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COVID-19 Updates: March 19, 2020
This update includes:
- Extremely Limited Supply of PPE, Immediate Action Needed by 4:30 p.m. TODAY
- COVID-19 Webinar for Health Care Providers: TOMORROW at 7:00 a.m.
- States Continue to Wait for CMS Memo Suspending Most Survey Activity
- CMS Delays Implementation of MDS 3.0 v1.18.1
- Governor Orders Scaling Down of Childcare Settings: Child Care Resources for SNF and ALF Caregivers
- CDC Loosens Guidelines to Allow Health Care Workers Exposed to COVID-19 to Keep Working
- Notes from DQA Webinar 3.19.20
- Relief Package Passes the Senate, Signed by the President
- CDC Guidance on When Health Care Personnel Can Return to Work
- AHCA/NCAL Guidance on Therapy Services During COVID-19
- Pharmacy and Pharmacists Procedures During COVID-19 Outbreak
- Direct Care Workforce Update
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As of today, there are 155 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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Extremely Limited Supply of PPE, Immediate Action Needed by 4:30 p.m. TODAY
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The State Emergency Operations Center has notified the Wisconsin Department of Health Services that
an extremely limited supply of personal protective equipment (PPE) from the Strategic National Stockpile (SNS) will be arriving soon in Wisconsin
. It consists of an extremely small number of items that are past their manufacturer-designated shelf-life and should not be used in surgical settings. These supplies include N95 respirators, surgical masks, face shields, gowns, coveralls, and gloves.
Please see the surveygizmo link below to complete your request/order. Follow instructions closely.
Long-term care facilities must complete the COVID-19 Essential Elements of Information daily in EMResource. Long-term care facilities should be optimizing current inventories of PPE per the
CDC guidance
.
Requesting facilities/agencies must meet all of the following criteria to order from the Strategic National Stockpile:
- Facility/agency supply is depleted or will be in one week
- Shortage or depletion is impacting ability to ensure patient care and/or worker safety
- Facility/agency has exhausted attempts to secure PPE from other sources
- Facility/agency has consistently implemented CDC strategies to optimize use of N95 respirators
The State Emergency Operations Center will use a Scarce Resource Decision Tree to determine how PPE is allocated. PPE from the Strategic National Stockpile will be allocated to those that are providing direct patient care.
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THIS REQUEST/ORDER NEEDS TO BE COMPLETED BY 4:30 P.M. ON 3/19.
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COVID-19 Webinar for Health Care Providers: TOMORROW at 7:00 a.m.
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Join the Wisconsin Department of Health Services this Friday, March 20, at 7 a.m. for a webinar for health care providers on the current COVID-19 situation.
Send your questions ahead of time! Email your questions to
[email protected] using the subject line: PROVIDER WEBINAR QUESTION by 5 p.m. today (Thursday, March 19). Questions sent in ahead of time will be prioritized during the Q&A part of the webinar.
Registration is required to submit questions and use chat during the webinar.
A recording of this webinar will be available at the same link.
Audience:
Local Health Officers, Tribal Health Directors, Enterics, Health Preparedness, Infection Preventionists, Public Health Nurses, Local Public Health Department Staff, and DQA Notifications.
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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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CMS Delays Implementation of the Minimum Data Set (MDS) 3.0 v1.18.1
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CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
In December of 2019, CMS posted a draft of the MDS 3.0 item set v1.18.0 and received feedback from our stakeholders. We would like to thank the stakeholders for sharing their concerns regarding the proposed changes to the MDS 3.0 item sets and more specifically the removal of the Section G items from OBRA assessments.
The MDS changes CMS planned for October 1, 2020 will now be delayed. CMS staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update software and IT systems.
Please direct any comments or questions regarding the above information to
[email protected]
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Governor Orders Scaling Down of Childcare Settings:
Child Care Resources for SNF and ALF Caregivers
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Officials with the Wisconsin Department of Children and Families (DCF) have advised WHCA/WiCAL of several resources that skilled nursing and assisted living providers can use to address the child care needs of the workers in their buildings.
As was reported on Wednesday, Gov. Tony Evers 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.
IMPORTANT NOTE: Child care providers are being asked to prioritize families of health care and essential service providers, including long-term care providers, and use good faith to determine who those families are. Please inform your childcare provider that you have been designated an essential service provider.
Child Care Resource & Referral Agencies
The most important resource that LTC operators who are looking for child care for their workers should reach out to is the Child Care Resource & Referral Agencies (CCR&Rs). These organizations are maintaining up-to-date lists of child care providers remaining open in their regions.
Find your local CCR&R
HERE and they can help you locate immediate care.
Day Care Center Regulations Relaxed
DCF has relaxed ratio requirements so that as long as the children over the age of 5 years old, the child care setting is not subject to the normal ratios and restrictions.
Click
HERE to review updates from DCF.
The relaxed rules will allow long-term care providers to provide child care to their employees in the facility. This development allows facilities may be interested in setting up their own centers to address these needs.
Future Developments
WHCA/WiCAL has been told by officials in Gov. Evers office said that while he may be open to opening schools to the children of long-term care and nursing home workers at this point they will not be moving in that direction. However, WHCA/WiCAL has been told by officials in the Governor's office that school buildings may be open to serve as make-shift daycare centers. Nothing official has been communicate regarding this concern.
WHCA/WiCAL officials have also been told the Department of Children and Families will be going to the Legislature with a package to fund childcare for essential service providers. Members are encouraged to keep records of these costs.
WHCA/WiCAL will continue to monitor the funding bill and will push for retroactive payments for childcare services for long-term care providers. As more details become available, WHCA/WiCAL staff will be contacting the committees of jurisdiction on this matter.
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.
WHCA/WiCAL has been told by DCF officials that the agency is also in the process of distributing a survey to educators to provide care to essential workers. It is not clear how this information will be used.
Please stay tuned to WHCA/WiCAL about any further updates as they become available.
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Notes from 3.19.20 Webinar/Call with DQA
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Today, DQA held a 1.5-hour webinar/phone call that discussed LTC provider questions/concerns related to COVID-19. The webinar included a helpful Q&A section.
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Relief Package Passes the Senate, Signed by the President
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Last night, the United States Senate passed and the President signed into law H.R. 6201, the Families First Coronavirus Response Act. Within our sector, the bill provides temporary 6.2% increase in Federal Medical Assistance Percentages (FMAP). This will allow for state Medicaid programs to have the funding needed to ensure that the most vulnerable patients and residents have continued quality care during the COVID-19 pandemic.
This bill also includes other provisions like free coronavirus testing, expanded food and unemployment assistance and paid sick leave.
This bill includes a temporary 6.2% increase in Federal Medical Assistance Percentages (FMAP). AHCA/NCAL has projected the impact to Medicaid funding for Wisconsin to be around $580 million.
Enhanced FMAP does not result in automatic rate increases. It’s up to each state to decide how to spend the funds. WHCA/WiCAL has submitted requests to Governor Evers and the Department of Health Services that outline costs we anticipate facilities will incur if faced with a COVID-19 infection inside the building. We will continue to keep members updated as we have more information about this funding.
There are numerous questions about how these additional provisions will be implemented and what they mean for employers. AHCA/NCAL is working on finding answers to those questions and will provide a summary to members as soon as possible.
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Forward Health Telehealth Update
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ForwardHealth has established
this page
to keep providers informed about news, resources, and policy related to the virus so they can effectively care for ForwardHealth members. Providers are encouraged to check this page frequently to stay informed in this quickly evolving situation.
ForwardHealth released an
update
to announce the policy changes to current telehealth policy effective for dates of service (DOS) on or after March 1, 2020.
As was previously announced, the Trump Administration earlier this week 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.
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CDC Guidance on When Health Care Personnel Can Return to Work
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When a staff person who is staying home because of fever or respiratory symptoms can return to work. CDC posted
guidance
from March 16, 2020 on criteria for return to work. Use one of the below strategies to determine when health care personnel (HCP) may return to work in health care settings:
- 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
- Test-based strategy, if tests are available. 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)
If HCP were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.
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Pharmacy and Pharmacists Procedures During COVID-19 Outbreak
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Nursing facilities, assisted living communities and pharmacies should work together to ensure appropriate access to the facilities and to medical records so that pharmacists and pharmacy personnel can continue to provide essential services to their residents while adhering to guidance on restricting entry to the building to only essential personnel.
There is currently no waiver in the requirements of participation for skilled nursing facilities in Medicare/Medicaid related to a pharmacist’s review. A pharmacist or pharmacy personnel must still be able to perform functions such as drug replenishment, controlled drug security/destruction, refilling electronic cabinets/eKits, and medication regimen review (MRR).
MRR reviews and some other pharmacy related duties can be performed remotely when possible, as long as the pharmacist has access to the full medical record. This may involve access to multiple electronic systems or a sequestered room within a facility (paper charts). Other emergency procedures include making deliveries dropped off at a dedicated location, such as a loading dock or secure area outside.
If a pharmacist or pharmacy staff need to enter the nursing facility or assisted living building to perform regulatory-required services, the pharmacy staff must follow appropriate screening and PPE procedures.
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Direct Care Workforce Update
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WHCA/WiCAL has reached out to the Department of Health Services about getting the Direct Care Workforce Funding pushed out immediately. We have also heard positive feedback that DHS is working with CMS to do this. Again, we will update as soon as we have details but please know that these processes should be moving forward soon.
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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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