there screenings for symptoms at all access points?

Education, Monitoring and Screening of Staff:
  • Provide documentation regarding education provided to staff on COVID-19 including symptoms, how it is transmitted, screening criteria, work exclusion
  • Document updates provided to staff regarding COVID-19 in your building
  • Outline steps if staff develop symptoms including if they are symptomatic during screening, develop during work hours, or if they are calling in from home
 
  Emergency Preparedness/Staffing in Emergencies:
  • How do you ensure you have enough staffing? Include nursing, dietary, housekeeping and all essential staff
  • What is your back up plan when specialized staff such as physician or infection preventionist are unable to work? Consider having several staff certified in infection prevention. The course is offered online is free.
  • How do you ensure that the facility operates according if your Administrator or Director of Nursing is not working?
HUD Update
This week, members received some key updates on HUD during the LeadingAge Illinois Monthly HUD Member Call with Linda Couch and Juliana Bilowich from LeadingAge in Washington, D.C. A number of issues were covered, including an update on the actions of HUD’s Office of Multifamily Housing related to COVID-19.
 
Here’s an update on HUD actions:
 
  • CARES Act.  On funding flowing from the CARES Act to Project-Based Rental Assistance, Section 202, and Section 811, most of this money will flow to replace reduced tenant incomes because of COVOD-19. The funding to replace tenant incomes will be triggered by tenant recertifications and should be a fairly quick and invisible process. For the portion of funding going to Service Coordinators, this is slightly more complicated because these dollars usually would come with a NOFA and a longer process. Work is being done on the procedures to see what can be done to waive and what they can do to get that funding out to properties as quickly as possible. 
  • Eviction Moratorium in CARES Act: For federal housing there’s a 120 day moratorium beginning March 27. No eviction for nonpayment of rent, no late fees. Tenants should be very careful with how they respond to this moratorium. Evictions are still possible after the end of the moratorium and tenants are still responsible for their portion of the rent. Resource materials are being developed for residents to help them understand their rights and responsibilities under this moratorium, and this should be coming soon. Tenants should also be aware that wile Act prohibits evictions for nonpayment of rent, evictions are still possible for other lease violations so residents should be mindful of how they think about that moratorium.

  • Tenant Income Recertifications. A lot of time spent in Multifamily thinking how there can be a reduction in the administrative burden and the face-to-face contact that is generally a part of annual and interim recertifications. Several tenants are affected by lost hours and this impacts their economic situation at home and their ability to pay their portion of rent. A number of steps have been gone through a number of steps to make this more straightforward for residents and owners. Tenants can complete annual and income recertifications within 90 days of their regularly scheduled date. If a tenant has problems completing certification materials, they can tell their landlord and then tenants will have up to 90 days to complete these. For lost income for both annual and interim certifications, it is allowable for tenants to self-certify or to provide family certifications in place of regular documentation. Openers need to document in their files why no third party documentation was present. COVID-19 and all the issues surrounding that present extenuating circumstances and self- and family-certifications are being accepted.

  • Signatures.  Where signatures are required in person and in ink, it is allowed for copies of signatures, photographs of signed documents, and emails of signed documents to be provided to owners as documentation. Owners must document why wet signatures were not documented and their plan to collect these at a later date. This includes signatures on HUD forms 9887 and 50059. These can be provided electronically. Owners need to provide their code in the TRACS system as to why this unusual form of certification was provided. There are three codes they might use: 1) medical, 2) extenuating circumstance, and 10) other. Owners need to maintain 90% of their tenants in active status to ensure their subsidy to their property will continue to flow.

  • Visitors at Properties. Owners and tenants are both concerned. Owners should be very mindful of all fair housing restrictions and regulations that apply to tenants. Owners should not do anything that violates tenants’ rights and their ability to use and enjoy their residences in a normal way expect when guided otherwise by the CDC or local health or law enforcement officials. So, use local guidance, use common sense, be mindful of the rights of residents. HUD does not provide any additional guidance other than what is provided by the CDC and state and local health and law enforcement officials.

  • Questions of HUD. Members with questions for HUD to address, can send them here.
OTHER NEWS
What You Need to Know About CMS Guidance and Waivers Webinar-April 15
In response to the COVID-19 pandemic, CMS has issued a number of guidance documents, changes to payments and a grant program and implemented a waiver process all targeted at giving providers flexibility and additional resources for responding to this crisis. Matt Murer, Meredith Duncan and Colleen Faddick, from Polsinelli will be presenting this information on Wednesday, April 15 from 10:15-11:45 a.m. LeadingAge Illinois has applied for 1.5 continuing education clock hour from NAB/NCERS. It is FREE for LeadingAge Illinois provider members and $158 for non-members. Register today!
NEW LeadingAge Resource to Help You Fill Jobs During this Crisis
LeadingAge is establishing partnerships with major national employers and associations to reach displaced workers from fields such as dining, retail, and hospitality, etc. They are directing out-of-work staff to their job board to find positions in your communities.
 
Please post jobs of all   kinds – for FREE - (including temporary positions and those that do not require certification) on the Leading Age Job Board .  
 
It’s easy to post a job! 
  • Under the Employers Tab at the top of the page, select Post a Job
  • Sign-in as I am a Member
  • Choose the (Members) Job Flash Package under the Type of Posting 
  • Fill out the Position Description
  • Input coupon code during checkout: STANDTOGETHER
  • Post job
Live LeadingAge Coronavirus Update
The team at LeadingAge has been inspired by the dedication of everyone working at member organizations. In the midst of a sacred week for many of us, they will pause their 2:30 p.m. live online update on Sunday, April 12, in recognition of Easter. Know that we will be working for you through the religious holiday, but will take this day to allow members a chance to observe in their communities and with their loved ones.
 
You can still expect live online updates today and Saturday. As always, you can subscribe to "LeadingAge Need to Know" via communications preferences in your MyLeadingAge account to receive email updates. Register here for the daily 2:30 p.m. live online updates.
 
HUD Speaker Next Week:
On the April 16 call, Toby Halliday, Director of HUD Multifamily Housing’s Office of Asset Management and Portfolio Oversight (OAMPO), will speak on hot HUD topics. OAMPO has broad jurisdiction over the operational and asset management aspects of HUD’s multifamily housing portfolio, including Section 8 Project-Based Rental Assistance, Section 202, and Section 811. Halliday and OAMPO are pivotal LeadingAge partners.
 
If you have questions you would like him to address, please send them by close of business on April 13 to Linda Couch and Juliana Bilowich .