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COVID-19 Updates:
March 18, 2020
This update includes:
- States Continue to Wait for CMS Memo Suspending Most Survey Activity
- NEW CDC Guidance on Use of PPE to Conserve Supplies
- Department of Health Services to Immediately Set Outstanding Rates Including 6.4% Increase
- Governor Evers Issues Emergency Order Waiving Work Search, Modifying Availability Requirements for UI Benefits – Asks Legislature to Repeal One Week Wait
- Governor Orders Scaling Down of Childcare Settings; But Designates LTC Work Force as Essential
- WHCA/WiCAL Submits 1135 Waiver Request
- Survey Suspension - No New CMS Memo
- DHS Holding COVID-19 Webinar for Long-Term Care and Assisted Living Facilities tomorrow, Thursday, March 19 from 9:00 a.m.-10:30 a.m.
- Senate Approves House COVID-19 Aid Bill, Awaiting Trump's Signature
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As of today, there are 106 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.
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States Continue to Wait for CMS Memo Suspending Most Survey Activity
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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.
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NEW CDC Guidance on Use of PPE to Conserve Supplies
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CDC issued today
new guidance on the use of masks, gowns and face shields including suggestions on what to do if in crises shortages (which most all of you are in) and when your supplies are exhausted (see below for summary).
As all of you are coming to realize first-hand, the country does not have enough masks and gowns to meet the needs of health care providers, particularly if this pandemic persists for the weeks that experts predict. In order to significantly conserve masks and gowns, nursing homes and assisted living communities need to implement significant conservation steps right now by reviewing the crises capacity strategies in the new guidance issued today by CDC. We strongly urge you to start today in order to extend availability of your remaining PPE until such time as production and supply improves or we can obtain masks and gowns from other health care sectors and manufacturing.
To help long term care providers take such actions, the Centers for Disease Control & Prevention's (CDC) new guidance will be helpful. These recommendations continue to protect from droplet exposure (which is how COVID-19 and most other respiratory viruses are spread). We believe these recommendations help preserve PPE supply given the dire shortage.
We understand that many of you are very close to running out of PPE and that any supplies you receive from your state or federal stockpile need to bridge the time until more masks and gowns become available.
Therefore, we urge you to adopt these new guidelines from CDC as soon as possible and for some, that may mean coming up with more creative ways to use or make your own PPE.
Highlights from the new CDC guidance on PPE use are below.
- Implement extended use of facemasks which allows the wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters.
- Restrict facemasks to use by HCP, rather than patients for source control. Have patients with symptoms of respiratory infection use tissues or other barriers to cover their mouth and nose.
- Implement limited re-use of facemasks, which is the practice of using the same facemask by one HCP for multiple encounters with different patients but removing it after each encounter. Discarded if soiled, damaged, or hard to breathe through.
- Prioritize facemasks for selected activities, such as:
- For provision of essential surgeries and procedures
- During care activities where splashes and sprays are anticipated
- During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable
- For performing aerosol generating procedures, if respirators
- Shift gown use towards cloth isolation gowns
- Consider the use of coveralls
- Extended use of isolation gowns (disposable or cloth), such that the same gown is worn by the same HCP when interacting with more than one patient known to be infected with the same infectious disease when these patients housed in the same location (i.e., COVID-19 patients residing in an isolation cohort). This can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as Clostridium difficile) among patients. If the gown becomes visibly soiled, it must be removed and discarded as per usual practices.
- Re-use of cloth isolation gowns among multiple patients in a patient cohort area without laundering in between.
- Prioritization of gowns for the following activities:
- During care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures
- During the high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of healthcare providers, such as: dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care
- When No Gowns Are Available consider pieces of clothing as a last resort, preferably with long sleeves and closures (snaps, buttons) that can be fastened and secured, particularly for care of COVID-19 patients as single use. Other options include:
- Disposable laboratory coats
- Reusable (washable) patient gowns
- Reusable (washable) laboratory coats
- Disposable aprons
- Combinations of pieces of clothing can be considered for activities that may involve body fluids and when there are no gowns available:
- Long sleeve aprons in combination with long sleeve patient gowns or laboratory coats
- Open back gowns with long sleeve patient gowns or laboratory coats
- Sleeve covers in combination with aprons and long sleeve patient gowns or laboratory coats
Reusable patient gowns and lab coats can be safely laundered according to routine procedures
- Implement extended use of eye protection is the practice of wearing the same eye protection dedicated to one HCP for repeated close contact encounters with several different patients, without removing eye protection between patient encounters including for disposable and reusable devices.
- Eye protection should be removed and reprocessed if it becomes visibly soiled or difficult to see through.
- If HCP touches or adjusts their eye protection they must immediately perform hand hygiene.
- Prioritize eye protection for selected activities such as: During care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures or prolonged face-to-face or close contact with a potentially infectious patient is unavoidable
- Consider using safety glasses (e.g., trauma glasses) that have extensions to cover the side of the eyes
- Designate convalescent HCP for provision of care to known or suspected COVID-19 patients
- Selected options for Reprocessing and clean Eye Protection are provided.
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Department of Health Services to Immediately Set Outstanding Rates Including 6.4% Increase
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WHCA reached out to DHS as we know many providers still haven’t received their rates since the 6.4% increase was passed in the state budget last summer. Today DHS has agreed to set rates for outstanding providers using 2017 audited cost reports but including the rate increase. They aim to have rates set within the next two weeks. Once that has been completed, they will continue on with the normal rate setting process using the 2018 Cost Reports. We originally requested they immediately set rates using unaudited 2018 Cost Reports but they voiced concern with difficulty collecting necessary documentation after the fact and having to recoup funds.
Note: Providers WILL NOT receive rate e-copies or other notices of the interim rates as DHS wants to remained focused on getting the adjustments out the door as soon as possible. You will be able to see the rates in the ForwardHealth Portal.
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Governor Evers Issues Emergency Order Waiving Work Search, Modifying Availability Requirements for UI Benefits – Asks Legislature to Repeal One Week Wait
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Gov. Tony Evers today issued an Emergency Order that will waive work search requirements and modify the availability requirements for unemployment insurance benefits for workers impacted by COVID-19. Gov. Evers is working with the Wisconsin State Legislature to act to waive the one-week waiting period for benefits so that unemployment insurance funds make it to affected workers quickly.
Gov. Evers announced that his order will waive the requirement that UI claimants conduct at least four weekly work search actions during the COVID-19 emergency. His order will also ensure that claimants who are otherwise eligible but out of work due to COVID-19 are considered available for work and therefore eligible for benefits.
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Governor Orders Scaling Down of Childcare Settings; Designates LTC Workers as Essential
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Governor Tony Evers today directed Department of Health Services (DHS) Secretary-designee Andrea Palm to restrict the size of all child care settings. Centers may not operate with more than 10 staff present at a time and may not operate with more than 50 children present at a time. This order can be found
here.
The restriction in size goes into effect at 8 a.m. on Thurs., March 19, 2020. The closure will remain in effect for the duration of the public health emergency declared by
Executive Order #72.
Childcare providers are being asked to prioritize families of healthcare and essential service providers, using good faith to determine who those families are. A Department of Children and Families guidance lists Long-term Care workers as essential, along with other workers found in this
memo.
“I know many Wisconsinites are looking for ways to help during this crisis,” Gov. Evers continued. “If you are able, keeping your kids at home is one of the actions you can take to have the most impact. I also want to recognize the child care providers around the state who are stepping up to support our communities-- we appreciate your service during this challenging time.”
Additionally, the Administration is working with healthcare providers, child care providers, and the National Guard to explore options to serve healthcare workers through on-site care. More information on this effort will be available in the coming days.
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WHCA/WiCAL Submits 1135 Waiver Request
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WHCA/WiCAL, along with LeadingAge Wisconsin, submitted an
1135 waiver request to the CMS Chicago Regional Office.
The following measures were requested:
- Allow non-certified staff and volunteers to provide care and services as deemed appropriate by the facility, and establish processes to quickly direct individuals not working due to the COVID-19 crisis (closed schools, restaurants, churches, etc.,) to quickly join the long-term care workforce. Issue a blanket waiver for laid off workers to work in long-term care under the supervision of nurse in a SNF, with guidance on scope of services these individuals can provide.
- Allow prospective CNAs to receive credit for past experience to serve as a CNA in the certification process.
- Authorize a blanket waiver to allow facilities to conduct on-line CNA Training, including on-line clinical training.
- Waive the CNA training lockout on facilities with CMPs, extended surveys, partial extended surveys, or DDPNAs prohibiting these facilities from serving as CNA training, testing and clinical sites for two years.
- Rescind past CMS decision to deny the expansion and Civil Money Penalty (CMP) funding for Wisconsin’s WisCaregiver Career Program. This program was previously approved by CMS but this year was denied due to the CMS policy on the use of CMP funds. The Wisconsin program was launched in 2018 by the Wisconsin Department of Health Services (DHS) in an effort to attract and retain more nursing home caregivers. To date, more than 9,000 people have registered for the program and 3,000 people have enrolled in training.
- Suspend the imposition of CMP and DDPNA penalties, including the CMS Chicago policy to impose DDPNAs within 15 days of issuance of the SOD, except for IJ violations.
- Waive the preadmission screening (PASRR) of applicants for admissions to nursing facilities: Temporary suspension of pre-admission screening and annual resident review which will allow a nursing home to continue admission of an individual who has not had assessment completed if there is a workforce disruption or hospitals reduce or limit outside contact in their facilities.
- Waive the 30/60/90-day schedule requirement for in-person physician visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.
- Create provisions allowing for additional flexibilities to allow for the utilization of physician extenders in place of Medical Directors and attending physicians, and via telehealth options.
- Immediately authorize the waiver of the 3-day hospital stay requirement to enable persons in need of skilled nursing care to receive Medicare coverage nursing home care.
- Allow nursing homes to implement time-savings processes limiting full completion of the MDS while still maintaining Medicare/Medicaid payment levels for these residents.
- Suspension of the 120-day limitation on CNAs who have not been able to take a test to become certified.
- Waive non-emergency Life Safety Code requirements that need outside vendors visiting a facility.
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DHS Holding COVID-19 Webinar for Long-Term Care Facilities
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Join DHS this
Thursday, March 19 at 9:00 a.m
. for a webinar for Long-Term Care Facilities on the current COVID-19 situation.
Or iPhone one-tap:
US: +13126266799,,723961504#
Or Telephone:
Toll Free: (844) 708-2570
US: (312) 626 6799
Webinar ID: 723 961 504
Registration is not required to submit questions and use chat.
A recording of this webinar will be available at the same link.
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Senate Approves House COVID-19 Aid Bill, Awaiting Trump's Signature
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The U.S. Senate voted earlier today to approve a COVID-19 aid bill, dubbed the Families First Coronavirus Response Act, on a 90-8 vote. President Trump is expected to sign the bill into law.
The bill provides free coronavirus testing and ensures paid emergency leave for those who are infected or caring for a family member with the illness. The bill also provides additional Medicaid funding, food assistance, and unemployment benefits.
Last week, the Senate approved an $8.3 billion House-passed measure that focused on vaccine research and development.
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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.
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Jim Stoa, J.D.
| Director of Regulatory Affairs and Government Relations |
[email protected]
Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
[email protected]
Allison Cramer
| Communications and Government Relations Specialist |
[email protected]
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