3.17.20
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COVID-19 Updates:
March 17, 2020

This update includes:
  • CMS Expands Telehealth Medicare Coverage
  • Update on Personal Protective Equipment Supplies
  • New CDC Guidance about Return to Work for Health Care Personnel with Confirmed or Suspected COVID-19
  • When Should Health Care Workers be Excluded from Work Because of Potential Exposure to COVID-19?
  • Governor Bans Gatherings of More Than 10 People
  • Governor Requests Innovative Ideas for Workforce and Childcare Solutions
  • Staff Vital Signs Checks Screening Tool
As of today, there are 72 confirmed cases of COVID-19 in the state of Wisconsin, including one recovered case. Click HERE to view the latest outbreak information from the Wisconsin Department of Health Services. State health officials yesterday stated that they believe there is community spread in Wisconsin, meaning that the spread is person-to-person associated rather than just travel associated.
States Await CMS Memo Suspending Survey Activity
DQA officials indicated today they are still awaiting a new memo from CMS suspending all survey activities except allegations of immediate jeopardy and follow up inspections to remove IJ scenarios. The Division of Quality Assurance gave the order earlier Monday to remove all of their staff from annual/biennial recertification/license visits across all of its programs, and they are standing by that action.
Childcare Needs
Thank you to our members for completing a childcare needs survey. This survey was coordinated by the Wisconsin Department of Children and Families.

During a media briefing today, a reporter asked Governor Evers if the state was considering a response similar to Minnesota, which is requiring schools to provide care to the children of emergency workers, including long-term care providers. Governor Evers responded that it was still a possibility.
CMS Expands Telehealth Medicare Coverage
Today, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.


To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf.

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click  here. For information specific to CMS, please visit the Current Emergencies Website.
Update on Personal Protective Equipment Supplies
The Wisconsin Department of Health Services (DHS) has been notified of the extremely limited supply of personal protective equipment (PPE) from the Strategic National Stockpile (SNS) that will be distributed to Wisconsin. The Assistant Secretary for Preparedness and Response (ASPR) will provide DHS with 48-hour notice as to when these supplies will be arriving, but as of this time no such notice has been received.

  • The stockpile of personal protective equipment (PPE) coming to Wisconsin is extremely limited. It consists of extremely small numbers of: N95 respirators, surgical masks, face shields, gowns, coveralls, and gloves. 
  • Long-term care facilities should be optimizing current inventories of PPE per the CDC guidance.
  • Long-term care facilities and DQA will be notified when supplies become available. The order form and instructions will be posted on the DHS Outbreak page
New CDC Guidance about Return to Work for Health Care Personnel with Confirmed or Suspected COVID-19
CDC has issued updated interim guidance describing two strategies for determining when health care personnel may return to work when they have laboratory confirmed COVID-19, or who have suspected COVID-19 (e.g., developed symptoms of a respiratory infection but did not get tested for COVID-19). The two strategies are: 

Test-based strategy. Exclude from work until
  • Resolution of fever without the use of fever-reducing medications and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens)
Non-test-based strategy. Exclude from work until
  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
  • At least 7 days have passed since symptoms first appeared
When Should Health Care Workers be Excluded from Work Because of Potential Exposure to COVID-19?
CDC published interim guidance on March 7, 2020, providing a framework for assessing the risk of COVID-19 based on different types of exposures in health care settings. Recommendations for excluding staff from work depend on whether the exposure is considered high, medium, or low-risk. 

In general, HCP with medium and high-risk exposure should be excluded from work for 14 days during which they should monitor for symptoms and/or fever in coordination with their local health department. However, for hospitals that would suffer significant staffing shortages that would compromise their ability to adequately care for patients, HCP with medium-risk exposures may continue to see patients if wearing appropriate personal protective equipment (PPE) and completing a daily check of symptoms in coordination with their employee health department. 

The Wisconsin Department of Health Services does not recommend requiring a negative COVID-19 test prior to returning to work for asymptomatic HCP.
*Delegated supervision: HCP should report daily symptom and/or temperature checks to occupational health to be cleared for work
Governor Bans Gatherings of 10 or More People...Health Care Facilities are Exempt from Ban
In a media briefing today, DHS Secretary-designee Palm and Governor Evers announced additional steps will be taken to slow the spread of COVID-19. Emergency Order #5.
 
  • Effective at 5 pm today: A statewide moratorium on mass gatherings of 10 people or more.
  • Effective at 5 pm today: All bars and restaurants shall close, except for take-out or delivery service.
  • Effective at 5 pm tomorrow (Wed, 3/18): All public and private schools and institutions of higher education shall close for instructional and extracurricular activities and shall remain closed for the duration of the public health emergency.

The order does not apply to long-term care facilities, as long as the facility is currently following DHS' Recommendations for Prevention of COVID-19 in Long-Term Care Facilities and Assisted Living Facilities and all Centers for Disease Control recommendations.
 
“To help our workers, we are asking the state Legislature to immediately take up legislation to repeal Wisconsin’s one week waiting period for unemployment compensation insurance, said Evers. "In addition, I’ll be talking tomorrow with leaders of the Legislature about a legislative package."
 
It is unclear at this time, and the Governor’s Office had not return inquiries when this report was prepared, on how the Legislature would meet, when they would meet, or how the process would be completed to pass any proposal. Earlier today, Sen. Fitzgerald postponed the March Senate floor session
Governor's Office Requests Innovative Ideas
The Governor's office recently asked WHCA/WiCAL staff for any “innovative solutions” that providers have been using to address challenges presented by the COVID-19 pandemic.

If you have any ideas about how your facilities are engaging in innovative solutions to the workforce or childcare solutions, please contact John Vander Meer.
Staff Vital Signs Checks
Every facility is required to screen their workforce when they come in prior to shift and ask the three respiratory questions. 

Click HERE to view AHCA's COVID-19: Screening Checklist for Visitors and Employees. Click HERE to view a start of shift employee screening log.
WHCA/WiCAL Staff
As a reminder, WHCA/WiCAL's staff team is ready to serve your facility. We are committed to providing members with the services you need to succeed in your mission to provide high-quality care to Wisconsin's most vulnerable residents.
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 | kate@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
WHCA/WiCAL | 608.257.0125 | info@whcawical.org | www.whcawical.org